A baby's first 1,000 days, from the time of conception until their second birthday, is a crucial window of opportunity to optimise their potential - through healthy nutrition for the mother during pregnancy, and then for the child after birth.
Undernutrition during this early period can cause stunting, which has major health and social effects later in life. Stunted children may never reach their full potential, and may suffer from obesity and related diseases for the rest of their lives. This costs the individual their health and their future, and costs governments billions in healthcare spending.
Many studies have shown that pregnancy support grants or vouchers improve women's nutritional status and their ability to access and benefit from antenatal care. Globally, around 41% of mothers with newborns receive a maternity benefit of some kind. This rises to more than 80% in Europe and Central Asia, but drops to 16% in Africa.
Currently, pregnant women in South Africa receive no such benefits. The child support grant, which amounts to R510 (approximately $27) a month, is only paid after a child is born and has a birth certificate.
In South Africa, more than a quarter of children under five (27%) are stunted. Improving pregnant women's nutritional status - and thus the health of their babies - should be high on the list of priorities for South African policymakers. It would contribute to ending childhood malnutrition, reducing poverty and unemployment and raising future generations of healthy, productive children who, as adults, will drive economic growth.
Read more: South Africa needs to change direction on maternal health to solve child malnutrition
As health economists we wanted to establish whether extending the child support grant to pregnancy would be cost effective for the South African government.
Our research found that it would decrease healthcare costs by R31,200 ($1,600) per baby over the first 1,000 days of life, largely as a consequence of mothers attending antenatal care more regularly and reduced neonatal complications.
Applied to the whole population, this would save the government about R14 billion (US$720 million) over the first 1,000 days of children's lives.
Mothers in need
A large proportion of pregnancies in South Africa (69%) occur in impoverished households. Almost half of all pregnancies (46%) occur in female-headed households. More than one third (35%) of pregnant women run out of money to buy food, and one quarter of them (25%) experience hunger.
Given that 13 million children now receive the child social grant, the number of mothers potentially eligible for a pregnancy support grant is likely to be sizeable.
Read more: How hunger affects the mental health of pregnant mothers
Making healthy food choices
A 2021 pilot study by GrowGreat, an organisation dedicated to achieving zero stunting by 2030, gave 2,618 poor pregnant women in the Western Cape province a R300 ($15.40) digital food voucher every two weeks for 16 weeks and showed that the women used the grant money to buy nutritious foods.
The pilot also highlighted the grant's psychological benefits. Having the power to make healthier food choices for themselves and their unborn babies not only relieved their financial burden but also gave them hope for the future.
Policy on a pregnancy support grant
A pregnancy support grant has already been proposed by the SA Law Reform Commission and would prioritise support for the most impoverished and vulnerable people.
Some people argue that the child support grant encourages women to get pregnant. Numerous studies have shown that this is not the case. In fact, many women with children who need the grant do not access it - especially teenagers.
Across the globe low- and middle-income countries, such as India, Bangladesh, Mexico, Nepal, Nigeria, Kenya and Brazil, have tried to address the financial burden placed on pregnant women by providing them with pregnancy support grants. These studies found that such grants promote weight gain during pregnancy, reduce maternal anaemia, increase access to services during pregnancy and childbirth, reduce maternal mortality, and prevent low-birthweight births and infant mortality.
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Read more: Maternal malnutrition affects future generations. Kenya must break the cycle
Benefits of extending the child support grant into pregnancy have the potential to enhance the lives of families and communities as well as individual children and save the South African government billions. The knock-on effects in terms of hope, motivation, learning and employment of women - and thus for the economy - are likely to be immense.
Susan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the Witwatersrand
Aisha Moolla, Health economist, University of Sheffield
