EAJPHR, VOL. 20, No. 2 (December 2014)

414 East African Journal of Peace & Human Rights [Vol 20:2

THE ROLE OF GRANDMOTHERS AS THE PRIMARYCAREGIVERS IN POOR HOUSEHOLDS AND THEIR

OWN RIGHT TO ADEQUATE FOOD: EXAMINING TWOCOMMUNITIES IN THE BREEDE VALLEY, WESTERN

CAPE PROVINCE, SOUTH AFRICAK.T. Rendal,** W.B.Eide,** M.L. Marais*** & P. O. Iversen****

ABSTRACT

South Africa’s elderly are experiencing serious challenges affectinghousehold food security. There are concerns about their use of the olderpersons grant regarding their right to adequate food. The aim of this studywas to understand if and how the role of grandmothers as primary caregiversin poor households living in two communities in the Western Cape Provinceof South Africa, affected the realization of their own right to adequate food. The grandmothers were the primary caregivers in the households and theirgrant money could not facilitate them meet their basic needs. Theirrealization of the right to adequate food was greatly affected by living withgrandchildren. They reported sacrificing their own basic needs includingfood, to feed their grandchildren. Living with grandchildren was the biggestconstraint to their access to adequate food for themselves and was identifiedas a major barrier to realizing their right to food and nutrition.

I. INTRODUCTION

According to the World Health Organization (WHO), the global number of people aged

* Master of Science in Nutrition, Institute for Basic Medical Sciences, Department of Nutrition,University of Oslo, Oslo, Norway. E-mail: <[email protected]>.

**. Associate Professor, Institute for Basic Medical Sciences, Department of Nutrition,University of Oslo, Norway. E-mail: <[email protected]>.

***. Senior Lecturer, Division of Human Nutrition, Faculty of Medicine and Health Sciences,Stellenbosch University, South Africa. E-mail: <[email protected]>.

****. Professor, Institute for Basic Medical Sciences, Department of Nutrition, University ofOslo, Norway and Division of Human Nutrition, Faculty of Health Sciences, Stellenbosch University,South Africa. E-mail: <[email protected]>.

2014] Grandmothers and the Right to Food in the Western Cape of S. Africa 415

65 and above increases annually at a rate of 2.7%.1 Most developed world countrieshave accepted the chronological age of 65 years as a definition of 'elderly' or olderperson, but like many westernized concepts, this does not adapt well to the situation inAfrica.

While the above definition is somewhat arbitrary, it is many times associatedwith the age at which one can begin to receive pension benefits. At the moment, thereis no United Nations (UN) standard numerical criterion, but the UN agreed cutoff is 60+years to refer to the older population. Almost 700 million people in the world today areaged 60 and above, and it is estimated that there will be more persons at that age thanchildren in the world by 2050 (more than one in five of the world’s population will beaged 60 years or older).2 The increase in the number of older people will be the greatestand the most rapid in the developing world, with Asia as the region with the largestnumber of older persons, and Africa facing the largest proportionate growth.3

The Advisory Committee to the UN Human Rights Council has recognized thatproblems of the elderly are very important and neglected throughout the world. In its2009 session, members pointed to millions of elderly people across the world facingunequal treatment or denial of basic rights, specifically in terms of chronic poverty,violence and abuse, lack of education, little or no access to the law, and exclusion fromsocial and political participation. The Committee advised the Council to bring forwardthe human rights of elderly people in an integrated manner in the work of the UNhuman rights mechanisms and highlighting the issues of responsibility andaccountability were most compellingly needed at the moment.4

A 2011 report of the UN Secretary-General to the UN General Assemblyexamined the human rights challenges and trends presented by populations ageing fasterthan at any other time in history.5 The report stressed that persons aged 60 and above

1. WHO, World Health Report (2013), Executive Summary, at 5. Health of the Elderly, retrievedfrom <http://www.who.int/whr/1995/media_centre/executive_summary1/en/index4.html>, (accessed 14November 2013).

2. UN Secretary-General, Follow-up to the Second World Assembly on Ageing. Report of theSecretary-General to the General Assembly, 22 July 2011, Paras. 3 and 4. U.N.Doc, A/66/173.<http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/428/83/PDF/N1142883.pdf?OpenElement>(Accessed 10 June 2014). See also <http://www.who.int/healthinfo/survey/ageingdefnolder/en/>.

3. Report of the Secretary-General to the General Assembly, id., para. 4.4. Office of the High Commissioner for Human Rights (OHCHR), Human Rights Council

Advisory Committee Adopts its Rules of Procedure and Closes Debate on the Right to Food. See especiallyi n t e r v e n t i o n b y A d v i s o r y C o m m i t t e e E x p e r t M s . C h i n s u n g C h u n g ,<http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=8696&LangID=E> , 6 August2009 (accessed August 2nd 2012).

5. Report of the Secretary-General to the General Assembly, supra note 2.


face diverse challenges depending on their context, but also that there are a number ofclearly identifiable challenges which require strategies at the national and global levels. It lists four broad categories: discrimination, violence and abuse, and lack of specificmeasures and services. Poverty is the single most pressing challenge to the welfare ofolder persons.

Poverty is characterized by homelessness, malnutrition, unattended chronicdiseases, lack of access to safe drinking water and sanitation, unaffordable medicinesand treatments and income insecurity. Despite their own poverty, older persons areoften the main providers for the household and the primary caregivers for grandchildrenand other family members. The report emphasizes that all of these questions should beviewed through a human rights prism, in developed and developing countries alike.

While it is encouraging that the suffering of older women receives growingattention in society, it is also recognized that a lot needs to be done to protect theirrights. This article brings to light the situation of a group of grandmothers in SouthAfrica and their right to adequate food. Very little research has been done withemphasis on grandmothers and their rights. There is reason to believe that many ofthem are not able to enjoy their own basic needs to food, health and care, due to povertyand their role as head of the households having to provide for both children andgrandchildren. The study on which the article is based explored the challenges theyface in light of general poverty and the role of social grants in South Africa, aimed atchildren and elderly people.

