Waiting in line: A feeding scheme in Lavender Hill, Cape Town, provided meals for about 200 children and adults a day during the lockdown. Picture: Gallo Images/Brenton Geach
Waiting in line: A feeding scheme in Lavender Hill, Cape Town, provided meals for about 200 children and adults a day during the lockdown. Picture: Gallo Images/Brenton Geach

As the data from the National Income Dynamics Study: Coronavirus Rapid Mobile Survey (Nids-Cram) began to come in during May, it was immediately clear that hunger was widespread.

As is reported elsewhere in the FM this week, 47% of Nids-Cram respondents reported that their households had run out of money to buy food, with 22% reporting that someone in the household had gone hungry in the past seven days. In households with children, 15% of respondents reported that a child had gone hungry in the past seven days.

These statistics are all worrying — and considerably higher than anything we have seen in other household surveys.

However, given that the Nids-Cram survey is sampled to look at the entire population, we could not reliably disaggregate these results and explore the impacts on especially vulnerable groups.

Two groups of people are at particular risk of long-term negative outcomes if they experience hunger: pregnant women, and new mothers and their young babies.

To sample a large enough group of these women, we conducted a separate survey, the Maternal & Child Health (Match) survey. This is completely independent of Nids-Cram.

With the permission and support of the national department of health, we were granted access to the MomConnect platform — an innovative cellphone service for which more than half the women receiving public sector antenatal care services in SA are registered. It is the largest database of pregnant women and new mothers in the country.

Together with Prof Ronelle Burger, of Stellenbosch University’s economics department, we drew a sample of 15,000 new and prospective mothers from the MomConnect platform, with the sampling broadly representative of the 930,000 new and prospective mothers on the platform.

We then conducted a short SMS survey of two waves of about 15 questions (in English), with mothers receiving R10 airtime per wave to thank them for their participation.

The survey covers access to antenatal care, vaccinations and antiretroviral treatment, as well as maternal hunger and mental health. In this article we focus on the latter two.

Because this is an SMS survey, the number and types of questions that can be asked are limited. Mothers’ English literacy levels are also likely to affect the results.

We asked mothers: "In the last seven nights did you ever go to bed hungry?" If they answered yes, we asked how many nights this had happened.

Of the 2,214 pregnant and new mothers who answered both questions, 350 (16%) reported that they had gone to bed hungry at least once in the past week.

More worryingly, 11% reported going to bed hungry for one to two nights, and 5% reported going to bed hungry for three or more nights in the previous seven.

The evidence is indisputable that in the first 1,000 days (from conception to age two) a child’s brain is hypersensitive to either benefits or harm. In utero, the foetal brain grows rapidly, and after birth the infant brain grows 1% heavier every day for the first three months of life, reaching 80% the size of the adult brain by the age of three. Because of this profound and rapid development, the foetus and infant are highly susceptible to potential harm, including from frequent hunger.

The consequences of maternal and child undernutrition are enormous and include shorter adult height, less schooling, mental illness, diabetes, obesity and reduced economic productivity, and — for women — lower offspring birthweight.

From existing research, we also know that maternal hunger is a risk factor for depression during pregnancy, and that maternal antenatal depression during pregnancy is a strong predictor of a depressive episode in the postnatal period that is itself associated with a range of later negative outcomes.

In addition to the questions about hunger, we also asked the respondents: "In the last seven days have you felt hopeless, down or depressed?", with frequency options of "No", "Yes, a few days" and "Yes, most days".

In the graph, these results are set against the reported frequency of going to bed hungry. The trends are quite clear and, incidentally, are identical for pre-and post-birth mothers.

New and prospective mothers who report going to bed hungry for three or more nights in a week were eight times more likely to say they felt hopeless, down or depressed "most days".

In our view, new and pregnant mothers must be prioritised when targeting government relief. Many do not yet receive the child support grant and are thus without that important lifeline. Maternal hunger and poor mental health can have profound long-term consequences for mother and child alike.

*Spaull is the principal investigator of the Nids-Cram project and co-investigator of the Match study; Tomlinson is a professor of maternal and child health at Stellenbosch University. For more information on the Nids-Cram survey, visit http://www.cramsurvey.org 

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