A recently completed “intervention scan”, conducted by researcher Gareth Haysom for the Nourished Child Project, has uncovered the complex and surprising ways that food interventions connect to the lived realities of women and children in South Africa, writes Ambre Nicholson.
“Walk around any city in the world and a variety of food will be visible,” says Haysom. “But just because it’s there does not mean it is affordable or accessible to citizens.”
In fact, as Haysom explains, many South Africans who live in cities face a double burden of malnutrition: healthy food is expensive and difficult to access while unhealthy food is often cheap and plentiful. This leads to poor health for adults and is especially dangerous for children under the age of five, since nutritious food is essential for healthy development.
“Everyday, all over the world, household food managers are making strategic decisions about nutrition, satiety, food storage and food safety. The majority of household expenses, including school fees, transport and energy costs, are fixed. A household’s food budget however is more variable. This is why food is a powerful lens through which we can glimpse the everyday lived experience of ordinary South Africans.”
It is important to recognise that the decisions we make about what to eat – what we eat, where we get it from and how we prepare it – are deeply influenced by factors such as what kind of dwelling we live in, how far we have to travel to buy food and whether we have access to clean water and affordable energy for cooking.
“Food is a truly transversal issue that spans a range of mandates and appears in many different public policy portfolios. On the face of it, transport policy or spatial planning may not seem to have anything to do with food but in fact the site chosen for a taxi rank or the placement of informal food vendors greatly influences our urban food systems.”
This is the question that Haysom’s research seeks to answer: How do these systems interact with government policies, programmes and services relating to food (what Haysom refers to as nutrition interventions). And, how do these interactions influence the everyday food environments of women and children living in urban settings.
“The idea behind the intervention scan was to map government interventions on a national, provincial and local level to discover how they interact with the food system, health system, urban system (how urban space is managed), social services system (social grants for example) and wider society.”
To begin with, Haysom conducted a broad scan of the intervention landscape, which resulted in the identification of 150 individual policies and programmes and included everything from the National Development Plan to the Road to Health baby booklet given to new moms at public clinics.
“From there we narrowed it down to 39 interventions that were relevant to children under the age of five and pregnant women (including those who might be likely to have children in the near future) who are currently living in our two research sites of Masiphumele and Zweletemba in the Western Cape.”
Learning from the COVID-19 crisis
Haysom is quick to note that the pandemic and resulting lockdown periods of 2020 did not hamper his research directly, thanks to the fact that the vast majority of South Africa’s public policy documents are accessible online.
“However, the COVID-19 crisis has had a number of effects on local food systems, including how many communities feared hunger more than the virus, which raised the awareness of nutrition, as well as how new groups of food focused citizens and activists are interacting with government.”
“For these reasons we decided to add another objective to the intervention scan, to understand how COVID-19 and associated government responses have influenced food systems, urban systems, and the system of existing interventions.”
Making connections, revealing contradictions
According to Haysom, the goal of the intervention scan was never to evaluate the efficacy of nutrition interventions, but rather to identify the ways they connect and sometimes contradict one another.
“These interventions are universally well intentioned. Their aim is to ensure that a five-year-old child growing up in a South African city has access to nutritious food thanks to food gardens and Early Childhood Development Centres, that the child’s caregiver can afford to buy healthy food thanks to a child support grant and that families are more likely to invest in healthy foods thanks to awareness campaigns, while simultaneously finding sugary drinks less attractive due to higher tax.
Nonetheless, the fact that these interventions often exist in policy silos means that gaps and contradictions occur all too easily.
“Take the case of babies in utero,” explains Haysom.
“It is an established fact that adequate nutrition in the first 1000 days of a baby’s existence is integral for healthy brain growth. What is sometimes overlooked is that 25% of this period takes place before a child is born.”
Haysom explains how a pregnant woman may be well supported by interventions within the health system, in the form of anti-natal clinic visits, but that it is likely that the urban system (having to travel long distances to work or not having access to a safe and affordable energy source for cooking) does not support her ability to cook healthy food.
“If you have a three-hour commute, you live in a place where it is not safe to be outdoors after dark and you can’t afford enough electricity for long cooking times you will choose a fast, cheap source of food over a meal with adequate protein that takes longer to prepare.”
This is where the findings of the intervention scan can point the way to future actions that increase coherence across food systems.
Combatting the slow violence of malnutrition
The aim of the Nourished Child Project is to unearth a whole system of actions that will benefit people living in urban settings, both by ensuring that existing interventions are aligned better as well as designing new actions that recognise the challenges people face in their everyday lives.
According to Haysom this is the real value of the interaction scan. Beyond providing an understanding of the current food framework that exists in South Africa, it also points to an important mismatch between our expectations of the state and the way that the state is structured to meet citizen’s needs.
“Many individuals within the state show a real desire to work more transversally but the way that the state response to food is structured can make this very difficult. In many ways state structures still reflect the idea of food and nutrition being only about food production. In the urban context food is never just about production. Food is available but people can’t afford it.”
Haysom believes that while the intervention scan remains a living document and not a final statement, it does pose valuable questions about our expectations of the state and the state’s assumption of its mandate.
I think we need to encourage a different way of tackling these issues. In South Africa we do not have time for endless forums, we need to get nutritious food to a mother who needs to feed her child every three hours. What I think the work of the intervention scan shows is how the components of the system that enables a mother to feed her child can better work together.”