II. ELDERLY WOMEN AND POVERTY IN SOUTH AFRICA

In general, women in peri-urban and rural areas of South Africa are most often theprimary caregivers of the children, and thus prevented from working and earning anincome compared to their male counterparts. In turn, lack of money precludes themfrom buying food, and in rural areas they have to produce food for themselves throughsubsidized farming. This is challenging, as they cannot afford to pay for land, seeds,fertilizers or water.6 The women are also more vulnerable than men to interpersonaland domestic violence, emotional and alcohol abuse, illiteracy, malnutrition andpesticide exposures, all of which worsen their quality of life.7

Moreover, the discrimination continues as they get older. As the women age,

6. E. Lahiff, Land Rights, in SOCIO-ECONOMIC RIGHTS IN SOUTH AFRICA (S. Khoza ed., 2007),at 200-201.

7. Y. BOWERS, ET AL. OBSTACLES TO THE RIGHTS OF ACCESS TO HEALTH CARE FOR FARM WORKER

WOMEN IN THE WESTERN CAPE (2009).


they usually outlive the men and are then faced with an even bigger challenge, namelyto provide for their families without the means necessary for doing so due to lack ofnecessary skills and opportunities to earn an income.8 Additionally, research has shownthat according to many African cultures, relatives (specifically grandmothers) areobliged to cope with the care of orphans when parents die at a young age, especiallyfrom HIV/AIDS.9 Families that are affected by this disease are often caretakers forterminally ill mothers, and their children remain as part of the household after her death. In large households, grandmothers often look after both their children, grandchildrenand even their own parents, leaving them in great despair.

Since the end of apartheid in 1994, the South African Government has useddifferent approaches to address poverty and inequality including social protection in theform of governmental grants, which has proven to reduce the poverty rates and provideprogressive realization of the right to food.10 The social grants are financed through taxrevenue; the Child Support Grant (CSG) and the Old Persons Grant (OPG) are thelargest in scale.11

In 2008 and 2009, the number of beneficiaries of the CSG was 9 million, whilethe OPG had 2 million recipients.12 Some households are not benefitting from the CSGdespite eligibility, and the pensions tend to be shared among the members of often largehouseholds where the pensioners are the primary caregivers. Lack of institutionalintegration and requirements for identity documents are preventing some groups of thepoor from accessing the grants, rural population being especially vulnerable to thisexclusion.13 The fact that people who are eligible for social grants in practice receivevery little or nothing at all, is of major concern.14 The applicable grants, their amountsand eligibility criteria are summarized in Table 1 below.

8. Report of the Secretary-General to the General Assembly, supra note 2.9. B.M. Mayosi, A.J. Flischer, U.G. Lalloo, F. Sitas, S.M. Tollmann & D. Bradshaw, The

burden of non-communicable diseases in South Africa. 374 LANCET (2009), at 9.10. J. HAGEN-ZANKER & J. MORGAN, SOUTH AFRICA’S CASH SOCIAL SECURITY

GRANTS: PROGRESS IN INCREASING COVERAGE. OVERSEAS DEVELOPMENT INSTITUTE(ODI); M. LEIBBRANDT, I. WOOLARD, A. FINN & J. ARGENT, TRENDS IN SOUTH AFRICAN INCOME

DISTRIBUTION AND POVERTY SINCE THE FALL OF APARTHEID. OECD SOCIAL, EMPLOYMENT AND

MIGRATIONWORKING PAPERS, NO. 101.11. M. LEIBBRANDT et al, id.12. Report of the Secretary-General to the General, supra note 2; South African Social Security

Agency (SASSA). 2008/09 Annual Report, retrieved from <http://www.pmg.org.za/report/20100216-south-african-social-security-agency-sassa-annual-report-200809> (accessed 14 November 2013).

13. Report of the Secretary-General to the General, supra note 2.14. Lahiff, supra note 6.


A. Human Rights Focus on the Food Security Situation of Grandmothers

The socioeconomic factors regarding food and nutrition in South Africa appear to becontradictory.15 While the national food supply is adequate, the country is still facedwith challenges regarding malnutrition, hunger and food insecurity.16 Moreover,although the per capita income is high compared to other developing countries, theincome is not equally distributed. As a result, the poor are prevented from accessingthe available food.17

The human right to adequate food is recognized in the Universal Declarationof Human Rights, 1948 (UDHR, Article 25) and further elaborated in the InternationalCovenant on Economic, Social and Cultural Rights (ICESCR, Article 11.1 and 2). Yet,the understanding of these and other socio-economic rights is often unclear when itcomes to the corresponding obligations. The broader content of the right to adequatefood was clarified through interdisciplinary conceptualisation and research,18 and civilsociety engagement19 basically between the 1980s and 1990s. This prepared the groundfor the standing official interpretation of this right in General Comment No.12 on theRight to food by the UN Committee on Economic, Social and Cultural Rights (CESCR)in 1999,20 followed by General Comment No.14 on the right to health in 200021 and

15. E.M. Maunder, S. Khoza, P. Kuzwayo, W.B. Eide, A rights-based approach to communitynutrition in South Africa, in COMMUNITY NUTRITION TEXTBOOK FOR SOUTH AFRICA: A RIGHTS-BASED

APPROACH (N.P. Steyn & N. Temple eds., 2008), at 2, 27.16. M. de Klerk et al. Food Security in South Africa: key policy issues for the medium term.

Human Sciences Research Council.17. Id. See also OHCHR, supra note 5.18. A. EIDE, W.B. EIDE, S. GOONATILAKE & J. GUSSOW OMAWALE (EDS.) FOOD AS A HUMAN RIGHT

(UNITED NATIONS UNIVERSITY PRESS, 1984); K. TOMASEVSKI & P. ALSTON (EDS.) THE RIGHT TO FOOD.NETHERLANDS INSTITUTE OF HUMAN RIGHTS (SIM), MARTINUS NIJHOFF PUBLISHERS, UTRECHT. 1984; UNSub-Commission on the Promotion and Protection of Human Rights. The right to adequate food as ahuman right. Final Report by Asbjørn Eide. UN doc. E/CN.4/Sub.2/2987/23 subsequently published in1989 as UN Human Rights Studiy Series No.1, Geneva and New York. 1989; A. Oshaug, W.B. Eide &A. Eide, Human Rights: A Normative Basis for Food and Nutrition-Relevant Policies, 19 FOOD POLICY

(1994), 491–516.19. See for example M. Windfuhr, Experiences from case related right to food work: lessons

learned for implementation, in W.B. Eide & U. Kracht (eds.) Food and human rights in development. Vol.II Evolving issues and emerging applications. Antwerpen-Oxford, Intersentia. Ch.13, at 351-358. 2007.

