Child Support Grant Research Articles

Impact of the South African Child Support Grant on memory decline and dementia probability in rural and low-income mothers, 2014–2021

IntroductionAging populations across sub-Saharan Africa are rapidly expanding, leading to an increase in the burden of Alzheimer's disease and related dementias (ADRD). Cash transfer interventions are one plausible mechanism to combat ADRD at a population-level in low-income settings. We exploited exogenous variation in eligibility for South Africa's Child Support Grant (CSG) to estimate the longitudinal association between potential CSG benefit and cognitive trajectories in rural mothers with <10 children (n = 1090). MethodsSouth Africa's CSG delivers monthly cash payments to primary caregivers, predominantly mothers, to offset the costs associated with child rearing. This study implemented a quasi-experimental design using data (2014–2022) from a rural, low-income cohort in the Agincourt research area, South Africa. We fit linear mixed effects models and generalized linear models to estimate the association of potential CSG benefit per eligible child with memory decline and dementia probability, respectively. We stratified all models by the mother's total number of children (1–4 and 5–9) and examined effect modification by household wealth and the mother's education level. ResultsHaving above median CSG per eligible child was associated with higher baseline memory scores (β = 0.12 SD units, 95% CI = 0.02, 0.22) but steeper memory decline (β = −0.02 SD units, 95% CI = −0.04, -0.00) compared to below median CSG. Within stratified analyses, this effect was primarily observed among mothers with 5–9 children. No associations were observed between potential CSG per eligible child and dementia probability. ConclusionsOur findings support the use of large-scale cash transfers as a promising intervention to promote healthy cognitive aging in mid-life women within rural, low-income settings. However, we found evidence that the CSG in its current structure may not be sufficient support for women to sustain measurable cognitive benefits over the long-term.

Food security and disability in South Africa: an analysis of General Household Survey data

Purpose We investigated the relationship between disability and food security in South Africa using data from the General Household Survey (GHS). Materials and Methods Regression models were utilised with GHS data (2014–2018) to gauge the likelihood of food insecurity (the dependent variable) among individuals with disabilities. Socioeconomic and demographic traits of the 2018 GHS sample were analysed. All estimates were weighted and represented nationally at the individual level. Results In this study population (32 187) of food insecure people, 9.64% are disabled. Food insecurity impacts more Black people with disabilities (91%) versus those without disabilities (90%), and disabled women (65%) versus nondisabled women (58%). Most reside in KwaZulu-Natal. Those with disability grants lower food insecurity odds, while child support grant recipients face higher odds. Household size and education are significant predictors, while marital status and gender are not. Conclusion This study data justifies the need for disability-inclusive food security programmes in South Africa, especially amid crises like COVID-19. Significantly, there is a nil data finding about people with eating/swallowing disabilities whose needs intersect with food security. This emphasises the need for inclusive data collection that operates within a food sovereignty framework to increase the visibility of people with disabilities.

Is the impact of the South African child support grant on childhood stunting robust? An instrumental variable evaluation

The Child Support Grant (CSG) is part of the South African Social Assistance Programme, which costs the country approximately 1.3% of GDP annually. Given the scale of this programme, it is important to assess whether it has had an impact on the long-term health outcomes of children. Extant literature on the impact of CSG on a child’s long run nutritional status as measured by the height-for-age relies on the optimistic assumption that estimation controls for all relevant variables (i.e. the ignorability assumption). Further existing analysis are based on older datasets (i.e. older waves of the National Income Dynamic Study (NIDS)). We examine the robustness of the results to bias due to unobserved variables, using more recent data (the 2014/2015 and 2017 NIDS). Using the possession of the necessary government-issued documentation to access the grant as an instrumental variable (IV) we find that existing results are robust to the IV framework. Further, acknowledging the limitation of the instrumental variable, we show that the result is robust to violation of various assumptions underlying the IV approach. We argue that while the CSG remains a crucial contributor to early childhood development in South Africa, there is a need to critically examine its impact on nutritional status given the importance of this variable for intergenerational transmission of poverty.

