Exploring the impact of a maternal support grant to improve mental health and food security amongst pregnant women in South Africa during the COVID-19 pandemic

Social protection during pregnancy may support pregnant women struggling to meet basic needs to ensure a healthy pregnancy and buffer negative impacts of multiple adversities. We assessed the effect of a bimonthly digital food voucher, delivered to pregnant women during the COVID-19 pandemic in the Cape Town area, on their mental health, hunger, and dietary diversity. Pregnant women from antenatal clinics in specific high-poverty areas were invited to join the voucher program; a subset was recruited for in-depth telephone interviews. Interviews were conducted before, during, and after voucher distribution. Generalized estimating equations were fit to examine whether each outcome was associated with voucher exposure over time. Of the 205 participants, most were aged 25-34, not recently employed, with at least one child in their household. Approximately 1/3 were first-time mothers and 32% reported mental health difficulties. Voucher exposure over 12 months was associated with significant reductions in mental health symptoms at midline and endline. Maternal hunger was reduced at midline and endline. High mental health scores were significantly associated with increased maternal hunger after adjusting for potential confounders. This study provides preliminary evidence for income support during pregnancy to shape positive health outcomes in South Africa.