20. CESCR (UN Committee on Economic, Social and Cultural Rights). General Comment No.12: The Right to Adequate Food (Art. 11 of the International Covenant on Economic, Social and CulturalRights). May 12, 1999.

21. CESCR, General Comment No. 14: The right to the highest attainable standard of health(Art. 12 of the International Covenant on Economic, Social and Cultural Rights). August 11, 2000.


No.15 on the right to water in 200322 elaborated within a similar conceptual framework.While the South African Government has still not ratified the ICESCR, its

commitment to food and nutrition is strongly reflected in the Constitution of SouthAfrica. Article 27 of the Bill of Rights guarantees the right of all people of SouthAfrica to health care, food, water and social security.23 In practical terms, it means thatthe Government is obligated to ensure that nutrition security (incorporating security offood, health and care) is respected, protected, promoted and fulfilled as a basic humanright.24

As the Government is also committed to social protection for the needy throughthe provision of social grants listed above, it is of interest to see these in relation to thepossible contribution of these grants to the right to food of the recipients. This articleis an input to understanding the links between the two as regards poor grandmothers incharge of supporting and feeding their grandchildren. It is a qualitative study with apartial human rights based approach also to its conduct, seeking selected poorgrandmothers’ own perceptions of their situation by having them talk and shareexperiences in a participatory manner in focus groups.

III. RESEARCH METHODOLOGY

A. Study Area

Two communities in the Breede Valley, Western Cape were used as research sites:Zweletemba and Avian Park in the Worcester area, with 35 000 and 10 000 residents,respectively.25 In Zweletemba, the unemployment rate is approximately 32% and themajority of the residents have either some primary or secondary schooling. In AvianPark, the unemployment rate is about 21%, and the majority of residents have somesecondary schooling. Both communities include both formal and informal housing. Tuberculosis and HIV/AIDS rates are high, as is the prevalence of babies born with lowbirth weight.26

22. CESCR, General Comment No.15: The right to water (Arts. 11 and 12 of the InternationalCovenant on Economic, Social and Cultural Rights). 2002.

23. See http://www.who.int/healthinfo/survey/ageingdefnolder/en/.24. Report of the Secretary-General to the General, supra note 2 3.25. Breede Valley Municipality, Integrated Development Plan 2007-2011, retrieved from

<http://www.westerncape.gov.za/text/2008/3/idp_cw_breede_river_winelands_2007.pdf> (accessed 14November 2013).

26. Id.


B. Study Participants

The participating grandmothers to be recruited had to satisfy the following inclusioncriteria: They were required to be living in Zweletemba or Avian Park for more than 3days a week in the same household with at least one grandchild, supporting thegrandchildren financially, and who spoke any of the following local languages:Afrikaans, English or isiXhosa.

Due to the high expenses and limited logistics of the study, the sample size waslimited to 40 grandmothers. Participants were stratified according to age and location(Zweletemba or Avian Park). The participants were divided into eight groups, with atotal of five persons in each group. The participants were divided equally basing onage, i.e. either 60 years and above or below. The age of 60 is the cut-off age for thegrandmothers eligible to receive the OPG and for one to qualify for this grant. Grandmothers were excluded from participating in the study if they were used as keyinformants to recruit participants, or having participated in a pilot study during thepretesting of the various research instruments. The field workers used their socialnetworks to identify potential candidates.

To develop a deeper understanding of grandmothers’ situation, in-depthinterviews were conducted with ten key informants. Some of these were English-speaking government staff whose duties were related to the realization of the right tofood, located in the area of Worcester. They were all identified by the researcher andinvited to participate, and these included: two ministers, one from each of thecommunities (Zweletemba and Avian Park); a member of a church organization inZweletemba; a member of the church/volunteer in the church in Avian Park; aworker at a health clinic in Zweletemba; a worker at the multipurpose communitycenter in Zweletemba; a worker at the municipality in Worcester, located in Avian Park;a worker at social services, family affairs; and two workers at the social servicesdepartment of social development.

C. Study Design

The study was conducted in February 2012. A mixed-method approach was followed. A qualitative study design using focus group discussions was adopted to obtaininformation about the personal views, cultural practices, beliefs and experiences of thegrandmothers.27 The focus groups were facilitated by a trained field worker and

27. M. Dalen, Intervju som forskningsmetode: -en kvalitativ tilnærming. Second edition. Oslo:Universitetsforlaget; 2011.


discussions lasted from two to three hours. Each session was recorded using two digitalrecorders, to be sure no material would get lost if one stopped working during or afterthe discussions. Field notes on non-verbal communication and group dynamic werewritten down by a second field worker who did not facilitate the discussion. Theresearcher also took notes on this to supplement the recordings.

Quantitative methods were also applied, and this entailed a questionnaire forthe grandmothers who participated in the study, for information regarding who washead of the household and the households’ financial situation. Completion of thisquestionnaire at their homes was considered the best way to get the participants toanswer all the questions in an open and honest way, with only one of the local fieldworkers present and no one else listening, as some of the questions were of a sensitivenature. A questionnaire in form of a hunger scale was added as it provides a proxy forassessment of food insecurity.28 The questions related to food access and intake thatgive indications of food shortage problems and hunger.

A structured interview guide was prepared for the key informants. Theseinterviews were conducted by the researcher, at venues chosen by the participants andconsidered appropriate for interviewing and recording. The interviews were conductedin English and lasted approximately 30-40 minutes. A local translator assisted theresearcher in translating the focus group discussion guide, the structured interviewguide and the questionnaires from English into two of the local languages Afrikaansand isiXhosa.