Disposable diaper usage, disposal practices and quantity estimation in rural areas

This study aimed to describe the disposable diaper usage, disposal practices and quantity estimation in a specified rural setting within a developing, sub-Saharan country, South Africa. Quantitative and qualitative data collection methods were used to collect primary data, which included survey research, focus group discussions, participatory thematic mapping, illegal dumping mapping and member checking. Most diapers end up within the natural receiving environment due to a lack of formalised waste management service provision. Dumping hotspots are water courses and streams. On average, each infant generates 4.47 diapers per day, while an average of 158,154 and 34,493 total diapers are generated daily within Bushbuckridge and Maruleng, respectively. High unemployment and grant-dependency rates characterise the study area, and households often spend the majority of child support grants to purchase diapers. Residents were willing to use a diaper disposal point and are not opposed to incineration. This study forms a comprehensive baseline to determine the feasibility of disposable diaper beneficiation options in rural areas.

Psycho-Social Factors Influencing Exclusive Breastfeeding Among the Primigravida Mothers at a Public Hospital in the uGu District, KwaZulu-Natal, South Africa

Primigravidae, first-time mothers are generally inexperienced at motherhood, which affects breastfeeding initiation and intent. Therefore, they need frequent professional and social support that must be clinical and practical for successful exclusive breastfeeding (EBF) outcomes. The study aimed to qualitatively explore the psychosocial factors influencing exclusive breastfeeding among primigravida mothers at a public hospital in the uGu District, KwaZulu-Natal (KZN), South Africa. A qualitative phenomenological and explorative research methodology was used to conduct the study. Semi-structured interviews were conducted with 11 purposive sampled primigravida mothers from the postpartum ward from day one today to four post-delivery. Data was collected until saturation was reached. Based on Bandura's Self-Efficacy and Social Cognitive Theoretical Framework, the study has shown that personal, social, and environmental factors strongly influence maternal attitudes toward breastfeeding efficacy. Five significant themes that emerged from the data analysis were (a) factors influencing maternal self-efficacy, (b) challenges to EBF, (c) cultural influence on EBF, (d) the role of support systems to EBF, and (e) breastfeeding support strategies. The study showed that stakeholders need to apply critical clinical interventions if South Africa reaches the global nutritional target of 50% EBF by 2025. These include healthcare workers (HCWs), Policymakers, Employers, the Department of Health, the Department of Education, the Department of Labour, and the Department of Social Services. Access to child support grants, social services, ARVs through mobile clinic services, and frequent face-to-face antenatal care were among the study's recommendations to address doubts, fears, and anxieties around EBF intent, practice, and duration.

Factors contributing to rise in teenage pregnancy in Sekhukhune district, Limpopo province.

The Department of Health in South Africa has reported an alarming total of 90 037 teenage girls between the ages of 10 years and 19 years who gave birth from March 2021 to April 2022, across all provinces and districts. The rise in teenage pregnancy is of serious concern as adolescents girls are more likely to experience difficult pregnancies and deliveries which could lead to detrimental effects on their health. The study aimed to explore and describe factors contributing to the increase in teenage pregnancy in the Sekhukhune district of Limpopo. The study was conducted in the healthcare facilities of Sekhukhune area. A qualitative, exploratory design was followed. Participants were purposively selected, and data were gathered through face-to-face individual interviews. Data analysis employed Tesch's inductive, descriptive coding method. Negligence, peer pressure, ambiguity, choice, lack of contraceptive use, and lack of family attachment were identified as exacerbating factors in the district's surge in teenage pregnancy. To reduce teen pregnancy, it is crucial to promote contraception, enhance cooperation between schools and the government, involve families in sexual and reproductive health discussions, prioritise a supportive home environment, advocate for child support grants, revitalise school health services, and empower teenagers to make informed choices and resist peer pressure.Contribution:The study will provide guidance to policy makers and other stakeholders in developing appropriate programmes to address the problem and improve the health and socioeconomic status of adolescents in rural areas. This will reduce healthcare costs associated with complications and premature birth.

The Use of Non-Prescribed Medicines in Infants from Birth to Six Months in Rural Areas of Polokwane Municipality-Limpopo Province, South Africa.

