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Worcester study highlights urgent need to support women during and after pregnancy

Written by Marcia Zali

Increased exclusive breastfeeding rates in the study were an indication that, given the opportunity, women would follow health guidelines.

A study on the nutritional status of children under the age of five years in communities around Worcester in the Western Cape has confirmed the vulnerability of children to stunting, but one child nutrition expert said that there are positives that could assist in improving efforts to fight stunting.

The study was conducted among 846 women and 854 children under the age of five in the area.

According to the World Health Organisation, stunting is “the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation”.

One of these positives was that the study found that 59% of mothers exclusively breastfed their infants during the first six months. Exclusive breastfeeding is when only breast milk is fed to the infant and no food or water is given. It has been found that exclusive breastfeeding for the first six months gives infants a head start in life protecting them from disease and malnutrition. National guidelines recommend exclusive breastfeeding for the first six months but the national rate for exclusive breastfeeding is as low as 32%.

“The fact that they found so many more mothers that are breastfeeding than in the national survey, points to two things, you can look at it as a positive out of the health system or women are so poor, they can’t afford anything else,” said child nutrition specialist from the University of the Free State, Dr Chantelle Witten.

Unemployment and child nutrition

With a majority of the women who participated in the 2018 study being unemployed at 71%, Witten believes that this could have influenced the high breastfeeding rate.

“It shows that when women do have the opportunity, they will do the right thing, when they are home with their babies, they will exclusively breastfeed. So on the one side it is positive that women are doing it but on the other it shows us how desperate the situation is,” she said.

But researcher Professor Lisanne du Plessis, who specialises in public health maternal and child nutrition at Stellenbosch University, does not believe that the unemployment status of the majority of the women in the study contributed to the “surprisingly” high breastfeeding rate.

“As far as the unemployment and the improved breastfeeding rates go, we haven’t seen that this in South Africa as something that stands out….even in unemployed communities breastfeeding rates were not necessarily better so it could be….but I am not convinced,” said du Plessis.

Dietary diversity

Another positive result found was that 80% of the children in the study were beneficiaries of the child support grant (CSG) and that only 32% of the children had an inadequate dietary diversity.

According to the study, dietary diversity is a tool that is used to measure the nutrient adequacy of populations.

And with Worcester being an agricultural community, du Plessis believes that this could have contributed to the higher percentage when compared to the national rate for dietary diversity of 23%.

“We know that Worcester is an agricultural area so there may be more available foodstuff available in circulation. We do also know that organisations like Food Forward started working in Worcester for the redistribution of foods and food that have come close to their expiry date, so some of these issues may have contributed to the better scores that we saw,” she said.

Despite these improved scores when it comes to dietary intake, Witten says that more should be done to measure what contributed to the improvements in Worcester in order to inform decisions that can be taken on at a national level when it comes to addressing stunting in the country.

The cost of healthy food

Making healthy food affordable for pregnant women and young children who mostly rely on the child support grant was also highlighted as a measure to support efforts to end stunting, malnutrition, undernutrition and over-nutrition.

This includes increasing the child support grant to be equal to the basic food basket which costs up to R4000 a month, according to the National Agricultural Marketing Council.

The researchers also supported calls for a pregnancy support grant which would give financial support to mostly pregnant and unemployed women so that they are able to buy and eat a nutritious diet during pregnancy. Pregnancy has been identified as the first phase where interventions to curb problems related to child nutrition should begin.

For women without proper nutrition during pregnancy, 19% of children in Worcester had a low birth weight of less than 2.5 kg. These children were found to be twice more likely suffer from stunting when compared to those of normal birth weight.

“If we want to push for solutions, I would suggest that we push for solutions that will benefit all children in South Africa. Subsidising the food basket for children is what we need. I don’t understand why children who receive the SASSA grant are not allowed access to a subsidised food basket,” said Witten.

Stunting in children

About 26% of children under the age of five in Worcester were stunted while 10% were severely stunted in the same age group.

The national stunting rate currently sits at just above 27% which has been highlighted as a concern.

While 11% of the children in the study were overweight and 5% of them were obese. The combined national prevalence of children who are are overweight and obese is 13.5%.

Flourish franchisee, Celeste Williams highlighted the need for support programmes for pregnant women and mothers.

She has also called on local businesses in Worcester to make food affordable for communities.

“Pregnancy is a stressful time for women and we need community members to support pregnant women. We also need women to be supported financially during pregnancy and as communities, we can have food gardens and share information about health eating,” said Williams.

While Nolubabalo Siyolo highlighted the need for early childhood development centres that would offer affordable rates for teen mothers who needed to go to school while their children were kept safe and fed healthy food.

Making public breastfeeding a norm for mothers, especially at churches was also an issue of concern for Siyolo.

“Breastfeeding mothers need to feel comfortable to feed their children everywhere, including at church. Churches need to encourage public breastfeeding without shaming women,” she said.

Similar studies are being conducted in other parts of the country and according to the Grow Great Campaign’s Executive Director, Dr Kopano Matlwa Mabaso, these studies will provide useful high quality data on the nutritional status of South African children that will inspire action from stakeholders. – Health-e News

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Marcia Zali