In 2014 the South African Law Reform Commission (SALRC)released a Discussion Paper on the practice of ukuthwala. TheDiscussion paper was revised and released again in 2015 toinclude public consultations and the proposed Prohibition ofForced Marriages and Child Marriages Bill (Prohibition Bill). TheProhibition Bill introduces an expanded crime of forcedmarriages and child marriages, including because of ukuthwala.In view of the SALRC's proposed Prohibition Bill, this paperinvestigates whether South Africa should criminalise ukuthwalaor not. The paper also examines the advantages anddisadvantages of criminalising breaches of ukuthwala in theprotection of women and girls affected by the practice by drawingupon the field research findings from the community where theS v Jezile 2015 2 SACR 452 (WCC) case originated. Amongother findings, the field research show that the practice ofukuthwala is deeply rooted in the communities where it is stillprevalent to the extent that the approach taken by the ProhibitionBill, expecting the victims to report their own parents or familymembers to law enforcement agents, might force the practice togo underground. Ultimately, we suspect that this might make itmore difficult to protect women and children's rights violationsassociated with ukuthwala. We therefore recommend that toeffectively address the malpractices surrounding ukuthwala, theprocess of law reform look at the elements of ukuthwala, theprocedure that is followed, appreciate the cultural significance ofthe practice, as well as understand the merits and demerits ofthe customary delictual claims that are already used bycommunities where processes of the practice have beenbreached. In this way, communities will be more receptive to anygovernment's efforts that are aimed at addressing forced andchild marriages linked to ukuthwala. In addition, we submit thatunless government prioritises awareness campaigns into thecommunities that are going to be affected by the proposed lawreform, such law, will again be what Himonga calls "paper law".
BACKGROUND In the statistics taken from media brief on ending child marriage in Zambia, (2014) states, “Zambia is the third highest country with cases of child marriages in the SADC region and 19th in the world. In Zambia, about 42 per cent of women aged 20-24 years are married by the age of 18 – a rate that has not evolved since 2002. The rates of child marriages vary from province to province, and are as high as 60 per cent in the Eastern Province. (www.girlsnotbrides.org.) accessed on 20th November 2014. At 13.42) The ZDHS [Zambia Demographic Health Survey] indicates that among married girls aged 15-19 in Zambia, 68 percent have already given birth. In addition, most of the births occurring to girls before age 18 are first births (85 percent), and a majority of these first births occur within marriage. A Central Statistical Office (CSO) report of 2010 carried out by Plan Zambia indicates that “only a few adolescent girls and boys complete upper primary education while the enrolment ratio in secondary education is 13.4% for males and 12.9% for females.” The report concludes that child marriage is the critical driver for this state of affairs. OBJECTIVE This study is aimed at determining the prevalence and factors associated with child marriage in Chipulukusu township of Ndola. Zambia. METHODS A cross-sectional study was conducted in Chipulukusu Township within the location of Ndola. A pretest questionnaire was used to collect information on child marriage prevalence and factors towards the practice of child marriage and other relevant socio-demographic characteristics. RESULTS the prevalence of early marriage in Chipulukusu township of Ndola district, Zambia was 20.7 % with it being significantly associated with lower social economic status (poverty), lower education level, orphanhood and teen pregnancies CONCLUSIONS the prevalence of early marriage in this study was high. Its prevalence was significantly associated with people of poor backgrounds (poverty), teen pregnancies, lower education level, and orphan hood.
Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.
Zambia's 2024 Measles-Rubella Supplementary Immunization Activity (SIA), conducted from 23 to 28 September across all 116 districts, targeted children aged 9-59 months to address immunization gaps exacerbated by COVID-19 disruptions and responding to ongoing measles outbreaks. This community case study evaluates the effectiveness of microplanning, the feasibility of real-time digital monitoring, and the equity of reaching zero-dose children during Zambia's 2024 Measles-Rubella SIA, using a mixed-method approach to inform scalable immunization strategies in resource-limited settings. Through comprehensive microplanning, strategic community engagement, and real-time digital monitoring, the campaign achieved 97% national coverage and reached 165,000 previously zero-dose children in underserved communities. Implementation utilized Google Sheets and Open Data Kit tools, with quality assurance through over 7,500 supervisory visits. Despite achieving high overall coverage, several challenges emerged: funding delays, logistical constraints in remote areas, and data quality issues. Key lessons include the necessity of timely funding disbursement, strengthened cold chain infrastructure, and rigorous data verification processes. Community involvement through local leadership engagement and radio campaigns proved essential to success, while digital monitoring enabled rapid adaptation to emerging challenges. This case study provides actionable insights for designing equitable immunization campaigns in resource-limited settings, supporting global measles and rubella elimination goals through evidence of effectively tailored, data-driven strategies.
