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The true cost of pregnancy: It is higher than we realis...

Maverick Citizen

OP-ED

The true cost of pregnancy is far higher than we realise 

Every pregnant woman wants the same thing – a safe pregnancy, free from worry and anxiety, and the delivery of a healthy baby. However, this is not the case for many South African mothers. (Photo: eco-business.com/Wikipedia)

February is Pregnancy Awareness Month and, there is a growing conversation about the importance of the first 1,000 days of a child’s life in South Africa. Yet, we fail to acknowledge that the first 270 of those days occur during pregnancy.

Pregnancy can be both beautiful and burdensome. And so, the miracle of life is also the burden of life. To truly support pregnant people requires us to open our eyes to more than the growing potential within the body. True social justice requires us to consider what we’re asking of the person who carries the potential and what we, as a society, can do to lighten the load. 

As Minister of Finance Enoch Godongwana prepares to deliver the budget speech on 23 February, we urge the minister to consider the following: 

  • Income protection during pregnancy and the postpartum phase is an important social protection mechanism. In South Africa, pregnant women are excluded from the social security system;
  • Formulation of a national budget that reflects political will to implement gender-responsive budgeting that promotes gender equality;
  • Income support for pregnant people as a matter of economic justice; and
  • The introduction of a pregnancy income support grant that is in line with the inflation-adjusted national poverty line, which was R624 last year.

February is Pregnancy Awareness Month. In South Africa, there is a growing conversation on the importance of the first 1,000 days of a child’s life, but we fail to acknowledge that the first 270 of those days occur during pregnancy. 

Pregnancy is expensive in many visible and invisible ways. It is a period of increased potential. Along with this potential, comes vulnerability. The physical, social and economic needs of pregnant women are complex and varied. When one is pregnant, you are eating, breathing and existing on behalf of another human being (or more). You need to ensure your diet is rich in essential nutrients that support your body and aid the growth and health of the developing foetus. You need to see a healthcare professional regularly to ensure the foetus is growing as expected, and that your body is adapting to the pressures of pregnancy. 

Whether or not antenatal health care is free or affordable, you will be spending time and money to travel to the said healthcare provider. This might also mean money to pay for childcare while you are away. If you work in the informal sector or are self-employed, it is likely that any time away from work is unpaid. For some pregnant women, this means losing an entire day’s worth of income (in South Africa, pregnant women are expected to attend eight antenatal visits to reduce the risk of adverse obstetric outcomes). 

You also require different clothing to accommodate the changes in your body, whilst enabling you to adhere to the spoken or unspoken dress codes of your workplace or community. All of the above costs are unique to pregnancy and occur well before there is an opportunity to access child-focused state assistance such as the child support grant.

Social security is a fundamental right

The child support social grant was established in 1998 and is the bedrock of South Africa’s comparatively comprehensive social protection infrastructure. It was established to ensure the best possible early life outcomes. This spirit of social interest in, and responsibility for children from the start of their life, is an expression of the promise to “improve the quality of life of all citizens and free the potential of each person”, as enshrined in our constitution. 

However, there is very little realisation of that promise for the life that does the work of growing and caring for children in the first 270 days of their existence. The failure to see pregnant women’s welfare and well-being as a matter of urgency is an egregious oversight that must be corrected by the establishment of social income support and protection for pregnant women. 

South Africa is an International Labour Organisation (ILO) member state. According to the ILO, maternity protection is a fundamental human right and an indispensable element of comprehensive work-family policies. ILO Convention 183 and Recommendation 191 outline several core elements of maternity protection, which include maternity leave, cash benefits, health protection at the workplace, employment protection and non-discrimination, as well as breastfeeding arrangements at work.

Currently, employed female contributors to the Unemployment Insurance Fund (UIF) can apply for benefits when they go on maternity leave. The UIF is not a comprehensive-effective-protective measure for pregnant women and women who have recently given birth. Firstly, it is only available after the baby is born and registered. Secondly, it is only accessible to women who are formally employed and whose employers have been contributing to the UIF on their behalf. UIF is not available to pregnant women who are self-employed or working in the informal economy. 

