A total of 265 interviews were conducted with mothers in informal work between December 2018 and March 2019. Just over 50% of participants had completed secondary school and nearly half were in a relationship but not living with their partner. Close to 50% of participants reported themselves HIV positive. Characteristics of participating mothers are shown in Table 1.
Table 1: Characteristics of participating mothers
Characteristics of participants
|
All participants
N=265 (%)
|
Median age
|
29 years (IQR 25-34 years)
|
Population group (Black / African)
|
265 (100)
|
Education
|
No schooling
|
2 (0.8)
|
Primary school Grade 1-7
|
7 (2.6)
|
Secondary school Grade 8-11
|
122 (46.0)
|
Completed school (Grade 12)
|
134 (50.6)
|
Most recent relationship status
|
Single
|
52 (19.6)
|
Married
|
22 (8.3)
|
Separated /divorced / Widowed
|
4 (1.5)
|
In a relationship, living with partner
|
61 (23.0)
|
In a relationship, not living with partner
|
126 (47.5)
|
Mother is currently in a relationship with the child’s father
|
208 (78.5)
|
Has another child aged less than 3 years
|
19 (7.2)
|
HIV status
|
|
Mothers reported having had an HIV test
|
256 (96.6)
|
Mother reported herself HIV positive
|
131(49.4)
|
Infant feeding and childcare
Due to the stratified sampling design there were similar numbers of participants with children aged less than 12 months of age and with children aged between 12- 35 months. Most mothers had breastfed their child, however, only 60% of infants less than 12 months of age were still breastfeeding. Most mothers (171/265; 64.5%) took time off work following childbirth and were financially supported during this time by the baby’s father (109/265; 41.1%), other family members (72/265; 27.2%), the SA CSG (71/265: 26.8%), and their own savings (21/265; 7.9%).
The duration of leave taken at the time of childbirth was short, with around 60% of mothers returning to work by the time the baby was 3months old. Over one-third of mothers did not take any time off work (Table 2).
Table 2. Duration of breastfeeding, duration of postnatal leave and childcare practices during work hours.
Characteristics
|
< 12 months
n=132 (%)
|
12 - 35 months
n=133 (%)
|
All
n=265 (%)
|
Baby’s age when mother stopped breastfeeding
|
Never breastfed
|
18 (13.6)
|
27 (20.3%)
|
45 (17.0%)
|
Still breastfeeding
|
80 (60.6)
|
15 (11.3)
|
95 (35.8%)
|
0 - < 3 months
|
15 (11.4)
|
15 (11.3)
|
30 (11.3)
|
3 - < 6 months
|
11 (8.3)
|
14 (10.5)
|
25 (9.4)
|
6 - < 9 months
|
8 (6.1)
|
17 (12.8)
|
25 (9.4)
|
9 - < 12 months
|
|
7 (5.3)
|
7 (5.3)
|
12 - < 15 months
|
|
17 (12.8)
|
17 (12.8)
|
15- < 18 months
|
|
5 (3.8)
|
5 (3.8)
|
18 - < 24 months
|
|
9 (6.8)
|
9 (6.8)
|
>24 months
|
|
7 (5.3)
|
7 (5.3)
|
Baby’s age when mother returned to work
|
Did not take time off work
|
40 (30.3)
|
54 (40.6)
|
94 (35.5)
|
< 3 months
|
43 (32.6)
|
22 (16.5)
|
65 (24.5)
|
3 - < 6 months
|
29 (22.0)
|
36 (27.1)
|
65 (24.5)
|
6 - < 9 months
|
4 (3.0)
|
15 (11.3)
|
19 (7.2)
|
9 - < 12 months
|
0
|
0
|
0
|
12 - < 15 months
|
|
1 (0.8)
|
1 (0.4)
|
15 - < 18 months
|
|
1 (0.8)
|
1 (0.4)
|
18 - < 24 months
|
|
0
|
0
|
>24 months
|
|
2 (1.5)
|
2 (0.8)
|
Not yet returned to work
|
6 (4.5%)
|
|
6 (2.3)
|
Missing /mother unsure
|
10 (7.6)
|
2 (1.5)
|
11 (4.5)
|
Took baby to work initially
|
26 (19.7)
|
28 (21.1)
|
54 (20.4%)
|
Person who usually cares for child while mother is working
|
Child’s grandmother
|
31 (23.5)
|
21 (15.8)
|
52 (19.6%)
|
Child’s father
|
2 (1.5)
|
1 (0.8)
|
3 (1.1%)
|
Child’s sibling
|
1 (0.8)
|
2 (1.5)
|
3 (1.1%)
|
Other relative
|
28 (21.2)
|
18 (13.5)
|
46 (17.4%)
|
Non-relative
|
44 (33.3)
|
69 (51.9)
|
113 (42.6%)
|
Mother herself (takes child to work or works from home)
|
26 (19.7)
|
18 (13.5)
|
44 (16.6%)
|
Place where child is cared for during working hours
|
Mother’s residence
|
76 (57.6)
|
47 (35.3)
|
123 (46.4%)
|
Carer’s home
|
22 (16.7)
|
20 (15.0)
|
42 (15.8%)
|
Current workplace
|
3 (2.3)
|
2 (1.5)
|
5 (1.9%)
|
Crèche or school
|
29 (22.0)
|
62 (46.6)
|
91 (34.3%)
|
Other
|
2 (1.5)
|
2 (1.5)
|
4 (1.5)
|
Conditions of informal work
Over 40% of participants had been at the same job between one and three years, and close to half worked five to six days each week. Three- quarters of women reported they worked regular hours, however over 60% did not benefit from a fixed income and were paid depending on the work done. An overview of informal working conditions reported by participants is shown in Table 3.