Moses Mwale, Kalesha-Masumbu Penelope, Peter Jay Chipimo et al.
Maternal and child health service utilisation remains critical for reducing mortality in Sub-Saharan Africa, where disparities persist. This study synthesised literature to identify key determinants, evaluate interventions, and examine care continuity. Systematic searching of databases and citation chaining identified 635 records, of which 103 peer-reviewed studies (2010–2024) from Sub-Saharan Africa met the inclusion criteria. Antenatal care coverage (4+ visits) averaged 69% nationally, with urban-rural disparities (85% vs. 54%). Skilled birth attendance averaged 61% (78% urban, 45% rural), while postnatal care was lowest at 45% (56% urban, 34% rural). Full immunisation reached 75%, with minimal urban-rural disparity (76% vs. 73%). Rural populations showed lower utilisation than urban populations, ranging from near parity for immunisation (1.04 times) to a 1.73-fold gap for skilled birth attendance. Household income was the strongest predictor (impact score: 92), followed by maternal education (87), women's autonomy (71), and media exposure (67). Geographic distance was the primary barrier (28%), followed by financial constraints (24%) and cultural barriers (18%). Community Health Worker programmes showed optimal effectiveness (65% effectiveness, 85% sustainability), while financial incentives performed poorly (23% effectiveness, 25% sustainability). Only 19% completed the full continuum of care, with the sharpest loss between skilled delivery and postnatal care, a 33-point drop in the waterfall analysis. Inequities persist in maternal and child health utilisation across Sub-Saharan Africa. Socio-economic factors determine access patterns, while community interventions outperform financial approaches. The postnatal care dropout reflects systematic failure requiring immediate attention. Achieving equity demands approaches addressing structural inequities and sustained community engagement.
INTRODUCTION: Universal access to quality early childhood development and care is a fundamental part of Sustainable Development Goal 4.2.1. Research from diverse settings, including that in low and middle income countries, now demonstrates the positive impact that interventions to promote play, stimulation, early communication and responsiveness can have, not just on child development, but on long term gains in education and economic growth. International agencies have recently produced the Nurturing Care Framework for Early Child Development in order to promote this and to encourage countries to move the focus from child survival to child thrival. Research on the best methods of integration of these programmes into present care practices, particularly in African settings is still very limited. METHODS: We used qualitative methods to gain an understanding of care practices (play, developmental stimulation, early communication and responsive feeding) for children 0-2 years. We conducted 18 focus groups (FGDs), six PFGDs (Participatory Research focus groups), 18 in depth interviews (IDIs) and 20 observations with caregivers in rural and urban settings of Malawi. We used a topic guide, audio-recorded the FGDs and IDIS and transcribed them in Chichewa or Yao and then into English. We coded data using an inductive approach to thematic analysis. We placed the data within a framework with the emerging major and minor themes. We conducted quality assurance for translations and coding frameworks through cross comparison of data and used respondent validation to check our results. RESULTS: Malawian caregivers see children's play as a consequence of good health and wellbeing, less an interaction that a parent undertakes to promote wellbeing and learning. Non-verbal communication and responsiveness with infants is clearly present and caregivers have many one-on-one interactions with young infants. Furthermore, many caregivers have good knowledge of feeding recommendations but cannot always follow these due to constraints on money. When children become mobile (toddlers), play is an activity done more often between children or with other caregivers such as siblings or grandparents. Community members consider that caring for children from 0-2 years is a woman's domain. Despite this, both men and women acknowledge the importance of maternal wellbeing in enabling good care of children. The present socioeconomic situation of most families in our study means that income generation and food security come first. Many mothers spend most of their time managing the responsibilities of daily living and have limited time to dedicate to children's play, responsiveness and communication with their children. DISCUSSION: Programmes promoted as part of the Nurturing Care Framework which provide advice on developmental stimulation, play, early communication and responsive feeding should ensure that topics within these programmes are culturally appropriate for the setting. Furthermore, programmes must not be an added burden to parents but be supportive to parents managing many responsibilities of daily living. Multi-sectorial approaches where both men and women are provided with knowledge but are also supported through programmes which address family finances, safe spaces for children whilst families are working, and family mental health and relationships may enable programmes to work more effectively.
Melissa Gladstone, John C. Phuka, Shirin Mirdamadi et al.