D. Data Analysis

After gathering the data, one local translator from each of the areas helped transcribethe focus group discussions into English. The data from these and the key-informantinterviews were coded and analysed using the software programme, Atlas TI version. The questionnaires were analysed by summarizing the responses and converting theminto percentage. When analysing the responses to the Hunger Scale Questionnaire, astandardized procedure was used as follows29: A score of five or more, i.e. fiveaffirmative/positive (Yes) responses out of a maximum possible of eight indicated afood shortage problem affecting everyone in the household. These families could beconsidered as "hungry". A score of one to four indicated that the family was at "risk

28. G. Gericke, D. Labadarios, J.H. Nel, Hunger scale questionnaire: A measure of hunger,retrieved from <http://www.sahealthinfo.org/nutrition/food8hungerscale.pdf> (accessed 14 November2013).

29. Id.


of hunger". A negative response (No) was assumed to mean a food secure household.Further analysis of the data included the frequency of an affirmative or negative (Yesor No) response for each of the eight questions.

E. Ethical Considerations

Approval for the study was obtained from the Health Research Ethics Committee of theFaculty of Medicine and Health Sciences, University of Stellenbosch (N11/11/318). The study was carried out according to the International Conference on Harmonizationof Technical Requirements for Registration of Pharmaceuticals for Human Use and theMedical Research Council of South Africa guidelines and conducted in full accordancewith the ethical principles of the World Medical Association Declaration of Helsinki. Written informed consent was obtained from the grandmothers as well as the keyinformants willing to participate in the study. They also provided consent to allowvoice recordings of the discussions and interviews. All participants were provided withinformation and copies of the consent form. Information and consent forms wereavailable in the three commonly used languages.

All participants were informed that any participation in the study wasvoluntarily, that they were free to withdraw at any stage and that refusal to participatewould not in any way compromise them. Participants were also informed that all datacollected was being handled confidentially to ensure their identities would not berevealed at any one time.

IV. RESULTS OF THE STUDY

The majority of the households represented in this study consisted of a grandmother andfour other adults. The number of grandchildren living in these households varied fromone to eleven, usually two to four grandchildren. It was observed that many of thegrandmothers were overweight while others were underweight. Several of the focusgroup participants reportedly suffered from diabetes and other non-communicablediseases.

A. Food insecurity

The results from the hunger scale questionnaire strongly indicated that overall, thehouseholds represented in this study were indeed experiencing food insecurity. Asmuch as 44 out of 45 (98%) households experienced hunger. However, when askedabout the frequency of experienced food insecurity, the percentages declined as could


be expected. For example, as many as 40% of the participants responded “no” to thequestion if any of the children or grandchildren ever went to bed hungry due to lack ofmoney.

B. The grandmothers’ role as primary caregivers in the households

As much as 76% of the grandmothers reported themselves as being the head of thehouseholds. Only 17% dedicated their husbands to this role, and a few (7%) reportedone of their own children being the head of the household. Their grandchildren werenot considered head of the household. Even more (87%) responded that they were alsothe one responsible for ensuring the households had enough food. Only 11% of thegrandmothers reported that one of their own children had this responsibility, and 2%said this was the responsibility of a grandchild. A total of 93% “strongly agreed” whenasked if they felt responsible for feeding the members of their households. Only two“agreed”, while one “disagreed”.

The grandmothers envisioned themselves as being the primary caregivers in thehouseholds with many responsibilities, such as getting food and clothes for everyonein their homes, as well as paying for medication, tuition for the children andinstalments. Their responsibilities also included bathing, feeding and caring for theirgrandchildren. The grandmothers reported not only living with their grandchildren, butsome also lived with their own children and even foster care children. They discussedhow living with their grandchildren affected them both economically and emotionally,and how it impacted their access to food. They reported spending all their money onthe children, which resulted into their failure to meet their needs.

There were also stories told about how they were treated by their children, andhow their daughters forced them to take care of their babies. The grandmothers furtherreported struggling and worrying about their grandchildren. Their concerns evolvedaround how they would be able to feed the children, and especially the ones that wereHIV positive and needed food to take their medication. One respondent stated that itis worse when you`re living with sick children, not knowing what you`ll do when itcomes to food.30

C. The grandmothers’ role as financial provider for the households

The majority of the grandmothers (78%) viewed themselves as being the main

30. Interview with a grandmother, aged below 60 in Zweletemba.


providers of the households. Only 11% reported that the husbands were the mainproviders, and even fewer (9%) their children. Only 13% of the grandmothers reportedthat a salary was the most important source of income.

All grandmothers responded that their households received one or moregovernment grant. The most important source of income in the households was reportedby 62% of the grandmothers to be the OPG and 20% reported that the CSG was themost important. A total of 98% of the respondents ranked the income from the grantto be “very important” for their access to food. Only one of the grandmothersresponded that the grant money was “of little importance”. When asked what themoney in the households was mainly spent on, food clearly stood out as the main itemfor expenditure among 98% of the households.

Although several alternative options were given, there seemed to be anagreement among the grandmothers that there were mainly two constraints to theirability to provide all the food they needed. Lack of income was reported as the biggestconstraint by the majority (80%) of the grandmothers, while 20% reported the foodprices as their main challenge.

The key informants confirmed that the grandmothers’ economic access to foodwithin the households was generally limited. There were several reasons for this, suchas grandchildren taking the money from the grandmothers, the grant was too small forthe grandmothers to be able to provide the households with food on only her monthlysalary and costly food. One of the informants described how the grandmothers usedtheir money on the grandchildren by “getting the children to be comfortable, given thatthey might be of schooling age”. Furthermore, one informant explained how somehouseholds spent the grant money on alcohol and drugs.

