Something doesn’t line up: girls, on average, do better than boys at school and are more likely to pass matric and study further, but this isn’t reflected in our workforce since the face of unemployment in South Africa is largely female. Those locked out of learning or earning opportunities are also more likely to be young black women living in poverty.
There are different contributing factors to this gender disparity and as many interventions needed to square this circle. One sharp factor is that girls and women bear the brunt of unpaid care work and domestic labour at home. Pregnant women, in particular, are more vulnerable to unemployment at a time when their need for nutritious food and healthcare is greater.
In South Africa, we have an opportunity to support women’s care work through a Maternal Support Grant (MSG) aimed at pregnant women living in poverty. But it’s been over a decade since the Department of Social Development commissioned a local study on the health and economic benefits of the MSG. Since then, evidence from 27 low- and middle-income countries shows that pregnant women who receive financial support eat better, feel better and are more likely to access antenatal care. Not to mention the research shows that these types of grants prevent low birth weight deliveries and infant deaths.
In 2023, researchers estimated that it would cost between R1.9 billion and R3.26 billion annually to implement the MSG, depending on the number of months it’s paid to beneficiaries – that’s roughly 0.1% of the government’s national expenditure. At R13.8 billion the estimated savings are more than four times the anticipated costs. The savings are calculated as the reduction of costs to the healthcare sector as a result of fewer complications related to babies born with low birth weight and other poor birth outcomes.
Despite strong evidence in favour of the MSG and the South African Law Reform Commission’s own recommendation that poor and vulnerable pregnant women receive financial support in the form of an extension of the Child Support Grant (CSG) into pregnancy, Cabinet has yet to approve a draft MSG policy for public comment – an important step toward implementing the grant.
This worrying delay suggests wavering on the part of the government. If true, it’s worth restating some of the powerful evidence-based arguments that civil society organisations and researchers have advanced in support of the MSG.
#1 It’s not charity – it’s an act of social justice
First, there is the social justice and gender equity argument that the MSG is a small recognition of women’s unpaid care work.
Roughly half of South Africa’s population live below the upper-bound poverty line of R55 per day. For women living in poverty, this grant is a lifeline of economic agency that would allow them to buy food to nourish their bodies and that of their unborn babies. They can use it to pay for a taxi or train to their nearest clinic for check-ups, buy electricity, or stock up on nappies.
When cash transfers to pregnant women were implemented in a small-scale study, the recipients’ spending patterns showed they put the needs of their families first. During the Covid-19 lockdown between 2020 and 2021, a study aimed at 2 775 pregnant women in the Western Cape found that those who received digital vouchers reported improvements in maternal hunger and mental health. They largely used the vouchers to buy food, electricity and stuff for their babies. These findings correlate with other studies that showed income support for pregnant women improved their nutritional status and their ability to regularly access antenatal care.
#2 The economic and public health case
Second, there is the economic and public health argument. Those among us who need an economic rationale to justify social spending on our country’s poor (as if being one of the most unequal countries in the world isn’t reason enough) would be happy to know that the MSG makes economic sense while reducing public healthcare costs associated with poor birth outcomes.
Healthier pregnancies lead to fewer instances of low birth weight and chronic malnutrition in children which lowers government’s healthcare expenses. By providing critical financial relief during pregnancy, the grant enables households to meet essential needs, boosting their purchasing power and stimulating economic activity.
Accessing a grant during pregnancy also increases the likelihood that mothers will access a CSG when their children are born unlike current trends which show that uptake of the CSG is low among infants under 12 months old. The CSG has been shown to improve child health and growth outcomes when accessed early, particularly in the first two years of life. Improved maternal and child health strengthens workforce participation and productivity, creating long-term benefits for both families and the economy.
#3 The case for breaking cycles of poverty
The third argument takes a holistic view of pregnancy in the context of generational cycles of poverty and inequality. Good child nutrition starts in the womb which is why we need healthy pregnancies to drive down chronic malnutrition in children at a critical stage when their brains are growing the fastest. Young children need nutritious food – rich in protein – to power their brains to learn and develop the skills they need to do well at school and the world of work.
The MSG is a powerful tool for breaking cycles of poverty by targeting the first 1 000 days of a child’s life, a period critical for 80% of brain development. Currently, nearly a third of children under the age of 5 are stunted (the result of chronic malnutrition) which has lifelong consequences for their health, learning, and earning potential. By ensuring proper nutrition and care during this window, the grant lays the foundation for healthier, more capable future generations with higher income-earning potential. Healthier children are more likely to succeed in school, potentially reducing the need for grade repetition and costly special education programmes, leading to further long-term savings. By investing early, the grant not only improves individual life outcomes but also contributes to a more skilled and productive society.
Taken individually or together, these are powerful reasons for the government to greenlight the MSG without further delay.
Rahima Essop is the Communications Director of the DG Murray Trust (DGMT). DGMT is part of the MSG Advocacy Coalition.
The Sowetan originally published this op-ed on 25 February 2025. Access it here.