Thirdly, a woman can only claim UIF benefits for a maximum of 121 consecutive days (four months). Postpartum recovery from pregnancy and childbirth can take many more months in the best of circumstances, to say nothing of cases of premature birth or birth trauma and injury. Researchers argue that a womanʼs body may not be fully restored to pre-pregnant physiology until approximately six months post-delivery. Many women are compelled by circumstances to work well into their third trimester. There are health risks associated with continuing to engage in certain kinds of economic activity too far into one’s pregnancy. Not getting an adequate rest period or returning to work too soon after childbirth has been shown to have negative effects on maternal and child health (both physical and mental health). A mother’s return to work often interrupts breastfeeding and mothers are forced to introduce infant formula or solid foods too early. 

Fourthly, we know that the UIF claiming process can be complicated and inefficient. Claimants can wait for months for their claims to be paid, and in some instances, they never receive their UIF payout or give up trying because the administrative process is too cumbersome.

Income support for pregnant women is a matter of economic justice 

Covid-19 sparked conversations globally about the status of mothers as essential workers and created awareness of the unpaid care work they perform in homes every day. Care work refers to the domestic labour that is necessary to support a well-functioning home, society and economy. Pregnancy forms part of the double burden of work that women are expected to perform. The recognition and support of unpaid care work is important to achieving women’s economic empowerment and gender equality. 

The Organisation for Economic Co-operation and Development (OECD) explains, “every minute more that a woman spends on unpaid care work represents one minute less that she could be potentially spending on market-related activities or investing in her educational and vocational skills”. 

We must also acknowledge that the employment gap is gendered. Women bear the economic brunt of the Covid-19 pandemic. This is particularly concerning when one considers that over 40% of South African households are female-headed — that’s over seven million homes. 

According to the National Income Dynamics Study — Coronavirus Rapid Mobile Survey (Nids-Cram), women experienced slower financial recovery than men as the economy reopened. Of the women who were employed pre-Covid, only 47% stayed employed across all four waves. Women were also more likely than men to increase the hours they spent on childcare with the closing and then reopening of schools and early childhood development centers, which demonstrated how women tend to take on a bigger share of the responsibility related to children in the home. This also meant that many women were prevented from working the same hours as before lockdown, and were delayed or prevented from returning to their jobs or job seeking. Pregnancy is a time of increased economic vulnerability because of tangible and intangible costs related to pregnancy. At the same time, pregnancy very often limits a birthing person’s income-generating potential. 

Improving maternal and child health outcomes

As it stands, there is no state-offered support to help pregnant women access antenatal and perinatal health care, better nutrition, childcare programmes, or to cover the increased cost burden of carrying a child to term. In 2021, Embrace in partnership with Grow Great, Stellenbosch University and other stakeholders was involved in the Co-Care Maternal Support Study. The study found that pregnant women living in disadvantaged communities in the Western Cape experienced high levels of hunger, poor mental health, and economic insecurity in the months following the national Covid-19 lockdown. Almost 40% of the 2,620 survey participants were pregnant with their first child, and the majority (71%) did not have employment or work-related income in the previous month. What is more, Grow Great estimates that 15% of infants are born with low birth weight, and over a quarter of all children aged under five years suffer from nutritional stunting, which has detrimental long-term consequences for their health, cognitive development, school achievement and future economic prospects. 

The purpose of Pregnancy Awareness Month is to strengthen pregnancy education and awareness about important issues that promote a healthy pregnancy and safe, empowered motherhood. The truth is that as a country, we offer limited support for those who are pregnant. We recognise and pay lip service to the contributions of mothers, but aren’t willing to talk about or accommodate for the increased vulnerabilities and needs experienced by pregnant women. DM/MC

*Note: Embrace acknowledges that not all pregnant people identify as women. However, for the purposes of this op-ed, we have used the term “pregnant women” as the article seeks to highlight the gendered nature of discrimination and the value of different kinds of labour. 

Rumbi Goredema Görgens is Operations Manager, Nonkululeko Mbuli is Communications and Advocacy Strategist and Julie Mentor is Movement Leader at Embrace.

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