D. The grandmothers’ reflections regarding the older persons grant

The grandmothers were asked about the OPG and if that money was spent onthemselves as the receivers. The grandmothers seemed to be coherent in theirresponses. Their money seemed to mainly be spent on the members of the household,health care expenses and fixed costs such as electricity. To make ends meet waschallenging “because there is clothes, food, uniform and school stuff with this littlemoney that we receive.”31

Several of the grandmothers expressed dissatisfaction regarding the amount ofmoney they received, and some explained that the money was too little to buy food.

31. Interview with a grandmother, aged above 60 in Zweletemba.


Although there was clearly some dissatisfaction with this grant, one of thegrandmothers said that because the money was just given to them, they could notcomplain about it. She emphasized the need to be smart with the money and buy foodbecause: “food is the most important thing that we buy because we stay withgrandchildren, we have to feed them, there always has to be food for them.”32

Their love and commitment for their families were apparent in their responses. Many reported not being able to passively see that the children or grandchildren did nothave something to eat. They were also concerned with the future of their grandchildrenand put the children`s needs before their own. One grandmother said that it was:“better than nothing because you know at the end of the month you`ll receive the grantand be able to buy the necessities of the household”33

E. The grandmothers’ perceptions of reasons for not receiving social grants

Members of one of the focus groups claimed that even though the women aged 60 andabove were applying for the OPG, few in fact received it. The grandmothers mainlygave three different reasons for not receiving a grant. Some of them discussed the factthat they had to meet in person to apply for a grant, whereas others did not applybecause they did not want: “to sacrifice their time”.34 Furthermore, doctors coulddecide that they were not eligible for applying for a grant. Another main reason for notreceiving a grant despite eligibility was the requirement for identity documents whichmany older persons do not have. The grandmothers reported that people werestruggling without proof of identity.

F. The grandmothers’ perceptions regarding who was looking after them

The grandmothers were clear in their answers about who was looking after them. Itseemed that it was either the neighbours or children who looked after them, althoughmany of the grandmothers did not have any support or assistance as “everyone has theirown problems.”35 One exception was a man from one of the church organizations whosometimes would give bread to the children if the grandmothers approached him forhelp, but this did not seem to happen on a regular basis.

32. Interview with a grandmother, aged above 60 in Zweletemba.33. Interview with a grandmother, aged above 60 in Zweletemba.34. View of a grandmother aged less than 60 from Avian Park.35. View of a grandmother aged below 60 in Zweletemba.


G. Help from the community in the context of food, money or water

The discussion regarding help from the community for food, water or money wasunambiguous. The grandmothers reported not receiving any help from anyone. Thereseemed to be lack of knowledge about who to turn to in this context as they did notknow the leaders of their communities.

H. Alternative food sources in times of no money

The grandmothers reported borrowing money in times when they were lacking food andmoney. They also emphasized the importance of paying back their debts, with interest,to be able to borrow money again. A grandmother stated how some people werestealing to feed their children. Several of the grandmothers went to the garbage binsin desperate need of food when they had no money. Others mentioned people theyturned to in times of need, including family members and neighbours to “ask aroundfor something to eat, potatoes or flour just so that we can have something to eat”.36 Other options for help were also discussed. However, there was some doubt regardingwhere and who they could turn to for help in times of need. Someone mentioned HomeBased Care; others stated how they had received food parcels from the social serviceswhen they needed help to get them through a difficult period.

I. Food production, preservation and alternative source of income

The grandmothers said there were few vegetable gardens in the communities. Reasonsoffered for the lack of vegetable gardens were the environment in which they lived, thepoor quality of the soil, the high water bills, theft and water contamination. Whenasked about food preservation, only one of the grandmothers reported that shepreserved food by putting the food in plastic bags and freezing it.

J. The grandmothers’ suggestions to improve their situation to achieve theirrealization to the right to food.

The grandmothers expressed many thoughts and ideas on how to improve their ownsituation, as well as their community in general. Education was especially highlighted,as most of the grandmothers did not have the opportunity to attend school in their

36. View of a grandmother from Avian Park aged 60 and above.


childhood. The grandmothers further expressed that they wanted the government toprovide them with food parcels, preferably on a regular basis, and to assist them inbuilding houses in order to improve their living conditions. Suggestions were made thatthe transportation taking the children to school and the crèches ought to be free ofcharge, and they also proposed that the government could provide the children withschool clothes.

Another important topic for discussion was that they wanted the governmentto create jobs for them, e.g. provide assistance in creating food gardens. Thegrandmothers wished that the government could contribute to progress in thecommunity, as well as take action to protect grandmothers against abuse and make themfeel safe. One of the key informants emphasized the importance of trying to preventthe young mothers to be able to just leave their babies with the grandmothers, throughlegislation. There is a need to create more shelters for foster care as children living onthe streets are getting placed with grandmothers, even though they were not related.

While one key informant felt that the government could increase the grantmoney, several of the informants mentioned that they felt the government could havecreated jobs for the grandmothers, for example, sewing, gardening, beading, paintingand creating items they could sell. Others emphasized the need for the social workersto go around looking where the grandmothers were staying and get to know theirsituations to possibly be able to help.

Another suggestion was to give the grandmothers vouchers to the supermarketsto get “the food that they know are healthy”.37 This informant thought that in this waythe government would ensure they ate proper food. Another informant suggested thatgovernment should hand out food vouchers according to the number of people livingin that specific household.

Reportedly, feeding schemes providing one meal per day had been in placeearlier but lack of financial support prevented them from maintaining the service. Oneinformant suggested handing out of food parcels, which was contradicted by anotherwho emphasized the importance of not just giving the grandmothers food or money asthat might create a bigger dependency on charity. The government should rather aimat empowering them to produce their own food and livelihoods, and “create somegardens or things like that, to have a sustainable food supply.”38

37. View of a Priest from Avian Park.38. View of an employee at a health clinic in Zweletemba.


K. Adequacy of resources according to key informants

According to the key informants, lack of resources and money in addition to the numberof grandchildren residing in the households, affected the food distribution as the focuswas mostly on children and thus the food for grandmothers did not last. There seemedto be some contradictory opinions held by key informants regarding the dietaryadequacy of the food available for the grandmothers. Some of the key informants whosupported dietary adequacy explained that especially grandmothers with diet-relatedhealth problems, like hypertension, followed the doctor`s instructions on what to eatand took care of their own health. Others regarded the food as being nutritious andadequate, “at least if it was bought from the shops”.