The purpose of this study was to determine the prevalence of NPM, describe the types of medications used, and explain why caregivers use NMP in infants younger than six months of age. A quantitative approach and a facility-based cross-sectional survey were used to conduct this study. Convenience sampling was used to select clinics, and proportionality and simple random sampling were used to select 146 participants. Data were analyzed using SPSS (29). A p-value of p < 0.05 was considered significant. In this study, the prevalence of NPM was 75.3%. Of the 146 participants, most were 25-35 years old (54%) and first-time mothers (36.3%). More caregivers had high school and matric (67.1%), and 84.2% of caregivers delivered in public health facilities. Almost three-quarters are unemployed (66.7%) and on a child support grant (56.4%). About 43.6% of infants received NPM within the first month of life. The main source of advice to give NPM was family members (86.4%). The main reasons for administering NPM were the treatment of the umbilical cord (57.3%) and the prevention of colic (32.7%). The results show a statistically significant association between the administration of medication and the age of the infant, p < 0.005. Non-prescribed medications are highly prevalent in the rural areas of Polokwane and are practiced by caregivers between the ages of 25-35 years advised by the families. Access to self-medication should be controlled, especially in the first month of life. Interventions to reduce the use of NPM should be targeted at young mothers and their families.

A results-based monitoring and evaluation system for the Namibian Child Support Grant programme

Background: Robust results-based monitoring and evaluation (ME) systems allow government to track the progress and impact of development programmes. This article focused on the current ME system as adopted for the Child Support Grant (CSG) programme of the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW) in Namibia.Objectives: The article examined whether the adopted ME processes and arrangements for the MGEPESW sufficiently track the outcomes for beneficiaries of the CSG programme to enable strategic decisions by the MGEPESW.Method: A desktop review of available literature on ME systems was complemented by a review of strategic reports and programme documentation of the MGEPESW that sets out the current ME arrangements. Further interviews with senior, middle and programme managers responsible for the implementation of the CSG programme assessed the suitability and gaps of these arrangements as well as the proposed recommendations to strengthen the existing ME arrangements.Results: The research found several gaps in current practice that hinders the MGEPESW and decision-makers in assessing the outcomes for child beneficiaries.Conclusion: Recommendations were offered to improve the current ME system to better track the outcomes of the CSG programme. This included a refined theory of change, revised indicators and strengthened institutional arrangements.Contribution: The improved results-based ME system for the MGEPESW offers a comparative base for the implementation of results-based ME systems for child-focused cash transfer programmes in similar contexts.

Child support grant expansion and cognitive function among women in rural South Africa: Findings from a natural experiment in the HAALSI cohort.

Cash transfers are a promising but understudied intervention that may protect cognitive function in adults. Although South Africa has a rapidly ageing population, little is known about the nature of association between cash transfers and cognitive function in this setting. We leveraged age-eligibility expansions to South Africa's Child Support Grant (CSG) to investigate the association between duration of CSG eligibility and cognitive function of biological mothers of child beneficiaries in South Africa. We analysed 2014/2015 baseline data from 944 women, aged 40-59 years with at least one CSG-eligible child, enrolled in the population-representative HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age-eligibility expansion years (2003-2012). Cognitive function was measured using a cognitive battery administered at the HAALSI baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. High vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD units; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores [β: 0.19 SD units; 95% CI: 0.05, 0.34, p-value = 0.02]. Government cash transfers given to support raising children may confer substantial protective effects on the subsequent cognitive function of mothers. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.

Ecclesiastico-pastoral care for social security grant holders in South Africa

This article aims to address the gap in research on ecclesiastical and pastoral care for congregational members dependent on government grants from the South African Social Security Agency (SASSA). It emphasises the impact of the dire socio-economic circumstances of congregants, and the role it plays in the life of the ordained pastor of the Uniting Reformed Church in Southern Africa (URCSA), navigating through the dynamics on their daily realities. The primary question addressed is: What amount of care is possible from the side of the church and the pastor to deal with SASSA related problems experienced by congregants? It is based on two types of data: firstly, five semi-structured interviews conducted with five women, three of them mothers who receive a Child Support Grant, and two grandmothers whose teenage daughters receive this grant. A second data set consists of recollections by a pastor who ministers in a community where the only income of most of the inhabitants is SASSA Grant related. Seven stories are told of pastoring needs related to SASSA Grant holders. Applying Narrative Therapy as method, data was analysed and nine themes emerged: (1) The church acknowledging and managing the needs of mothers; (2) the church providing a ‘haven’ for young mothers harassed by the father of the child; (3) pastoring domestic unrest among older grant holders; (4) pastoring congregants who are scammed out of a SASSA Grant; (5) supporting congregants who escape domestic violence through SASSA; (6) the church co-ordinating between significant others; (7) pastoring honour and shame; (8) protecting the elderly; and (9) pastoring conflicting cultural expectations vis-à-vis the SASSA Grant. This article concludes with a summary of and recommendations on ecclesiastico-pastoral care for SASSA Grant holders.Contribution: This article emphasises the importance of a multi-dimensional, non-theoretical approach in providing insight into the reality of ecclesiastical-pastoral care of congregants – care that extends beyond spiritual well-being to the livelihoods of vulnerable communities with various socio-economic needs, particularly those solely dependent on government grants.

