SOUTH AFRICA – Addressing unmet social needs for improved maternal and child nutrition: Qualitative insights from community-based organisations in urban South Africa

by Agnes Erzse, Chris Desmond, Karen Hofman, Mary Barker, Nicola Joan Christofides

Global Public Health 2024;19(1) + PHOTO: The Conversation/ Getty Images, 25 February 2024


Maternal and child malnutrition persists globally, despite existing healthcare and social protection systems. Socio-economic disadvantages contribute to high malnutrition rates, particularly in poor urban communities where many disadvantaged mothers cannot fully benefit from services. To address these disparities, a novel social needs framework has been proposed, emphasising the importance of addressing individuals’ unmet needs to enhance the benefits of nutrition services. This study investigates the perceived impact of community-based organisations (CBOs) in addressing the social needs of mothers in a resource-constrained urban township in South Africa. Interviews were conducted with 18 employees from 10 CBOs working on maternal and child health, food security and social support in Soweto. Thematic analysis revealed 23 services and four pathways through which CBOs believed to address unmet social needs of beneficiaries. Services were small-scale, including food aid, learning support, and social protection assistance, available to a few in dire need. CBO services partially addressed social needs of mothers due to scale, coverage, and sustainability limitations. The South African government should reaffirm its commitment to financially supporting the non-profit sector and integrating it into government sectors to provide tailored services and resources to address diverse social needs and mitigate nutrition inequalities among mothers and children.

From the Introduction

Addressing malnutrition in all forms is one of the foremost objectives of the United Nations Decade of Action on Nutrition. Interventions to improve nutrition, particularly during the first 1000 days of life from conception to a child’s second birthday, are critical for the growth and development of children, and for social and economic progress. Countries across the globe have adopted evidence-based actions to enhance early life nutrition, spanning health, agriculture and food systems, social protection, and water, sanitation, and hygiene (WASH). The specific combination of direct and indirect actions varies depending on each country’s context. There is no one-size-fits-all approach. South Africa’s support for maternal and child nutrition consists largely of interventions delivered through the primary health care system, and policies that constitute part of a well-developed social protection system. The latter includes food parcels for children at risk of or presenting with malnutrition, subsidised meals at registered early childhood development centres, and a Child Support Grant (South African Rand [ZAR] 500, [USD 25] per child as of 1 April 2023), a means-tested unconditional cash transfer programme for children from low-income households. Despite free primary health care services and social protection policies, South Africa grapples with persistently high rates of maternal and child malnutrition; 27% of children under the age of five have stunted growth, 61% of children and 31% of women of reproductive age are anaemic and 33% of mothers are overweight or obese. Further, in 2022 South Africa was recognised as the world’s most unequal country, where the top 10% of the population held a staggering 71% of the country’s wealth, while the bottom 60% of the population held only 7%, and earning gaps for women reached 38%. Such extreme wealth and gender inequalities, coupled with unequal distribution of employment opportunities, adequate housing, and quality education have profound implications for maternal and child nutrition….