Several of the informants doubted the dietary adequacy of the food. The mainreason offered was that access to adequate food was related to the poor economy andlack of knowledge. One informant was of the opinion that the bread they bought wasso cheap and had a low nutritional value - “to accommodate the poorest of the poor”. Some also talked about how having little money and many mouths to feed made thegrandmothers buy “something that can feed a lot of people, so it`s not alwaysadequate”. Racial inequalities were also mentioned: “The white, they are the peoplethat can buy food that is healthy, but our people in Avian Park, they can`t affordhealthy foods”.

Sadly, one informant mentioned that the diet of the grandmothers ultimatelymade them sick. He stated how people (including grandmothers) went to the dumpingsite to find food they could both eat themselves as well as bring home to their families,for example, dead chickens dumped on these sites, by a factory. The hungry peopleignored that they could get sick, not knowing why it was thrown away or how theywere stored.

The majority of the informants reported that the grandmothers did have accessto culturally acceptable food. However, a few informants explained how thegrandmothers sometimes had to eat what was available, not having the chance to takespecial considerations. Only few of the key informants believed that the grandmothershad adequate physical access to food within the households. One explained that itdepended on how the grandchildren were raised, saying that if they did not respect thegrandmother then they would most likely not have easy access to food in the household:“And when they mistreat you, no, you won`t have access to the food”.

L. The grandmothers’ knowledge of human rights and the right to food and water

The grandmothers were asked about their awareness of human rights, especially in the


context of food and water. The responses to this question were vague. Some said theydid not have any knowledge regarding their rights while others seemed to have moreknowledge on the subject, but without being able to elaborate on the topic.

M. Roles and responsibilities of key informants in relation to the grandmothers’ rightto food

One informant stated that her job going from door to door on a daily basis in an attemptto try and change the mind-set of people living under poor conditions, also regardingfood and water. Others explained how their role was to refer the grandmothers thatneeded assistance, to the Family and Marriage Society of South Africa and thedepartment of social services. Another said that his role was to educate the people, andaddress problems he came across. One informant told how they sometimes gave outfood parcels and clothing to help the people in times of need.

Another informant reported that their role was to compile a database of peoplewho were in need and to give the information to the South African Social SecurityAgency. The informant further explained that they worked with “various stakeholders,our NGO`s, and the various departments”.

N. Policies and programmes in the context of the right to food.

There seemed to be some inconsistency in the grandmothers’ answers to the questionabout existing policies and programmes to promote the right to food. One told that theruling party, the African National Congress, and other politicians around election-timegave the grandmothers some food and blankets, just to get their votes.

In both Avian Park and Zweletemba, people aged 60 and above could go to aservice center and contribute a minimal amount of money. They would then get a plateof nutritious food: “For every day, every day of the week, 5 days of the week”. Anotherinformant talked about the Social Relief of Distress programme managed by thecommunity development section, and that people earning less than R1000 per monthcould apply for financial assistance for a period of two months.

The grandmothers reported inaction on part of government in spite ofunsolicited living conditions. None of the grandmothers knew of any existing policiesor programmes in the communities to fulfil their need to food or water. Onegrandmother answered: “We only see at other places where people are given food


vouchers, there`s nothing like that here in Worcester.39

All the key informants reported that the water available for the grandmotherswas adequate, safe for consumption and environmentally sustainable. They said thewater was being controlled by the municipality, and if there were any problems, themunicipality would sort it out. There seemed however to be different views on whetherthe water was physically accessible for the grandmothers. Some of the informants saidthere was no problem with the grandmothers’ access to water, explaining that the tapswas conveniently located to allow access to water for all. Others explained howwalking to fetch water could be a problem for the aged, living in the informalsettlements, where they would have to leave their homes to collect water. Oneinformant made a suggestion of making water more easily accessible for people withoutwalking long distances. The suggestion was that the government could have a truckwith water driving around to those who had difficulties getting it themselves, and at thesame time this would create jobs for the locals.

The key informants reported that water was economically accessible for thegrandmothers. They reported that the ones living in brick houses had their own taps intheir yards and were entitled to receive a certain amount of water for free, but that theypaid for additional water consumption. The people living in shacks, however, did nothave to pay for the water as they only had access to community taps placed by themunicipality. Grandmothers who received OPG, made arrangements with themunicipality to pay a reduced amount each month for the water and the municipalitydid not terminate the services if they failed to pay their bill.

IV. DISCUSSION

A. Methodological Considerations

Qualitative approaches are considered useful to gain in-depth information about theparticipants’ perceptions, thoughts and beliefs, which provide information that cannotbe retrieved when applying quantitative study designs alone. However, there are somelimitations identified with using qualitative approaches. It is both time and resourceconsuming, which in turn limits the number of participants, thus couldn’t be regardedas a representative sample. The analysis of qualitative data is challenging and can leadto researcher bias due to subjectivity. Researchers must be restrictive in terms ofmaking generalized conclusions when applying qualitative study methods.

39. View of a grandmother in Zweletemba, aged 60 and above.


All the participants (grandmothers and key informants) in this study wereselected on the grounds that they could contribute valuable information relevant to theinvestigation. Furthermore, the key informants were working and living in the area ofWorcester, and thus were knowledgeable of the living conditions and cultural practicesin the relevant communities, as well as relevant policies and programmes pertainingolder persons.

B. Summary of the main findings

In general, it was found that living under the strain of poverty clearly affected thegrandmothers’ access to food, lacking money and having to provide for largehouseholds. Food insecurity appeared to be prevalent in the two communities andaffecting people of all ages. Furthermore, the difference between the grandmotherseligible for receiving the OPG and the ones who were not was not as evident as mightbe expected. There were indications that the grant money received by the grandmothersdid not even enable them fulfil their basic needs. The grandmothers reported theirmoney being spent by all members of the households with very little, if anything, leftfor their own use. However, the grandmothers receiving the OPG stated how they tookcomfort in knowing they would receive that money once a month. The grandmothersaged 60 and below did not have the same privilege. The study did not find any apparentdifferences regarding the grandmothers’ role in the household in terms of age (< 60 or> 60 years) or residence (formal/informal, Zweletemba/Avian Park). The evidencepoints towards the grandmothers having the same role as primary caregivers in thehouseholds regardless of these factors.