A cost-effectiveness analysis of a South African pregnancy support grant

Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion ‐ ZAR23.2 billion/ $1.57 billion ‐ $264 million) and averted 59,000 DALYs (95% CI: -6,400–110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.

THE RELATIONSHIP BETWEEN FOOD INSECURITY, THE CHILD SUPPORT GRANT AND CHILDCARE ARRANGEMENTS

Food insecurity is endemic in South Africa because of high levels of poverty. Children in foodinsecure households may be exposed to childcare instabilities. However, the role of social protection in mediating the relationship between food insecurity and childcare arrangements is not well understood. This study explored the relationship between food insecurity, childcare arrangements and the child support grant (CSG) in a township in Cape Town. The study designwas mixed-methods; a hunger scale was administered to 120 participants and in-depth interviews conducted with 23 primary caregivers of children under 2 years of age. The findings indicated that despite being food insecure, many households had stable childcare arrangements, presumably because of the CSG and the age of the children at the time of the study. Further research is needed to unpack the relationship between food insecurity, childcare arrangementsand the CSG. Keywords: childcare arrangements, child support grant, food insecurity

Assessing the cost-effectiveness of economic strengthening and parenting support for preventing violence against adolescents in Mpumalanga Province, South Africa: An economic modelling study using non-randomised data.

There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.

A basic healthy food basket approach to evaluate the affordability of healthy eating in South Africa and Kenya

IntroductionUnderstanding the affordability of healthy eating has always been a critical question but has escalated in importance considering the global context of more recent soaring food prices and the worsening of food and nutrition security indicators since the COVID-19 pandemic. The objective of this study was to evaluate the cost and affordability of basic healthy eating in South Africa and Kenya, through the application of a Basic Healthy Food Basket (BHFB) modeling framework applied within the food intake and nutritional context of the target countries.MethodsThe construction of the BHFB models was based on a number of key considerations (i.e., ‘building blocks’): household demographic (size and composition), socio-economically disaggregated household income levels, minimum wage data, typical food intake patterns, nationally monitored food retail prices and official country-specific nutrient intake and food consumption guidelines. For both countries BHFB’s were compiled and interpreted at a national level, as well as for a ‘more plant-based’ BHFB. The nutritional adequacy of the national BHFB’s was evaluated.ResultsBased on national demographical statistics in Kenya and South Africa, the reference family was defined as a four-member reference household consisting of 2 adults and 2 children. The detailed composition of the national BHFB’s is presented, consisting of 31 food items in Kenya and 24 food items in South Africa – covering all the food groups according to nutritional guidelines. The nutritional adequacy of the various BHFB’s is discussed and were generally deemed adequate for the majority of micro-nutrients – particularly the micro-nutrients of concern in the various countries. In January 2023 the cost of the national BHFB in Kenya and South Africa amounted to KSh33 800 (US$270) and R4 715 (US$ 262) respectively, − potentially excluding approximately 60% of the population from being able to afford a basic healthy food basket. A movement to ‘more plant-based’ BHFB’s (i.e., proportionally less meat/fish/eggs and proportionally more legumes) reduced the cost of the BHFB’s with 15% in Kenya and in South Africa. From a social support perspective, the analyses indicated that social support in the form of child support grants and children benefiting from school feeding programmes could result in the share of households able to afford basic healthy eating to increase by approximately 10 percentage points in the South African context.Conclusions and recommendationsThe study showed that the high (and rising) cost of basic healthy eating prevents large numbers of households in South Africa and Kenya from being able to afford basic healthy eating when considering current income distribution data. The research outcomes of the BHFB methodology applied in this study to monitor and evaluate the cost and affordability of basic healthy eating, should be monitored regularly and taken into consideration to inform food and nutrition policy decisions and actions. However, from a methodological perspective several critical challenges will have to be addressed to improve the measurement accuracy of the BHFB models, including the availability of official food retail price monitoring of a wider range of food items; household demographics, household income data, food intake data and household-level food expenditure data that are more frequently updated, as well as socio-economically and geographically disaggregated data on typical food intake behavior. From the perspective of plant versus animal protein sources, the study suggested that food intake patterns with an increased focus on legumes as a source of plant-based protein could help to improve the affordability of basic healthy eating. However, it is also important to consider consumer acceptability in this context from various perspectives, including sensory acceptability, cultural acceptability, and the available time for food preparation. The study identified the critical need to evaluate the cost of basic healthy eating on a geographically more refined level. This is based on the diversity of food intake behavior in different regions within the target countries as pointed out by in-country experts. However, future research to develop an improved understanding of food intake pattern in different regions/provinces/counties will be a critical enabler, along with geographically disaggregated food retail price data and demographical information.

