A half dozen pregnant women sit around a table, singing lullabies to the water bottles they are cradling to their chests as if breastfeeding. The women, members of a pregnancy support group at a clinic in Johannesburg’s Soweto section, erupt into laughter at the exercise.
“The Flourish [group] has been eye-opening, in a good way … I’ve learned so many things as a first-time mom,” says Neo Frans, who participated in the program, co-led by the clinic and Grow Great, a national NGO, during her pregnancy. Frans says she learned a lot about maternal nutrition, like the importance of eating spinach and dairy when possible.
The impact of this knowledge becomes clear a few blocks down the road, where a community health worker (CHW), Mapula Makara, conducts a routine growth check on a little girl. When Mandisa Shongwe’s baby was born, she weighed 2.5 kilograms (5.51 pounds)—just a hair shy of the WHO standard that defines low birth weight as weight at birth of <2500 grams (5.5 pounds). “I was so scared,” says Shongwe, recalling how small her baby was on the day she was born. Shongwe explains that she suffered from gestational hypertension and lost a lot of blood during the premature delivery.
On the day of her growth check at 20 months old, her smiling child weighs just over 10 kilograms (about 22 pounds). “She was born a little bit smaller, but when we plotted her measurements now, we could see that she’s within the right range,” says Makara. The improvement is in part thanks to nutritional and health support by the local CHWs like Makara, funded by local health departments, who visit neighborhoods daily to offer support, monitoring, and, if needed, referrals.
However, Makara’s specific knowledge of maternal health is somewhat unusual for her profession. She received specialized training from Grow Great to identify and prevent possible child stunting.
According to Grow Great, “… as much as 32% of children at the age of two are stunted, which is unbelievable and shockingly high for any country,” says Edzani Mphaphuli, Grow Great’s executive director. That’s significantly higher than the global average, which, per UNICEF, is 23%. “So, it’s a no-brainer that we need the Maternal Support Grant [MSG],” Mphaphuli adds.
The proposed MSG would financially support qualifying pregnant women for six to nine months. The amount proposed—around $34 a month—mirrors the existing Child Support Grant.
“So really, what the MSG is trying to do is saying that if women had some form of social protection, it would improve their antenatal care,” says Liezel Engelbrecht, nutrition lead of the Hold My Hand Accelerator—another stakeholder in the Maternal Support Grant Advocacy Coalition currently pushing for the policy.
The hope is that the money would go towards improved maternal nutrition, directly reducing LBW rates and other complications. It may also help more mothers-to-be receive antenatal care, which may be far away or expensive to reach during pregnancy.
Research supports the idea that women will use additional financial resources to benefit their family’s nutrition.
Jacobus Van Rooyen, a neonatologist and senior lecturer in pediatrics and child health at the University of the Free State, explains that strong antenatal care directly lowers the risk of LBW. Pregnancy complications, infections, and poor socioeconomic conditions all contribute to this, making the need for support and education important. “For this reason, the low-birth-weight rate is often considered an important indicator of the socio-economic environment and the overall health status of a population,” he says.
The MSG could also pave the way to getting mothers registered on the national social security system for future grants. While the vast majority of qualifying children in South Africa are registered for the Child Support Grant, this number is around 50% for children under 1 year of age. The MSG would likely increase this number, and possibly even lead to an automatic registration of the later grant.
The MSG would also save the government money—averting an estimated $800 million in health costs by investing around $145 million. “Giving birth to a low-birth-weight baby is really expensive for the health system,” Engelbrecht says.
Of course, implementation would have to be effective for the MSG to have its desired effect. “A grant would likely be most effective if it is implemented alongside other public health and socioeconomic interventions that target the root causes [of LBW],” van Rooyen says.
The Department of Social Development started developing the grant 14 years ago, but it has been delayed in government processes for some time. In response to GHN’s request for comment or an update, the department said that it is currently waiting for a cabinet decision on the matter and is currently not taking the lead on the matter.
But, with the country’s presidential State of the Nation Address this past February specifically referencing grants around maternal nutrition, Engelbrecht says there is a “window of opportunity” to push for change.
In fact, the coalition presented the MSG to the South African Human Rights Commission’s National Inquiry into the Food Systems of South Africa in February. Since then, it has continued to pressure the government to make funding available for the grant, including in a June press release.
Meanwhile, there are studies underway that continue to research the effectiveness of the possible grant in South Africa, including a pilot program of food vouchers to women in the Western Cape, launched by the government in 2025. With over 2,000 women enrolled, it is considered a success so far.
Engelbrecht hopes that all this work and advocacy will help build more political will before the national medium-term budget is tabled in Parliament at the end of October. In the meantime, pockets of change, like the Grow Great program, show the importance of support and education from CHWs like Makara.
Out on another visit, Makara weighs and takes measurements of a woman, who is six –months –pregnant, in her backyard, and comments, “Her pregnancy is coming along okay, but the stress is there.” Makara is worried about the fact that the third-time mom-to-be does not have an income other than her existing child support grants. Her hope is that the MSG could make a palpable change for those who need it.
This article was originally published by Global Health Now, which is affiliated to the Johns Hopkins Bloomberg School of Public Health on 07 October 2026. Read it here.