Table 3. Overview of informal work conditions of participants
Conditions of informal work
|
All workers
n=265 (%)
|
Length of time in the same job
|
Less than one year
|
93 (35.1%)
|
1-3 years
|
114 (43.0%)
|
4 or more years
|
58 (21.9%)
|
Number of days worked per week
|
3-4 days
|
94 (35.5%)
|
5-6 days
|
119 (44.9%)
|
7 days
|
52 (19.6%)
|
Works in same location every day
|
208 (78.5%)
|
Regular hours of work
|
201 (75.8%)
|
Work setting
|
Mostly indoors
|
220 (83.0%)
|
Mostly outdoors with shelter
|
22 (8.3%)
|
Mostly outdoors without shelter
|
23 (8.7%)
|
Wage is fixed or variable
|
Receives a fixed wage
|
101 (38.1%)
|
Not fixed / depends on work done
|
164 (61.9%)
|
How often receives wages
|
Weekly
|
42 (15.8%)
|
Monthly
|
176 (66.4%)
|
Irregularly
|
40 (15.1%)
|
Other
|
7 (2.6%)
|
Types of informal work
Just over 40% of participants reported they worked as employees in informal enterprises, including as cleaners (19), hairdressers (18), waiters (7), shop assistants (24), factory workers (12), office administrators (4), call centre workers (3), and security guards (3). Home based work included hairdressing (23), and making and selling goods, such as crafts, sewing, and baking (9). Other participants were self-employed as informal traders and in a variety of other own account jobs such as crèche work, fashion design, catering, plumbing, welding, sewing and marketing (Table 4).
A comparison of the characteristics of the different categories of informal work are shown in Table 4. Home-based workers were most likely to work seven days per week and not receive a fixed wage. Employed women and domestic workers benefited from more regular hours compared with other informal workers, however, many still could not rely on a fixed wage.
Table 4: Working conditions in different types of informal work
|
Conditions of work (N=265)
|
Type of work
|
Proportion in each category
n (%)
|
Earning <R1000 monthly
n (%)
|
Irregular working hours
n (%)
|
Work 7 days per week
n (%)
|
Paid monthly
n (%)
|
Fixed wage
n (%)
|
Domestic workers
|
56 (21.1)
|
12/56 (21.4)
|
5/56 (8.9)
|
1/56 (1.8)
|
49/56 (87.5)
|
36/56 (64.3)
|
Home based workers
|
49 (18.5%)
|
25/49 (51.0)
|
29/49 (59.2)
|
28/49 (57.1)
|
19/49 (37.8)
|
1/49 (2.0)
|
Employed in informal business
|
116 (43.8)
|
31/116 (26.7)
|
20/116 (17.2)
|
10/116 (8.6)
|
84/116 (72.4)
|
60/116 (51.7)
|
Own account workers: Informal traders
|
29 (10.9)
|
10/29 (34.5)
|
6/29 (20.7)
|
10/29 (34.5)
|
16/29 (55.2)
|
3/29 (10.3)
|
Own account workers: other
|
15 (5.7)
|
1/15 (6.7)
|
4/15 (26.6)
|
3/15 (20.0)
|
8/15 (53.3)
|
1/15 (6.7)
|
Income among informal workers
Most participants (149/265; 56.2%) reported earning between R1 000- 3 000 (USD70- USD200) per month for their work. However, many women (79/265; 29.8%) earned less than R1 000 (USD70) per month, with the highest proportion being home-based workers. A minority of women earned more than R3000 (>USD200) per month (37/265; 14.0%).
Most participants received additional income from the CSG (208/265; 78.5%), either for one (89; 33.6%), two (74; 27.9%), three (32; 12.1%), or more (13; 7.8%) children. In most cases participants reported that the father of their child was working (194/265; 73.2%) and had provided either money or material items for the baby in the past one month (181/265; 68.7%).
Most participants reported having a bank account (178/265; 67.2%). Despite being low paid, many mothers were saving money monthly (128/265; 48.3%), had a savings plan (123/265; 46.4%) and paid towards a funeral insurance policy (110/265; 41.5%).
