Grant to prevent malnutrition is in limbo

In South Africa, 29% of children under five are stunted, and 2.5-million live in nutritionally insecure households. A Maternal Support Grant was proposed more than a decade ago, but there’s been some pushback from government. Photo: Canwest News Service via Wikipedia (public domain)

• The proposed Maternal Support Grant has been delayed for over a decade.
• Cabinet’s Social Protection committee sent back the proposal in 2024 due to concerns over cost, dependency and policy alignment.
• But civil society groups say the grant is urgently needed to address maternal and child malnutrition.

More than a decade since it was first proposed, the Maternal Support Grant (MSG) policy remains in limbo.

“Children of mothers who are malnourished in pregnancy have higher odds of poor birth outcomes, including low birthweight, undernutrition, poor neurodevelopment, and increased risk of chronic diseases in later life,” says Dr Wanga Zembe, senior specialist scientist at the South African Medical Research Council.

In South Africa, 29% of children under five are stunted, and 2.5-million live in nutritionally insecure households.

This comes as civil society groups have renewed calls for the government to fast-track the process to get monetary support to pregnant women. The current proposal suggests that the maternal grant be an extension of the existing Child Support Grant.

But this may not happen anytime soon. This week, the Department of Social Development (DSD) confirmed that the draft MSG policy, in the making since 2012, has not yet reached Cabinet.

In November 2024, the draft policy was submitted to the Social Protection, Community and Human Development (SPCHD) Cabinet Committee, but was “sent back for further work,” said department spokesperson Bathembu Futshane.

He said the committee “did not obtain general support” for the draft and raised several issues, including the need for a joint government approach to poverty, unemployment and inequality.

The current proposal suggests that the maternal grant be an extension of the existing Child Support Grant (CSG).

Other recommendations included factoring in fiscal constraints, avoiding “creating a dependency syndrome,” considering conditions for the grant, and aligning with food security and economic transformation goals, he said.

But civil society groups believe this delay is “deeply disappointing”. The MSG Advocacy Coalition, made up of organisations and researchers, said: “It has been more than a decade since the DSD commissioned research on the benefits of a pregnancy support grant. That body of evidence has only grown stronger.”

The coalition said the South African Law Reform Commission had already identified the absence of income support for pregnant women as a gap in the country’s social security framework, and recommended a pregnancy grant. “It is unclear what the binding constraint is, considering the coherent legal arguments in favour of the MSG and the urgent need to improve maternal and infant nutrition.”

The group urged the DSD to talk openly with other departments and prepare the policy for resubmission. “While DSD has demonstrated support for the MSG, buy-in from across government is needed, starting with the Presidency.”

According to the group, the MSG would require between R1.89-billion and R3.26-billion annually. But potential savings to the public health system could exceed R13-billion by preventing low birth weight complications, the group said. “Social protections are not acts of charity, they are critical investments.”

Why should pregnant mothers get state support?

According to Dr Wanga Zembe: “It is essential for pregnant women to have access to nutritious food, as a baby’s survival — both as a foetus in-utero and as a child once born — literally depends on it.”

Zembe said maternal nutrition is key to foetal development, immune systems and cognitive ability. She warned that poor maternal nutrition has “far-reaching consequences” for a child’s life, productivity and long-term health. “Stunting has devastating impacts on child development, especially cognitive development, leading to delays, poor school performance and reduced productivity.”

Zembe referred to UNICEF’s 2021 global guidance on maternal nutrition study, which highlighted the importance of improving women’s diets before and during pregnancy as well as while breastfeeding.

A 2024 Global Health Action review found that conditional cash transfers for women in Sub-Saharan Africa were associated with improved child survival rates, reduced foetal and infant mortality, and enhanced functional health outcomes, such as decreased illness episodes. Unconditional cash transfers were linked to improved maternal well-being, including fewer symptoms of depression. (Conditional cash transfers require recipients to meet specific criteria, like attending health checkups, while unconditional grants would be given without any requirements.)

Nicola Eley, deputy director at the Grow Great campaign said, “25% of all pregnant women in SA have reported going to bed hungry. That’s not just a statistic. It represents thousands of mothers and their unborn babies and futures being shaped.”

She said the first 1,000 days, from conception to a child’s second birthday, are critical. “Stunting impairs both physical and brain development. It compromises learning, weakens immune systems and increases lifelong health risks.”

Eley said people can only apply for the child support grant once the child is born, with 52% of eligible children accessing it only after their first birthday. “By then, the critical window for brain and body development has passed. It’s like trying to build a house after the foundation has started crumbling.”

Meanwhile, the MSG Advocacy Coalition has refuted claims that the MSG will “incentivise pregnancy and create dependency”.

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