BHEKISISA | ‘Only pap and rice by the end of the month’: Why bigger grants can fix child malnutrition

A rooster crows, waking baby Athande from her afternoon nap.

She lets out a loud shriek and starts to cry, while her young mother, Emihle Ngeseki, hushes her.

It’s been just over a year since Ngeseki, 18, gave birth.

She’s cradling Athande on a bed held up by a stack of four bricks on each of its corners in the one-room hut where they live, next to another rondavel and an add-on where her mother and four siblings sleep.

Outside, the roosters scuttle around the sandy grass as a dog sniffs the ground in search of leftover bones around the rondavel nestled on the hills of Lusikisiki, about 30km north of Port St Johns in a rural part of the Eastern Cape. 

Ngeseki puts Athande in a white puffy jersey and lays her down on the bed. 

The only money Ngeseki and her family have to live on are five child support grants for the children under 18 in the household. 

But it’s not nearly enough. 

At R530 a grant, it comes to a monthly income of R2,650. Of that, just more than R500 is spent on baby Athande’s needs, like nappies, body wash, formula milk, clothes and transport to get to the clinic for her check-ups or childhood immunisations.

From what’s left, the Ngesekis have to cover school transport for the other children, contributions to a stokvel (a community-based savings scheme) and a funeral policy, and groceries. 

They spend roughly R1,400 on food: rice, mealie meal, fruit, cabbage, oil, sugar, potatoes, flour and soup — food items the Household Affordability Index shows women choose to buy for their families first when money is tight. 

Says Ngeseki’s mother, Thandeka: “By the end of the month all we’re left with is pap and rice.” 

An election, a social grant and a poverty line

Thirteen of the 15 political parties whose manifestos Bhekisisa analysed for the centre’s election tool considered social grants important enough to include in their policies for South Africa’s future. 

The child support grant in particular is too little, many say. 

And they’re right. 

South Africa’s food poverty line — the minimum amount needed to buy a month’s healthy food for one person — is R760. At R530, the monthly grant for child support is almost a third below that benchmark. 

It’s especially here in the Eastern Cape that there’s a dire need: almost three-quarters of children younger than 18 survive on child support grants in the province. 

Grants for children work to reduce food insecurity in places where people have little money, research from Brazil and Mexico shows. It holds here at home too: a study from Mqanduli, a town in OR Tambo district, found that when households get a child support grant, children are far more likely to have enough healthy food every day and able to grow and develop normally than in households without a grant. 

Why grants need to be increased

To really fight malnutrition among children in the Eastern Cape, the Human Rights Commission office in the province recommended in 2022 that the social development department should up the grant to the food poverty line. This is similar to the findings of a study commissioned by the social development department last year, which showed that R23bn more than the available R77bn would be needed to top up the grant to that level. (The government has set aside between R81bn and R90bn a year for the grant over the next three years.) 

But even if the grant is increased to match the food poverty line, it won’t ensure other basic needs like transport, hygiene and clothing are met, the report adds, and will mean there’s less money for other grants like the National Student Financial Aid Scheme, the incoming National Health Insurance and early childhood development programmes, which are “all important in children’s basic needs”.

Moreover, grants should be given to pregnant mothers, some groups say, because it can help them to eat healthily and get regular check-ups so that their babies can develop well. 

Allowing women to get the child support grant from about week 20 of their pregnancy (by when they should have had their first antenatal visit) would cost the government an extra R2,300 per child per year, a 2024 analysis shows. 

But over the first two years of the child’s life, it would save the government R14bn in healthcare costs because more women would be able to attend antenatal appointments, which could lower birth complications or health problems in newborns that could affect them lifelong or even lead to early death.

‘Enough to avoid hospital but not enough to grow’

Athande was tiny when she was born, weighing just 1,500g, far less than the minimum of 2,500g considered a normal birth weight. Thirteen months later, she’s not grown to the expected 70cm at this age.

In South Africa, almost a quarter of children younger than five are stunted, meaning they’re too short for their age according to the World Health Organisation’s standard growth curves. This is because they don’t get enough healthy food that gives them the right amount of energy, protein, fats, and vitamins and minerals they need to grow normally. 

It’s a slow form of malnutrition, which is different from when children get so little to eat that they become thin and dehydrated quickly and need to get medical help immediately (this is called acute malnutrition).   

“Stunting happens when children get enough nutrients to keep them from being admitted to hospital, but not enough for their brains and bodies to grow to their full potential,” says Amanda Edwards, who manages studies on stunting at Grow Great, a nonprofit whose work aims to help shape policies so that this childhood development problem can be solved.

Not having a good balance of nutrients like vitamins, minerals and proteins at a young age is a problem because it can lead to children’s brains not developing well, which makes it hard to concentrate or do thinking tasks like understanding stepwise instructions, and can increase the chance for health problems like obesity and diabetes later in life.

The OR Tambo district, where Lusikisiki is located, is especially hard hit by food insecurity. In 2022, the district had the most deaths and hospital admissions of children younger than five due to severe acute malnutrition in the province. In Mqanduli, two hours from Lusikisiki, almost one in every four children don’t grow like they should because of chronic malnutrition. 

