Regional inequalities in single orphanhood, child nutrition and social protection in South Africa: a spatial econometric approach

Abstract

Abstract Background: Orphanhood and parental absence are both associated with a range of childhood socioeconomic disadvantages. However, their separate effects on child health are not adequately understood. Absence limits parents’ psychosocial investment in children. In the case of orphans, reduced resource flows to children add an additional layer to the disadvantage. Social protection and extended family networks can compensate for material and psychosocial disadvantages. This paper studies the case of South Africa, where high rates of parental absence, orphanhood and child stunting co-exist. These disadvantages are geographically concentrated in the former homelands, impoverished areas affected by a range of apartheid-era discriminatory legislation. Homelands households typically form around the elderly who take care of children on behalf of absent migrant worker parents, or who adopt orphaned children. Methods: This paper firstly maps the geography of single orphanhood and child nutrition, establishing whether various disadvantages are concentrated in the same regions. Spatial econometric models accounting for regional spill-over are used to estimate associations between child nutrition, parental absence, orphanhood, state support and household resources. Results: There are strong overlapping regional inequalities in child nutrition and orphanhood. Disadvantages are concentrated in former homelands. Father absence and paternal orphanhood rates have similar positive associations with local stunting rates. Household resources and access to social services do not moderate this association. By contrast, maternal absence and maternal orphanhood are insignificantly correlated with stunting. However, maternal absence is negatively correlated with child underweight. Conclusions: Father presence is more strongly associated with child outcomes than material resources, suggesting that fathers also make non-material or psychosocial contributions to child health. Maternal absence and orphanhood rates have smaller associations with chronic health outcomes. In fact, our results support the hypothesis that absent working mothers who migrate to urban areas remit incomes to benefit the acute nutrition status of children. Addressing regional inequalities in orphanhood and child nutrition requires more than the local expansion of public social safety nets in areas of high vulnerability. Rather, the bigger challenge of addressing father presence will make a large contribution to improving children’s health outcomes.