‘We are literally taking food out of the mouths of babes’

At the start of Child Protection Week (CPW) 2021, which runs from 30 May to 6 June, the Children’s Institute (CI), based at the University of Cape Town (UCT), wrote about the impact of government’s cuts to the Child Support Grant (CSG) and early childhood development (ECD) services.

Sunday [30 May] heralded the start of this year’s CPW. During the 2020 campaign, the Minister of Social Development called on the nation to work together to “protect children during COVID-19 and beyond”. This past year has been especially challenging for parents and caregivers who needed to keep their children safe and stimulated in unusually difficult circumstances, including long periods when schools were closed. But in a time of continuing crisis when families need extra support, we see the state cutting back, especially when it comes to families with young children.

“Critical support systems to help struggling families and vulnerable children have been eroded.”

President Cyril Ramaphosa has repeatedly promised to tackle violence against women and children and recently emphasised that childhood nutrition is central to national plans to rebuild the economy. After a year in which millions of households were thrust into desperate poverty and children suffered the effects of food insecurity, came a shock decision to limit the CSG increase to just R10. However, government has targeted social grants for budget cuts and allowed them to fall behind food price inflation. ECD services have also fallen victim to budget cuts, alongside impossibly stringent registration requirements, and many have been forced to close altogether. These critical support systems to help struggling families and vulnerable children have been eroded.

COVID-19 has led to loss of employment, less household income and growing food insecurity. Apart from the risk of the virus itself, lockdown has entrapped many households in overcrowded and cramped conditions, further compromising physical and mental health and putting children and their caregivers at risk. Also, reducing the value of the CSG in relation to the food poverty line increases the strain and anxiety caregivers feel and is likely to result in more physical and emotional violence and mental health problems. Reducing access to ECD services increases the burden of care on women and deprives parents of access to violence prevention programmes, a key component in breaking the ongoing cycle of violence in the home.

Violence prevention

The Birth to Twenty Plus study provides us with harrowing insights into violence in the lives of children over a course of more than 20 years. This study found that 99% of children in this birth cohort had experienced or witnessed some form of violence and that nearly half of preschool-aged children were reported to have experienced physical punishment by parents or caregivers, and that physical punishment is often used as a method of discipline. But one of the authors of the study is worried about more severe forms of violence.

“Infanticide (the killing of a newborn infant) is emerging as a hidden problem through data collected from the Child Death Review project and pointing to the urgent need to support pregnant women as part of our violence prevention response,” said Professor Shanaaz Mathews, director of the CI.

Nearly half (45%) of all child homicides are associated with child abuse and neglect and nearly three-quarters (74%) of these child abuse deaths were in the under-five age group and occur in the home.

There are multiple drivers of violence against children which are interrelated, for example. Social norms, patriarchy, and past experiences shape how parents discipline their children and resolve conflict. But structural factors such as poverty, overcrowding, and food insecurity are also major contributors. In addition, depression during pregnancy and postnatally is concerning.

Community-based studies indicate antenatal depression rates as high as 47% in South Africa with limited access to community mental health services. Postnatal depression is underdiagnosed and can further drive problems such as infanticide and poor infant-parent bonding. Pregnant women are not exempt from gender-based violence, and some studies show an increase in violence during pregnancy. All these factors have been exacerbated during lockdown.

“Exposure to ongoing violence is especially damaging during the first 1000 days of life,” said Lizette Berry, senior researcher at the CI. “The impact of excessive physical and psychological stress or trauma, also known as toxic stress, can disrupt the development of the brain architecture, which may result in lifelong consequences.”

Studies from South Africa and elsewhere show that male children who experienced violent discipline or other maltreatment during childhood are more likely to be violent towards their children and partners in adulthood. For girls, experiences of abuse during childhood increase the risk of becoming a victim of intimate partner violence. Experiences of intimate partner violence, in turn, increase the risk of women using corporal punishment against their children. It is therefore critical to intervene early and support children and families to break this intergenerational cycle of violence. This is why government has a responsibility to ensure that violence prevention programmes are introduced as early as possible to break this intergenerational cycle of violence. Now is not the time to cut back.

Importance of ECD

Intervention with parents (both men and women) of young children has the potential to disrupt cycles of violence, minimising the risk for young children and their caregivers. The most effective ECD programmes reach children and families early, address multiple risk factors, and are integrated across multiple platforms/disciplines.

From other countries on the continent, we are learning that couples’ programmes with expectant fathers and mothers can promote men’s engagement in maternal and child health, caregiving and prevent intimate partner violence and women’s use of harsh physical punishment of children. 

“Good parenting programmes have demonstrated a reduction in violence and harsh parenting.”

Parenting programmes and support for parents is therefore important to enhance their understanding of their child’s development, behaviours and hones their skills for responding positively and in nurturing ways. Good parenting programmes have demonstrated a reduction in violence and harsh parenting – it, therefore, is a powerful tool to prevent violence against children.

