From 1 to 7 August the world celebrated Breastfeeding Week under the theme “Enabling breastfeeding: making a difference for working parents”. This global campaign aims to create support and awareness about the benefits of breastfeeding among women who are physically able to do so. Exclusive breastfeeding for babies within the first six months of life is encouraged – also in South Africa – because breast milk contains all the nutrition a baby needs. To improve infant nutrition by 2025, the World Health Organization (WHO) set targets to eliminate malnutrition and increase breastfeeding rates to at least 50% – targets South Africa also subscribes to.

Poor, unemployed, and hungry

However, in South Africa and especially in poorer communities, the challenges of breastfeeding are often more nuanced in the face of a litany of socioeconomic difficulties. For example, often mothers are poor, unemployed, and hungry – all factors affecting their ability to breastfeed and, ultimately, the nutrition their babies receive.

According to Dr Chantell Witten, dietician and researcher in the Community Paediatrics Division at the University of the Witwatersrand, often low-income mothers do not want to breastfeed because they feel, as one study participant from her PhD research said: “When I breastfeed my baby, I feed her my hunger.”

Witten says the child support grant is not enough for mothers and children. “We need macro policy interventions like a basic income grant, a subsidised food basket for women on social grants, and more community food initiatives such as food banks, meals on wheels for pregnant and breastfeeding mothers. Happy, healthy mothers produce healthy, happy children, but hungry mothers give us sick, hungry children,” Witten says.

Hungry mothers

Nozenze Solana (37) from Soutpan, a small town 40km outside Bloemfontein, is unemployed with three children, two of whom are younger than five.

She agrees with Witten that the child support grant is not enough to keep her children fed.

Exclusive breastfeeding for six months is recommended by the World Health Organization for the optimal health and growth of infants, but it is not a common practice in South Africa. (Photo: Unicef / Spotlight)

Solana says she breastfeeds her four-month-old but finds it very challenging to keep up. Very often, says Solana, she also has no food. She says she is also struggling to feed her four-year-old boy and feels that he is not getting the nutritional food he is supposed to be receiving at his age.

According to the South African Demographic Health Survey of 2016, South Africa has an exclusive-breastfeeding rate of 32% among children under six months – still below the WHO’s global target of 50%, which member states should reach by 2025.

Solana tells Spotlight that she fell pregnant in high school and then dropped out of school, which is among the reasons she finds it difficult to secure formal employment. She lives with her 68-year-old mother, an unemployed 21-year-old nephew and her three children in a small RDP house. During Spotlight’s visit the household ran out of electricity units.

Nozenze Solana lives in Soutpan, 40km outside Bloemfontein. She is unemployed with three children, two of whom are younger than five. (Photo: Refilwe Mochoari / Spotlight)

In 2019, when she fell pregnant with her second child, she lost her job. She had been working as a cook at a farm school in Soutpan for five years but this, she says, was interrupted by the pregnancy.

Sometimes I wish I could take my life, but I think about my children. If they are suffering now while I am still on Earth, what more when I am dead?

“Life was difficult during that time, but at least with the R1,800 salary that I was earning every month I could provide for my children,” she tells Spotlight. “Today, I only rely on the child support grant for two of my children and that is not enough.”

Solana says she relies on donations from neighbours and relatives to help feed her children.

“It is embarrassing to knock on people’s doors asking for food. Sometimes we go to bed hungry and it is difficult to keep up with breastfeeding my baby when I am also hungry.”

She says her baby is not yet registered for the child support grant, so currently her only source of income is R1 000, which is R500 per child.

“With the R1 000 I buy basic food such as maize meal, cabbage, and electricity, but, unfortunately, the food does not last the whole month. I often end up being stranded with no other plan to feed my children. It is easy for friends to buy you alcohol, but it is difficult for them to buy you food when you are hungry,” she says, admitting that she ends up consuming alcohol to help her cope. “It makes me forget about my problems. Sometimes I wish I could take my life, but I think about my children. If they are suffering now while I am still on Earth, what more when I am dead? My mother is too old, so she will not be able to look after my children when I am gone.”

Inadequate access to food 

According to a Statistics South Africa report published in March 2023, more than half a million (683,221) households with children aged five years or younger reported experiencing hunger in 2021. Narrowing it down to the Free State, 17.7% of households in the Mangaung metro reported having severely inadequate access to food. The report also notes that 32,896 households with children five years and younger reported that they experienced hunger in the province. The data also shows that the number of households with people who experienced hunger outside the metro area was 77,221. The national total was 2,078,496 households.

