Inequities in under-five child nutritional status in South Africa: What progress has been made?

Abstract

Despite the emphasis given to poverty reduction in policy statements and a substantial increase in social spending, money-metric poverty has shown little improvement since South Africa's transition to democracy in 1994. Alternative approaches to measuring well-being and inequality may show a more positive trend. This article uses the 2008 National Income Dynamics Study to assess the magnitude of inequalities in under-five child malnutrition ascribable to economic status. The article compares these results with those of Zere and McIntyre, who analysed similar data collected in 1993. In both cases, household income, proxied by per-capita household expenditure, was used as the indicator of socio-economic status. Children's heights and weights have increased since 1993 and being stunted or underweight has become less common. Furthermore, pro-rich inequalities in stunting and being underweight have significantly declined since the end of apartheid. This suggests that pro-poor improvements in child welfare have taken place. Policies that may have contributed to this include the Child Support Grant, introduced in 1998, and improvements in healthcare and the education of women.

Keywords:

• nutrition
• anthropometry
• children
• health inequalities
• South Africa

Acknowledgements

This article was produced with financial support from the Programme to Support Pro-Poor Policy Development, a partnership of the Presidency, Republic of South Africa and the Delegation of the European Union, and from the UK Economic and Social Research Council (grant number RES–238–25–0030). The contents of the article can in no circumstances be regarded as reflecting the position of the European Union.

Notes

³A second wave of the NIDS was collected in 2010 and released in March 2012. As with most panel data, NIDS Wave 2 is not necessarily representative of the South African population and these data are not used in this article. Our measures of children's ages and their mothers' schooling, however, do make use of information collected in Wave 2 about a number of children for whom the Wave 1 data are deficient.

⁴The recommended post-stratified weights are used for both surveys (Wittenberg, 2009).

⁵The sample size for some population groups, notably Asian/Indian and White, is too small to report on disaggregated results. We provide this information in the figures for completeness but do not interpret these findings.

⁶Household and child poverty trends are more optimistic when income is used as the indicator of well-being. This is noted by Hall & Wright (2010), who reports a significant decline in child poverty using the General Household Survey. In line with most international literature adopting money-metric measurements of poverty, we retain expenditure as our preferred indicator.

⁷To further assess whether failure to measure the heights and weights of more than one-third of the children has biased our results, we also fitted Heckman selection probit regressions to these data, using interviewer number as an additional predictor of non-response in order to identify the models (results not shown). These models did not yield any evidence that the unadjusted results are biased and supported substantive conclusions that are virtually identical to those we reach on the basis of the models presented in Table 3.

⁸No evidence exists that the income and housing variables are related to children's nutritional outcomes even if the consumer durable score is left out of the regression model. Although they are correlated, these variables measure different aspects of a household's economic circumstances.