As young children enter out-of-home places of learning, childcare and ECD programmes should be safe spaces, where non-violent methods of resolving conflict are taught and modelled, and positive strategies for behaviour management are promoted. However, the provision of ECD programmes is largely informal, under-funded and the COVID-19 pandemic has exacerbated the fragility of the sector. Large numbers of programmes, serving poor communities, are unable to register to enable their access to government’s partial subsidy. Civil society presentations at the Children’s Amendment Bill (CAB) hearings called for a comprehensive review of the CAB, to minimise the barriers to programme registration and enable greater reach of the subsidy to the most vulnerable communities.   

Backwards step

Dr Katharine Hall, senior researcher at the CI, explained to the Standing Committee on Appropriations last week: “The CSG was already below the food poverty line – it couldn’t provide a child with adequate nutrition. Yet in nominal terms, this is the smallest increase that the CSG has received in the past six years (since 2015). In relative terms, this is the first time since its introduction that the value of the CSG will fall relative to food price inflation.”

The grant buys even less food this year than it did last year. Along with the rise in unemployment and poverty, food prices increased (by as much as 9.8% for the period February 2020 to February 2021, according to the PMB Household Affordability Index).

Between May and October 2020, caregivers received additional payments on top of the CSG as part of the disaster relief package to help mitigate against the hardship caused by the lockdown. The NIDS-CRAM recorded that child hunger rates increased after the grant top-ups and caregiver grant were discontinued.

“The real-world cuts to the CSG are a backwards step,” warned Paula Proudlock, senior legal researcher at the CI. “The United Nations Committee’s General Comment 19 on budgeting makes it clear that states should not take regressive measures in relation to socio-economic rights, and the South African courts have reminded the government that they need to put children first.”

Experts from the CI and the Centre for Child Law called on Parliament to review grant allocation and reminded the Appropriations Committee of the High Court’s ruling that “even in times of economic crisis, regressive measures may only be considered after assessing all other options and ensuring that children are the last to be affected, especially those in vulnerable situations.” 

The Minister of Social Development has acknowledged the inequity in the grant structure and that the CSG is the only grant below the food poverty line.

‘Tip of the iceberg’

According to CI communication and education specialist Lori Lake, “child malnutrition is a form of ‘slow violence’ that systematically destroys a child’s developing body and brain, damaging their health, education and employment prospects.”

Even before the start of the COVID-19 pandemic, malnutrition was a problem. A third of children lived in households below the food poverty line, that cannot afford to buy enough food to meet their minimum daily energy requirements, let alone providing their children with a diverse nutrient-rich diet needed to promote optimal development. It is therefore not surprising that a quarter (27%) of young children are stunted – a sign of chronic malnutrition, which stunts children’s physical growth and cognitive development. These stunting rates are very high for a middle-income country and have remained stubbornly unchanged for the last 20 years.

Rising unemployment coupled with rising food prices has pushed households even deeper into poverty. By February/March 2021, one in seven households reported that a child went to bed hungry in the week before the survey. This is nearly double pre-pandemic levels and beneficiaries of the CSG were most likely to run out of money for food. Yet, child hunger is just the tip of the iceberg.

“Rising insecurity is fuelling an increase in domestic violence and common mental disorders.”

As families attempt to shield their children from hunger by eating less and purchasing cheaper, less nutritious meals, these empty calories are likely to further exacerbate South Africa’s already high rates of stunting, micronutrient deficiencies and obesity.

At the same time, rising insecurity is fuelling an increase in domestic violence and common mental disorders, that further compromise the care and protection of children. While the disruption of routine healthcare services has made it harder to identify and support children at risk of malnutrition, experts are predicting a 14% increase in the global prevalence of moderate and severe acute malnutrition which are associated with 50% of child hospital deaths in South Africa. It is therefore vital that the state take decisive action to address these immediate threats to children’s health, survival and development. 

Child rights advocates and health professionals have been advocating to increase the CSG to the food poverty line — about R585. This would provide a vital lifeline to families living in extreme poverty, but instead of decreasing the gap between the grant and the food poverty line, the current allocation has resulted in a widening of the gap. 

Reducing value ‘unconscionable’

South Africa’s children are least impacted by the direct physical effects of COVID-19 but they are battling two epidemics: violence and hunger.

The ongoing economic fallout from the pandemic is eroding the capacity of families to look after their children. In this situation, it is unconscionable that we are reducing the real value of the CSG; we are literally taking food out of the mouths of babes. Time and again, studies have shown that investment in ECD has positive effects on the development of individual children that result in long-term sustained boosts to the economy. Yet, subsidies have been cut and many programmes are struggling to keep their doors open.

The effects of malnutrition and increased exposure to violence last a lifetime and perpetuate eternal vicious cycles of inequality, poverty, and pain. We cannot put measures to prevent violence and malnutrition on the back burner waiting for the health pandemic to abate. We must give families the support they need now.