‘Maternal hunger & mental health’ – with Mark Tomlinson

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(The article below first appeared in the Financial Mail on the 15th of July under the heading ‘Feeding a family‘ – a slightly longer version of that article is included below.)

As the NIDS-CRAM data began to come in during the month of May, it was immediately clear that hunger was widespread. As has been reported in other articles in this edition, 47% of NIDS-CRAM respondents reported that their household had run out of money to buy food, with 22% reporting that someone in the household had gone hungry in the last 7 days. In households with children, 15% of respondents reported that a child had gone hungry in the last 7 days. These are all especially worrying, and considerably higher than anything we have seen in other household surveys. However, given that NIDS-CRAM survey is sampled to look at the entire population, we could not reliably disaggregate these results and explore the impacts on especially vulnerable groups. Two groups of people are at particular risk of long-term negative outcomes if they experience hunger: (1) pregnant women, and (2) new mothers and their young babies.

In order to sample a large enough group of these women, we conducted a separate survey, the Maternal and Child Health (MATCH) survey. This is completely independent of NIDS-CRAM. With the permission and support of the national Department of Health, we were granted access to the MomConnect platform. This is an innovative mobile-phone service and more than half of the women attending public sector antenatal care services in South Africa are registered on the platform. It is the largest database of pregnant women and new mothers in the country. Together with Professor Ronelle Burger, we drew a sample of 15,000 new and prospective mothers from the MomConnect platform with the sampling done such that it is broadly representative of the 930,000 new and prospective mothers on the platform. This was a short SMS survey with two waves of about 15 questions (in English), with mothers receiving R10 airtime per wave to thank them for their participation. The survey covers access to antenatal care, vaccinations, ART, as well as maternal hunger and maternal mental health. We will focus on these last two in this article. It must be noted that because this is an SMS survey, the number and types of questions that can be asked are limited. Mothers’ English literacy levels are also likely to affect the results.

We asked mothers “In the last 7 nights did you ever go to bed hungry?” and if they answered yes, then how many nights they went to bed hungry. Of the 2,214 pregnant and new mothers that answered both questions, 350 (16%) reported that they had gone to bed hungry at least once in the last week (246 for 1-2 days and 102 for 3+ days). More worryingly, 11% reported going to bed hungry for 1-2 nights and 5% reported going to bed hungry for 3+ nights in the last seven.

The evidence is now indisputable that in the first 1000 days (conception to age 2) a child’s brain is hypersensitive to either benefit or harm. In utero, the foetal brain grows rapidly, and after birth the infant brain grows 1% heavier every day for the first three months of life and reaches 80% the size of the adult brain by the age of 3. Because of this profound and rapid development, the foetus and the infant are highly susceptible to potential harms, including frequent hunger. The consequences of maternal and child undernutrition are enormous and include shorter adult height, less schooling, mental illness, diabetes, obesity and reduced economic productivity, and—for women—lower offspring birthweight.

From existing research, we also know that maternal hunger is a risk factor for depression during pregnancy, and that maternal antenatal depression during pregnancy is a strong predictor of a depressive episode in the postnatal period and beyond which is itself associated with a range of later negative outcomes. In addition to the hunger questions we also asked women “In the last 7 days have you felt hopeless, down or depressed?” with frequency options of a few days or most days. Figure 1 below reports those results relative to reported frequency of going to bed hungry. The trends are quite clear, and incidentally are identical for pre- and post-birth mothers. New and prospective mothers who report going to be hungry for 3+ nights in the week were eight times more likely to say that they felt hopeless, down or depressed “most days”.

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In our view, new and pregnant mothers must be prioritized when targeting government relief. Many do not yet receive the Child Support Grant and are thus without that important lifeline. Maternal hunger and poor mental health can have profound long-term consequences for both mother and child.

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*Dr Nic Spaull is the Principal Investigator of the NIDS-CRAM project and the co-investigator of the MATCH study. Prof Mark Tomlinson is a Professor of Maternal and Child Health at Stellenbosch University.

**Note the MATCH data should be publicly available in the next 2 weeks.

 

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