C. Analyses of the Main Findings

1. The grandmothers’ role as primary caregivers—To appreciate thegrandmothers’ role as primary caregivers, an understanding of the householdcomposition is important. The majority of the households represented in the studyconsisted of a grandmother and four other adults. The number of grandchildren livingin these households was usually two to four grandchildren. A study investigatinghousehold structure and composition in rural parts of South Africa from 1992 to 2003found that average household size decreased, while the proportion female headedhouseholds increased.40 This is consistent with the finding of the present study.

40. S. Madhaven & E.J. Schatz, Coping with change: Household structure and composition inrural South Africa, 1992 – 20031.35, SCAND. J. PUBLIC.HEALTH (2007), at 2.


Furthermore, Madhavan and Schatz argued that the reason for this change is not solelycaused by the increase of HIV/AIDS.41 They emphasized the importance of consideringall the post-apartheid changes, such as democratization, freedom of movement as wellas unemployment as contributors to the changes in South African rural householdcomposition.

Being a grandmother within the African context is different from their Westerncounterparts. They are often younger in age and responsible to on the role as head ofthe household. When the daughter in a household becomes a mother herself, thefindings from this study show that her mother is often left with the responsibility ofboth her own children and her grandchildren. Some of the adolescent mothersdisappear, often migrating to other places for work or whatever other reason, leavingtheir children with the grandmothers. Evidence has shown that also when daughtersmarry men other than previous children’s fathers, they often leave their children in theirown mother’s care.42 Grandmothers living in South Africa’s poorer communitiesstruggle with challenges related to girls getting pregnant at a young age. This is aphenomenon familiar on the African continent,43 which impacts negatively on the foodsecurity in the household.

According to the United Nations Population Fund (UNFPA), the reasons foryoung girls getting pregnant are numerous and they are unable to take care of theirbabies both mentally and physically. This, according to UNFPA, results in the youngmothers compromising their future and facing poverty, poor health, and dropping outof education,44 leaving them ill-equipped to ensure food security for themselves andtheir babies. This adds to the grandmothers’ burden of responsibilities. However, theabsence of young parents in the household does not appear to be the only reason for thegrandmother being the primary caregiver of her grandchildren, they sacrifice their ownneeds as they become the primary caregiver, encouraging their daughters to completetheir education, caring for her children and grandchildren, providing food and clothingto all household members, paying school fees and medication, using her older personsgrant. This is consistent with the findings of another study which reported that olderwomen in fact act like surrogate parents to their grandchildren which is consistent with

41. Id.42. E.J. Schjatz, Taking care of my own blood: Older women's relationships to their households

in rural South Africa, SCAND J. PUBLIC HEALTH (2007).43. UNFPA, Giving Girls Today and Tomorrow: Breaking the cycle of adolescent pregnancy,

a v a i l a b l e a t<http://www.unfpa.org/webdav/site/global/shared/documents/publications/2007/giving_girls.pdf>(accessed 14 November 2013).

44. Id.


the findings of this study.45

2. The grandmothers’ right to adequate food—The evidence points towardsthe grandmothers having very little knowledge on the subject of their right to adequatefood. However, although the participants did not have an in-depth understanding of theconcept of the right to food, they were indirectly talking about their rights during thefocus group discussions as they were in despair talking about their lack of money andhence food, as they sacrificed their own needs to be able to feed the children in thehouseholds.

It became evident that many of the grandmothers for the most part did not haveaccess to nutritious food. It is widely reported in the literature that “the double burdenof malnutrition is a paradox caused by poverty, hunger, and food insecurity”.46 Manyof the grandmothers in this study appeared to be overweight while others wereunderweight. It is evident that the transgression of the grandmothers’ right of foodimpact on the realization of their right as health as well. Several of the participantssuffered from diabetes and other non-communicable diseases associated withinadequate diets. Women and older persons are not usually economically active thusit was not surprising that few of the participants reported salary to be the most importantsource of income. Furthermore, one quarter of the South African labour force isunemployed47 and the historically disadvantaged groups, females, uneducated and youthare worse off.48

Although South Africa has experienced higher employment rates and increasedeconomic growth since the end of apartheid in 1993, the country has not kept up withthe increased need for labour force. There were strong indications that the grant moneywas very important for the grandmothers’ access to food, which proved to be thebiggest item of expenditure for the study population. This entailed all forms ofgovernment grants. These findings could be expected as food insecurity and hungerwas highly prevalent in the communities. An investigation of the cash transfers to theelderly in South Africa in 1998 indicated that the OPG proved to benefit all members

45. See http://www.who.int/healthinfo/survey/ageingdefnolder/en/.46. S.A. Tanumihardjo et al, Poverty, Obesity, and Malnutrition: An International Perspective

Recognizing the Paradox, 107 J. AM. DIET. ASSOC. (2007), at 1966.47. M. Makiwane & E. Udjo, Is the Child Support Grant associated with an increase in teenage

fertility in South Africa?: Evidence from national surveys and administrative data, available at<http://www.hsrc.ac.za/en/research-data/ktree-doc/1337> (accessed 14 November 2013).

48. V. Arora, L.A. Ricci, Unemployment and the Labor Market, retrieved from<http://www.imf.org/external/pubs/nft/2006/soafrica/eng/pasoafr/sach3.pdf> (accessed 14 November2013).


of the household.49

Furthermore, the OPG has been called “an effective tool of redistribution”,since it predominantly reaches poor households. Case and Deaton argued that the OPGis in fact making the older persons the principal earners of the households, and that thedecision-making powers can be directly linked to their earnings.50 Moreover, the OPGprotects the younger members of the households against adverse lab or marketconditions in rural South Africa.51

The results from this study did not show large disparities among those eligiblefor the OPG compared to those who were not. Both groups seemed to be lackingmoney. However, the women aged above 60 expressed relief of knowing they wouldreceive grant money at a certain point in time. This was not the case for thegrandmothers aged less than 60 years.