A community of practice approach for school-based developmental social work in South Africa: Reflections of social workers

This article reports on social worker reflections on the benefits and barriers of a multisectoral community of practice to improve child well-being for beneficiaries of the Child Support Grant in poor urban communities in Johannesburg, South Africa. The findings could inform cash plus school based social work policies and practice.

The Perceptions of Caregivers and other Stakeholders on the Usefulness of the Child Support Grant: The Case Study of Emalahleni, Nkangala District

The South African government faces the triple challenge of poverty, unemployment and inequalities. This article focuses on the challenge of poverty. One of the ways in which the government of South Africa seeks to address the challenge of poverty is through the Child Support Grant (CSG) programme that was first implemented in 1998. The Child Support Grant is intended to ensure that the basic needs of the children of a vulnerable group of society are met. The context is Emalahleni Local Municipality, and the main objective is to investigate the perceptions of caregivers on the utilisation of the Child Support Grant. The study adopted qualitative research which focuses on the issues to be understood by applying qualitative measures. In this regard, qualitative data collection and analysis methods and primary and secondary data were used. The primary data was collected through a survey that focused on the residents of Emalahleni Local Municipality. Key findings of the study are that the Child Support Grant improves households’ ability to meet basic needs such as food and clothing. In addition, the grants assists families make investments in education, which increases the chances of breaking the cycle of poverty. However, there was some evidence from community members (who are not caregivers) suggesting that there are cases of abuse of Child Support Grant money by some recipients in the community. As a result of this, the researchers suggest that SASSA must employ social workers directly to monitor whether caregivers use the grants for the intended purpose, which is to take care of the needs of beneficiaries. This, however, does not in any way suggest that the Child Support grant is not making a positive impact on recipient households. The article makes a contribution to the body of knowledge by providing empirically backed conclusions on this important social security intervention by the South African government.

‘We should not have to choose between hunger and death’: exploring the experiences of primary caregivers of recipients of a South African child cash transfer programme during COVID-19 lockdown in Cape Town, South Africa

Background:The advent of the COVID-19 pandemic in South Africa and across the globe posed special challenges and implications for low-income families with children. In this study we explored the experiences of primary caregivers of children receiving a South African social assistance programme, the Child Support Grant (CSG), during lockdown in Cape Town, South Africa, and sought to understand whether and to what extent the underlying logic of cash transfers such as the CSG speaks to the pitfalls of the social protection paradigm and the potential for moving closer to a transformative social policy approach. Methods:We conducted 26 telephonic qualitative interviews with primary caregivers of recipients of South Africa’s CSG that were part of a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security. Results:Even though primary caregivers of the CSG and their children and households were already living in precarity before the pandemic, COVID-19, and particularly the hard lockdown, worsened their social, economic and living conditions, especially as regards hunger and food insecurity. Conclusion:Low-income women bore the brunt of the pandemic in their roles as mothers, providers and homemakers. The pandemic has highlighted the inadequacies of the social protection paradigm that underlies the design of cash transfers such as the CSG, which has a narrowed focus on chronic poverty and vulnerability. It has also highlighted opportunities to shift to a transformative social policy framework that incorporates production, redistribution, social cohesion, adequacy and protection.

The impact of child mortality on fertility in South Africa: Do child support grants and antiretroviral treatment matter?