The district is also one where almost half of the total population of roughly 1.5-million people depend on a social grant to get by every month. (To qualify for the child support grant a single parent needs to earn less than R4,400 per month or R8,800 for married couples.)

In the family hut, Ngeseki tucks Athande under her shirt. After a few failed tries, she finally latches onto her mother’s breast.

But not for long.

Footsteps from Ngeseki’s siblings, who’ve just arrived home from school, scare a hen and her baby chicks and they burst through the door. The children follow and peep curiously into the room to wave at their mother and sister before going to change out of their school clothes.

The value of a grant

Athande’s chances of survival in OR Tambo, the district where she’ll be growing up, aren’t great. 

The latest District Health Barometer, a report used by the health department to track health data in the country’s 52 districts, found that in this district there will be 29 children out of every 10,000 live births who die before their fifth birthday. This is second only to the Francis Baard district in North West, where this statistic comes to 30 out of every 10,000 live births.

Families should get help so children can eat better, the report says.

Malnutrition is one of the biggest causes of death in children in South Africa. The type that causes stunting is not only because children don’t eat well after birth but also because of poor maternal health, says Edwards.

Maternal health matters especially during a child’s first 1,000 days (from conception to two years of age). If a mother goes for regular antenatal check-ups, as one study from Ethiopia shows, it reduces the odds of her child developing stunting because it helps mothers monitor how their children are growing and also helps health workers to see if mothers aren’t eating well. 

And this is where social grants come in. Payouts like the child support and disability grants are used by governments to help improve the living standards of people living in poverty.

But if the bigger social system that has to make sure that people can access services doesn’t work, the safety net of social grants is full of holes. 

Four generations of statelessness

In Lucingweni, Port St Johns, about two-and-a-half hours’ drive from Lusikisiki, Bomkazi Nkebe, 30, waits in line at a mobile government clinic.

She lives nearby with her son, five, her two adult brothers and her mom. None of them has a job. 

“I had to drop out of school in grade 11 because I didn’t have an ID and couldn’t register to write my matric,” Nkebe explains. “I try to get piece jobs here and there like cutting trees in the forest, but it’s difficult to feed my child.”

To qualify for a child support grant, parents need to have their ID as well as the child’s birth certificate. 

But because Nkebe doesn’t have an ID, her son wasn’t given a birth certificate when he was born and so doesn’t qualify for the R530 grant. It’s been going on like this for four generations in her family, and now it’s trickled down to her son. 

Says Nkebe: “Since my grandmother’s mom, no one’s had an ID or birth certificate.”

Third time lucky

Things like not having a birth certificate or ID document and having to get paid transport to a government office often block mothers from registering for a grant. 

That’s what happened to Ngeseki too. 

Their nearest home affairs office is in Port St Johns, more than 30km away. Taking a taxi there and back costs R330 — more than half a month’s grant. Moreover, there was no guarantee that she’d get helped the first time round. That’s because even if someone has the right documents, some women have reported that the queue might be too long and they’d have to come back again.

“I was lucky when I had to register for the child support grant,” says Ngeseki. “I only had to go [the home affairs office] once.”

When Athande was a few months old, healthcare workers at the clinic realised that her low birth weight led to her having a disability, which would make her eligible for the care dependency grant, which pays R2,180 per month. 

But registering for that wasn’t easy. 

“When I switched to this grant [from the normal one for child support], I had to go to home affairs three times before I got it [approved] in February this year.”

The first time she went to the Port St Johns office she was told she needed an official medical report to confirm Athande’s disability. For that, she had to take a taxi to get to St Elizabeth’s Hospital, a provincial facility in Lusikisiki about 20km from her home, to see a state doctor. Not only did she have to pay for transport to the hospital, but it also meant her first trip to Port St Johns was a waste of money.   

The second time she went to home affairs — a day on which it poured — she couldn’t stand in the rain with Athande while queuing at the offices, so she went home.

It was third time lucky. After having spent more than R1,000 on transport, Ngeseki was able to register Athande successfully on the system, but without knowing when the new grant would kick in. 

Looking ahead

At their home in Lusikisiki, Athande is sitting on her mother’s lap with a lollipop in her hand. Ngeseki takes it from her to remove the wrapper, but Athande starts crying.

Ngeseki laughs and gives it back to her daughter, who sucks on the bright red sweet.

Until there is an increase in the social grants, women like Thandeka and Emihle Ngeseki will have to continue to find creative ways to feed their children enough healthy food.

Thandeka goes outside to check on the maize she’s been growing and is surprised to see that some are ready for harvesting. She picks a few cobs and carries them into the rondavel where a pot of food is bubbling on a fire.

She blows at the glowing wood burning underneath the three-legged potjie, a cloud of smoke rising slowly to the thatched roof.

Sometimes she has to ask her neighbours for groceries, she says. She looks on, wondering if this month will be the same.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.