Receiving a social grant requires supporting documentation which has provento be a key barrier to social grants access.52 Such documentation may include children’sbirth certificates, official bar-coded identity books for adults, and/or legal orders offoster guardianship. The data from this study suggested that despite eligibility, noteveryone had access to the social grants. This is something that should be addressedas a matter of urgency by the Government, as part of the obligation to respect, protectand fulfil the right to food enshrined in the South African Constitution.

3. Policies and programmes relevant for the right to food ofgrandmothers—The grandmothers seemed to be unaware of the various policies andprogrammes instituted by the South African government to facilitate their right toadequate food and to promote food security. It may be due to a lack of understandingof the right to food as both the grandmothers and key informants related their opinionsin terms of political events rather than empowerment of the community to increase their

49. A. Case & A. Deaton, Large Cash Transfers to the elderly in South Africa, THE ECONOMIC

J O U R N A L ( 1 9 9 7 ) , a v a i l a b l e a t<http://www.princeton.edu/~accase/downloads/Large_Cash_Transfers_to_the_Elderly_in_South_Africa.pdf>.

50. Id.51. S. Keller, Household formation, Poverty and unemployment – the case of rural households

in South Africa, available at <http://ideas.repec.org/p/sza/wpaper/wpapers9.html> (accessed 14 November2013).

52. M. Samson, K. MacQuene & I. Van Niekerk, Policy brief 1: Inter-Regional InequalityFacility sharing ideas and policies across Africa, Asia and Latin America. Social grants South Africa,retrieved from <http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/1688.pdf> (accessed 14 November 2013).


resilience in terms of food security.

4. Human rights reflections—In a human rights perspective, all governmentshave obligations or duties to respect, protect, fulfil, (facilitate and/or provide) everyhuman right.53 The government is responsible for ensuring that a right can preferablybe legally established and thus legitimately claimed by all members of society. Firstly,the grandmothers reported suffering from extreme poverty and severe household foodinsecurity. The support from the government was manifested in their access to safe andclean water in addition to the monthly provision of social grants, which however provedinadequate to help realize the grandmothers’ right to adequate food when living withgrandchildren, in part due to inaccessibility to the grants.

Secondly, to be able to claim their rights, the right-holders must be aware oftheir rights and responsibilities. The participants reported having very little knowledgeof their human rights and how to claim them, including the right to adequate food. Education about human rights implies that all government officials are aware of theirduty in realising the right to food of vulnerable population groups, such as thegrandmothers, and they should be empowered to support these groups optimally.

The findings revealed that this group of grandmothers perceive a lack ofgovernment commitment towards their human rights obligations concerning thegrandmothers’ realization of the right to adequate food. General Comments 12 (on theright to food), 14 (on the right to health) and 19 (on the right to social security) weredeveloped by the UN Committee on Economic, Social and Cultural Rights (ICESCR)to assist State parties fulfil their reporting obligations on these rights; adequate food,health and social security.

Even though the International Covenant for Economic, Social and CulturalRights is yet to be ratified by the government, these principles were enshrined in the1996 South African Constitution. Implementation of the relevant policies andprogrammes has been slow. Thus, it appears the principles provided in these generalcomments do not fully benefit all segments of the population in South Africa. Thisgroup of grandmothers living in two poor peri-urban areas with their grandchildrenseem almost excluded from the rest of society and are neither able to have fulfilled norclaim their human rights. To address these concerns, the South African NationalDevelopment Plan (SANDP) for 2013 proposes several actions to relieve the burden ofthe poor and food insecure population groups and is making renewed effort to removebarriers to the attainment of human rights of the nation.42

53. UNFPA, The human rights-based approach: Advancing human rights, available at<http://www.unfpa.org/rights/approaches.htm> (accessed 14 November 2013).


The importance of gender equality and women`s empowerment has long beenrecognized. The Committee on the Elimination of all Forms of Discrimination againstWomen (CEDAW) “establishes an agenda for national action to enddiscrimination”.54 These aspects form an integral part of the SANDP and there isstrong emphasis on the women’s role in decision making positions. Thus, thegovernment of South Africa aspires to implement initiatives to promote the rights ofwomen, through ending discrimination and ensuring an equal society where women canbe part of political and public life, have good health, be educated and employed. Empowering women, including through education, have shown to have positive impactson the children, which in the long run may strengthen them when they becomegrandmothers.

V. CONCLUSION

South Africa is currently experiencing serious challenges affecting household foodsecurity. For grandmothers, the situation is critical. Instead of being looked after bytheir children, they are now taking care of their grandchildren. As a result,grandmothers living in poor rural and peri-urban areas in South Africa suffer bothphysically and economically. By empowering this usually neglected group, there isreason to believe that all members of their households will benefit.

The findings from this study strongly indicated a violation of the grandmothers’human right to adequate food. With high prevalence of food insecurity and hunger,immediate actions should be taken to relief the poverty in the communities. More dataon the situation of grandmothers and their role as primary caregivers when living withtheir grandchildren is needed, especially in the context of their right to adequate food. The overall aim should be to encourage interventions that can help empower thegrandmothers and women as grandmothers-to-be, as well as getting relevantstakeholders and duty bearers to commit themselves to ease the situation of thisvulnerable group, promote equality, reduce poverty and eradicate hunger.

54. REPUBLIC OF SOUTH AFRICA, NATIONAL PLANNING COMMISSION. NATIONAL DEVELOPMENT

P L A N , V I S I O N F O R 2 0 3 0 ,<http://www.npconline.co.za/medialib/downloads/home/NPC%20National%20Development%20Plan%20Vision%202030%20-lo-res.pdf>, (accessed: 6 February 2014).

EAJPHR, VOL. 20, No. 2 (December 2014)

Documents

adequate food

department of nutrition

university of oslo

division of human nutrition

basic medical sciences

number of older people

older population

household food security