This paper investigates the effect of under-five mortality, child support grant (CSG) coverage and the rollout of antiretroviral therapy (ART) on fertility in South Africa. The study employs the quality-quantity trade-off framework to analyse the direct and indirect factors affecting fertility using the two stage least squares fixed effects instrumental variable approach. The analysis uses balanced panel data covering nine provinces from 2001-2016. This period was characterised by significant increases in the child support grant coverage and ART coverage. Furthermore, this period was characterised by a significant decline in the under-five mortality rate. We find no evidence to support the hypothesis that increases in the CSG coverage are associated with an increase in fertility. This finding aligns with previous literature suggesting that there are no perverse incentives for childbearing associated with the child support grant. On the other hand, results indicate that an increase in ART coverage is associated with an increase in fertility. Results also show that a decrease in under-five mortality is associated with a decline in fertility over the sample period. HIV prevalence, education, real GDP per capita, marriage prevalence and contraceptive prevalence are also important determinants of fertility in South Africa. Although the scale up of ART has improved health outcomes, it also appears to have increased fertility in HIV-positive women. The ART programme should therefore be linked with further family planning initiatives to minimise unintended pregnancies.

Law, South African Mothers Living in Poverty and the COVID-19 Pandemic

Sometimes being a mother in tough economic times can be a challenge. Socio-economic demands occasioned by the COVID-19 pandemic have been especially cumbersome for mothers already living under conditions of poverty. Since the beginning of 2020 the pandemic has further exacerbated the daily struggles of the poor during periods of economic uncertainty, disease and death. Conscious of this additional socio-economic pressure and to lessen the financial burden carried by mothers living in poverty, the South African state introduced a COVID-19 relief Child Support Grant to assist during this trying period. This article explores the role played by law in poverty discourse where mothers are concerned. It is suggested here that the conceptualisation of poverty in law, at least where mothers are concerned, is limited by law's neglect of the socio-political identity of women as mothers, which is rooted in history. This failure reaffirms that law is implicated in contemporary socio-economic inequalities

Maternal tobacco smoking and childhood obesity in South Africa: A cohort study.

Tobacco use and obesity are major public health problems and part of the leading causes of preventable disease and death worldwide. The prevalence of overweight children has escalated over the years; making the weight gain in children a critical issue for health professionals and academics alike. This study examines the association between maternal tobacco use and body weight abnormalities among South African children. The study uses data from the National Income Dynamics Study (NIDS), conducted from 2008 to 2017. The survey is available in five waves which have been merged into a panel dataset of 211,718 children aged between 0 to 5 years old, drawn from a nationally representative sample of households followed across time. Thus, the subgroup of children aged between 6 and 15 years old was excluded from the analysis. The empirical investigation employs a logistic regression model to estimate the marginal effect of maternal smoking on childhood overweight prevalence measured by three anthropometric based proxies, namely risk of child overweight, child overweight and child obesity. This framework assumes unobserved child characteristics to be uncorrelated with independent variables (random effect assumption); hence allowing to control for time-invariant sociodemographic factors which are likely to affect child nutritional health. In addition to sociodemographic and health characteristics of mothers, empirical findings suggest that maternal smoking exhibits a significant odds and/ or probability of weight abnormalities in children. Notably, children of smoking mothers are likely to be obese, overweight, or at risk of becoming overweight with a possible coexistence of mother-child overweight. Similarly, weight irregularities in children are likely to increase with mother's age. Conversely, married mothers although associated with increased odds of children having high BMI, display a reduced probability of children being abnormally weighted. Finally, child support grant has the potential to improve children nutritional health as children whose mothers are recipient of such grant have a negative probability of having high BMI. Overall, maternal smoking contributes to child overweight and/or obesity in south Africa; suggesting that maternal healthy lifestyle could be an alternative strategic tool to fight against overweight in children. However, mothers' inability to remain and/or follow a healthy life style is plausible as age increases, with spillover effect on child care. Thus, policymakers should prioritize programs to reduce smoking, especially amongst pregnant women and caregivers, to minimise the risk of overweight in children. Promoting the consumption of healthy foods accompanied by physical activity may reduce mothers' stress levels and their incentive to self-medicate using tobacco substances. In addition, comprehensive action programs including child support grant and recommendations for treatment plans that address the problems of children who are already suffering from overweight, remain essential.