Robyn Bowden

South Africa

Category: written unpublished

Robyn is freelance food systems researcher and consultant. She currently lives in Cape Town but works on various food related projects across South Africa.

She has a masters in Sustainable Development and with a passion for food justice has focused her work on various aspects of the food system. Her work focuses on rural development, urban food security, formal and informal food retail and regenerative farming practices.


Overworked, overweight and undernourished: the burden of South African women

It is 8am on a Monday morning and Nosisa Makaleni is waiting in line at the clinic to check her blood pressure and receive her medication. She now missed work for the second Monday this month, much to her employer’s irritation. Seated and standing in the waiting room, are almost all women. “Previously it was all women,” she states “but more recently children have started coming in too.” The children are suffering from diabetes, while the women are suffering from diabetes, kidney disease, high blood pressure and other heart related diseases.

South Africa suffers from some of the highest obesity rates globally, and is experiencing a steady increase in non-communicable diseases linked to poor diets [1]. Almost seventy percent of women are overweight or obese, and around thirty percent of men [2]. Conventional wisdom states that with better consumer decision-making and nutritional education people will switch to healthier diets. The reality is that most are not able to. With the responsibility of providing nutritional meals falling predominately on women in South Africa, they are disproportionally feeling the effects of poor diets.

Despite Makaleni’s medication, high blood pressure leaves her tired. She struggles with her labour-intensive job as a domestic worker. Her employer complains that she is lazy, and with no formal employment contract, Makaleni is nervous she will lose another job. Suffering from obesity, high blood pressure and diabetes Makaleni only works twice a week due to poor health. “If I run out of food,” she states “I cannot ask my neighbours, as they will tell me I am lazy and I need to work more days.” Makaleni is anything but lazy, like many other women in Africa she provides food for her entire family and does the unpaid care work of the household.

So why does Makaleni not simply eat a healthier diet?

Globally, urbanisation has coincided with a change in diets from micronutrient-rich whole foods, complex carbohydrates, fruits and vegetables to a diet consisting of more processed foods, fats and animal-derived foods [3]. This dietary change is resulting in the steady increase of non-communicable diseases and obesity. Most people in Africa are predicted to live in cities by 2050 as a result of ongoing mass urbanisation. The majority of which will live in densely populated slums that lack adequate housing, sanitation and other vital services necessary to store and prepare food [4]. With this transformation, further dietary change can be expected, making urban food security and health one of the biggest development challenges facing Africa.

“I used to garden” Ntombikayisa Hela says “I would help my mother grow vegetables in the Eastern Cape but it is too difficult to grow food here in the city.” Hela now lives in a two-roomed shack made out of corrugated iron. The home is in a densely packed neighbourhood with only enough space for a single person to walk between the houses. Growing food with this limited space is not an option. Adding to this, the soil quality is poor and water is difficult to access for household use, let alone irrigation. Thus the only way Hela can access food is through purchasing it at the supermarkets and informal traders in her area - not an easy feat on the meagre income she is able to pool through informal work.

Purchasing food is not the only challenge for Hela, she also struggles to afford the gas necessary to cook it. “Sometimes it is cheaper for me to buy food at the street traders than prepare it at home” Hela says. Though it may be cheaper, this food comes with high health costs. Most of the foods she can afford are either packaged and heavily processed goods such as chips, sweets and soft drinks or premade meals of processed meats on white breads. One commonly eaten bread is a deep fried ball of dough called a ‘vetkoek’, an Afrikaans word that ironically translates to ‘fat cake’.

The high sugar content in these sweets and soft drinks help Hela and her children acquire the energy necessary to get through the day, while the white bread satiates, relieving the feeling of hunger. But these are short-term solutions, and as the name ‘vetkoek’ suggests, place Hela and her family at risk of health issues such as diabetes and obesity.

Having to support her three young children, Hela often goes hungry to ensure that the little food there is, goes to her children. She has no steady income and earns money doing her neighbours’ washing when asked. “People here cannot always pay me” Hela says “if they do not pay me that day, we will not eat.” Hela is desperately seeking a job, but with almost a third of South Africans unemployed, the majority of which are women, it is unlikely she will find one soon [5].

Food security interventions in Africa focus predominately on addressing this challenge by increasing food production. Yet South Africa generally produces enough food to feed its entire population a nutritious diet. The challenge is therefore less about the quantity of food produced but rather access to food with high nutritional quality.

Makaleni and Hela buy the majority of their food at Shoprite, one of South Africa’s five leading supermarket chains. A handful of corporations control food processing and retail in South Africa and as a result, the sector is highly concentrated. With little competition, these corporations are able to dictate the prices and quality of food sold - often to the detriment of the consumer.

Originally, supermarkets focused their attention on capitalising on higher-end markets. But over the last twenty years there has been a steady increase of supermarkets in lower income areas [6], bringing with them more processed less nutritious foods. While two supermarkets focus on lower income markets, none specifically target the abject poor. As a result, women like, Hela are out of the focus of these key food gatekeepers.  

According to an annual report, the monthly spending of lower income households on food is less than half of what is required to get the minimum nutrition needed for a healthy life (R1 912.89 vs.  R4 124.77 for a household of seven) [7]. A key reason for this is that household budgets are split between food and non-food essential expenses. Makaleni has to pay a set amount for energy, transport and debt repayments. The only way she can save money is through buying less or lower quality foods. For this reason, food is the first expense to be reduced in times of economic struggles. With more than half of South Africans living in poverty, this compromise is commonplace [8].

“I have to buy most of my food at the beginning of the month” Makaleni says, “if I don’t then other expenses will come up and I will not be able to put food on the table.” Makaleni does not own or have access to a fridge, and so is forced to only buy foods that will not perish. Once a month she buys Maize meal, white rice, flour, sugar and cooking oil in bulk and uses them sparingly throughout the month. If she is able to acquire more income she will buy other foods, but the majority of her household’s diet is made up of these caloric dense foods.  While they may be able to prevent the pangs of hunger, they lack the nutrients to ensure health and wellbeing.

Makaleni’s doctor stresses that she must eat more fruit, vegetables and fish. The reality is that after feeding her family of five she cannot afford such luxuries for herself. Like many other women in her situation she is the first to forgo nutritional meals to ensure that the rest of her household is fed. This is why women are lining up at the clinics in South Africa. They are the mothers and wives who are burdened with the impossible task of putting food in the pot - a task that is costing them their lives.

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