Maternal capacity to adhere to recommended infant and young child feeding (IYCF) practices may be influenced by psychosocial factors. However, research examining associations between psychosocial factors and IYCF practices, and in particular complementary feeding indicators, is limited. As part of the Khula birth cohort study, we aimed to investigate associations between maternal depression, exposure to intimate partner violence (IPV), social support and stimulating home environments with IYCF practices among mother-child dyads in Malawi (n = 153) and South Africa (n = 255). When children were 10-16 months of age, mothers completed a series of psychosocial and child diet questionnaires. Regression modelling assessed associations between maternal psychosocial measures and IYCF indicators, adjusting for maternal age, education, marital status and household socioeconomic status. IYCF practices were suboptimal in both settings, with 50%-54% meeting the minimum dietary diversity (MDD), 67%-73% the minimum meal frequency (MMF) and 39%-45% the minimum acceptable diet (MAD) indicators. In South Africa, mothers exposed to IPV in the previous 12 months were less likely to meet the MDD and MAD recommendations (MDD: OR 0.38, 95% CI: 0.19, 0.75; p = 0.006; MAD: OR 0.41, 95% CI: 0.20, 0.85; p = 0.02). There was a significant positive association between stimulation (i.e., more books/toys/play activities) and dietary diversity scores in South Africa. In adjusted analyses, maternal depression and social support were not significantly associated with IYCF indicators in either setting. IYCF programmes may benefit from supporting maternal psychosocial wellbeing and integrating nurturing care to improve children's dietary intakes, growth and development.
Taryn J. Smith, Chikondi Mchazime, Pious Makaka et al.
BACKGROUND: There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care. METHODS: The case of the FTD initiative was constructed through a triangulated analysis of document reviews (34), in depth interviews (22) and observations. The analysis drew on Hall's 'ideas, interests and institutions' framework to understand the shift from political agendas to the implementation of the FTD. RESULTS: In the Western Cape province, the FTD agenda setting process was catalysed by the increasing global evidence on the life-long impacts of brain development during the early childhood years. This created a window of opportunity for active lobbying by policy entrepreneurs and a favourable provincial context for a holistic focus on children. However, during implementation, the intersectoral goal of the FTD got lost, with limited bureaucratic support from service-delivery actors and minimal cross-sector involvement. Challenges facing the health sector, such as overburdened facilities, competing policies and the limited consideration of implementation realities (such as health providers' capacity), were perceived by implementing actors as the key constraints to intersectoral action. As a result, FTD actors, whose decision-making power largely resided in health services, reformulated FTD as a traditional maternal-child health mandate. Ambiguity and contestation between key actors regarding FTD interventions contributed to this narrowing of focus. CONCLUSION: This study highlights conditions that should be considered for the effective implementation of intersectoral action - including engaging cross-sector players in agenda setting processes and creating spaces that allow the consideration of actors' interests especially those at service-delivery level. Networks that prioritise relationship building and trust can be valuable in allowing the emergence of common goals that further embrace collective interests.
Abstract This qualitative study aimed to capture community perspectives of the risks and protective factors for social emotional development and mental health of young children in low-income South Africa settings, and was conducted as one component of a larger study with the ultimate aim of co-designing the Mazi Umntanakho (‘know your child’) digital tool. Twenty focus group discussions (n = 154, 97% female) were held with staff of community-based organisations (CBOs) and community health worker (CHW) programmes in urban and rural sites from four geographical regions. Data were analysed thematically, and grouped according to components of nurturing care (responsive caregiving, safety and security, good health, adequate nutrition, opportunities for early learning) and risk and protective factors. Risks reported by participants far outweighed protective factors, and the most dominant theme identified was risks associated with responsive caregiving from CBO and CHW perspectives. These related to participants’ perceptions of caregivers’ attitudes, knowledge, beliefs, behaviours, and challenges not conducive to the provision of responsive caregiving. The most commonly perceived risks to safety and security were substance abuse, along with economic challenges, neglect, abuse and violence. Basic needs not being met was reported as the main risk to adequate nutrition and good health, followed by insufficient services. Limited resources and caregivers’ limited education and literacy were perceived to be risks to early learning. These findings highlight the urgent need to mitigate risks and amplify protective factors for the social emotional development and mental health of young children in South Africa. It is critical that these are considered within the contextual realities of low-income communities.
Catherine Elizabeth Draper, Caylee J. Cook, Elizabeth A. Ankrah et al.
This paper examined the impact of COVID-19 on the Botswana public Early Childhood Education Programme during the pandemic in the period of 2019 - 2022. COVID-19 impacted various sectors of Botswana, the education sector included. However, the education system was not adequately prepared to cater for young learners’ education and therefore this had serious consequences on the lower levels of learning. The study adopted the qualitative approach and used the chaotic theory to guide the line of argument in the paper. Data were collected using open-ended questionnaires, structured interviews, focus group discussions and observation of outside equipment. The findings indicated a backlog of pupils entering the Early Childhood Education programme and Standard One after the Covid-19 pandemic. Standard One accepted learners of different competencies and parents refused to send their students back to school after re-opening because of fear of reinfection. The paper concludes that the Ministry of Education, like other levels of education, could have put something in place for ECE learners to keep on learning at home during the pandemic after three years of suspending teaching and learning