Hunger has increased across the board, especially under South Africa’s Covid-19 lockdown when adults were going hungry for the sake of their children. (Photo: Deon Ferreira)

Solana becomes pensive when she says: “I regret dropping out of school.”

She was, however, excited that it was Thursday. This meant she could go to a post-natal class offered free of charge by the Grow Great Campaign’s Flourish project. This meant, she says, that at least for that day she would receive a decent and healthy meal.

The social programme Flourish, along with other NGOs and NPOs working to support women and families, are important buffers against the rising number of malnutrition cases and deaths of under-fives in the Free State.

According to Lize Speelman from Flourish in Soutpan, their services have been a great support for unemployed mothers in the area. “We offer antenatal and post-natal classes twice a week. We host 10 mothers per class and during class, we educate them on how to take care of themselves and their unborn babies. During post-natal classes, we encourage the new mothers to exclusively breastfeed the children for the first 1,000 days of their lives,” she says. “We also offer the new mothers lunch and nutritious food during their weekly class and give them nappies and some basic essentials for the babies because the majority of the mothers are unemployed.”

Another organisation providing support to unemployed mothers, the South African Red Cross Society, has a Young Women in Development Programme to empower mothers. Claudia Mangwegape, the society’s Free State manager, says the organisation is slowly moving its work into food security issues.

“We help unemployed mothers in poor communities with short courses that will assist them in starting some income-generating activities. So they are able to start baking businesses and vegetable gardens to sell vegetables. In this manner they are able to sustain their families,” says Mangwegape.

Building buffers against hunger

Ensuring that mothers have access to nutritious food, and are healthy and breastfeeding, is an important step in mitigating malnutrition.

Free State Health spokesperson Mondli Mvambi previously told Spotlight that 21 children in the province died of severe acute malnutrition and one died of moderate acute malnutrition from 1 April to the end of June 2023. Between April 2022 and March 2023, 17 under-fives died from moderate acute malnutrition and 98 children succumbed to severe acute malnutrition. These numbers, Mvambi said, refer only to deaths recorded in health facilities.

Mvambi did not respond to a new set of questions about how the province intends to address malnutrition – especially how it supports mothers to continue breastfeeding.

Even in 2023, infants under five years in the Free State are still dying from a lack of healthy food. From April to June, 21 children in the province died of severe acute malnutrition. (Photo: Black Star / Spotlight)

In 2022, when Spotlight reported on the rise in malnutrition deaths in the Free State, Dineo Mopeli, the Thabo Mofutsanyana district nutrition manager for the Department of Health, said they want to get the exclusive breastfeeding rate up to at least 80%.

This week, Mopeli said: “Currently, as we help mothers with educational programmes we educate them to plant vegetables in their own yards. We also give them nutritional supplements that they can eat when they do not have food. We also try by all means to assure them that their breast milk is the best thing for their children, whether they have eaten or not.” Mopeli said the South African Social Security Agency (Sassa) had a programme where mothers used to get R700 but this has been discontinued because of the R350 Social Relief of Distress grant.

Organisations such as the Grow Great Campaign’s Flourish programme offer ante-natal and post-natal classes to mothers and teach them how to take care of themselves and their babies. (Photo: Refilwe Mochoari / Spotlight)

However, Thembile Nqabeni, the spokesperson for the Department of Social Development in the province, said they do have support programmes that benefit unemployed mothers. “One way we do this is to encourage them to start non-profit organisations and cooperatives as we have funding earmarked to assist such initiatives. The plan is to provide them with skills, which will enable them to create work opportunities not only for themselves but for other women in their communities.”

Read more in Daily Maverick: Children are still dying of malnutrition in the Free State

Nqabeni said the department works with other government agencies, including the National Development Agency, Sassa as well as other provincial departments. “The reality is that we will not be able to address the challenge on our own. We also use media platforms to raise awareness about the various services on offer and to encourage women to be on the lookout for the calls for service plans and business plans through which we can provide services. This is how we partner with women in addressing unemployment, poverty and a variety of social ills.”

She referred to two women and youth-owned cooperatives the department launched and funded in Qwaqwa last month. One of them is the Albumen Primary Agricultural Cooperative in Tsheseng Village which rears laying hens and sells the eggs to the community at large.

“The other cooperative is the Makoane Arts and Food Security cooperative in Makone Village. This project focuses on arts, farming and selling of their products to the community,” Nqabeni says. DM

This article was published by Spotlight – health journalism in the public interest.