Financial responsibilities
Participants were asked about current financial outgoings for themselves, their child and the household. Most expenses for which the mother was responsible were shared with others (Table 5). Expenses related to the child were frequently shared with the child’s father. Over half of participants reported they did not contribute to household bills or that these costs were shared with other family members. However, most participants reported being responsible for their personal expenses such their own clothing (122/265; 46.0%), toiletries and/or cosmetics (73/265; 27.5%) and paying for their cell phone or airtime (21/265; 7.9%). Some participants reported they regularly financially supported other family members (25/265; 9.4%) including their parents, siblings or other children not living with them.
Table 5: Financial responsibilities of participants
Participants’ financial responsibilities
|
All
n=265 (%)
|
Household expenses
|
|
Responsible for paying water, electricity, rates, monthly costs
|
Mother alone
|
62 (23.4%)
|
Shares the cost
|
62 (23.4%)
|
Do not pay / not applicable
|
141 (53.2%)
|
Who cost is shared with (n=62)
|
Father of the child
|
27
|
Other family members
|
35
|
Responsible for paying for rent
|
|
Mother alone
|
50 (18.9%)
|
Shares the cost
|
19 (7.2%)
|
Do not pay / not applicable
|
196 (74.0%)
|
Who cost is shared with (n=19)
|
Father of the child
|
12
|
Other family members
|
7
|
Non-family member
|
0
|
Responsible for paying for groceries
|
|
Mother alone
|
72 (27.2%)
|
Shares the cost
|
157 (59.2%)
|
Do not pay / not applicable
|
36 (13.6%)
|
Who cost is shared with (n=157)
|
Father of the child
|
61
|
Other family members
|
95
|
Non-family member
|
1
|
Responsible for transport costs
|
Mother alone
|
207 (78.1%)
|
Shares the cost
|
37 (14.0%)
|
Do not pay / not applicable
|
21 (7.9%)
|
Who cost is shared with (n=37)
|
Father of the child
|
33
|
Other family members
|
1
|
Non-family member
|
3
|
Expenses for the child
|
|
Responsible for paying for children’s clothes
|
Mother alone
|
66 (24.9%)
|
Shares the cost
|
181 (68.3%)
|
Do not pay / not applicable
|
18 (6.8%)
|
Who cost is shared with (n=181)
|
Father of the child
|
168
|
Other family members
|
10
|
Non-family member
|
2
|
Responsible for paying for child’s food or milk
|
Mother alone
|
56 (21.1%)
|
Shares the cost
|
154 (58.1%)
|
Do not pay / not applicable
|
55 (20.8%)
|
Who cost is shared with (n=154)
|
Father of the child
|
140
|
Other family members
|
13
|
Non-family member
|
1
|
Responsible for paying school fees
|
|
Mother alone
|
72 (27.2%)
|
Shares the cost
|
32 (12.1%)
|
Do not pay / not applicable
|
161 (60.8%)
|
Who cost is shared with (n=32)
|
Father of the child
|
27
|
Other family members
|
5
|
Non-family member
|
0
|
Responsible for paying childcare
|
Mother alone
|
89 (33.6%)
|
Shares the cost
|
41 (15.5%)
|
Do not pay / not applicable
|
135 (50.9%)
|
Who cost is shared with (n=41)
|
Father of the child
|
40
|
Other family members
|
1
|
Non-family member
|
0
|
Household food insecurity
A household is considered to be food secure if household members can access sufficient, safe and nutritious foods of their choice without anxiety. Most women had experienced some form of household food insecurity in the last month, and less than half were designated as food secure (112/265; 42.3%). Some participants experienced mild food insecurity (38/267; 14.3%) where they could maintain the quantity of the household food, but the food was less diverse and not their preferred choice. Nearly 30% of participants had moderate food insecurity (72/265; 27.2%) where not only was the food was of lower quality, but sometimes the quantity of food had to be reduced by limiting either the number or the size of meals. Further, 16% (43/265) of participants had severe food insecurity where they often had to reduce the number or size of meals, or had run out of food, gone to bed hungry, or spent an entire day and night without food.
Severe household food insecurity decreased with increasing income: 19/79 (24.0%) participants with an income <R1 000 were severely food insecure, compared to 22/149 (14.8%) of participants with an income of R1 000-3 000 and 2/37 (5.4%) participants with an income over R3 000. There was a significant higher prevalence of severe food insecurity among the lowest paid compared to the highest (p= 0.027).
In multivariable analysis, moderate or severe food insecurity was higher among mothers with an income less than R1 000 per month, and among mothers reporting themselves HIV positive. Mothers who reported receiving financial support from the child’s father were less likely to be food insecure.
Depression risk
Among all participants, 8.3% (22/265) were identified at risk of depression using the EPDS score cut off ≥13. To provide estimates of depression risk in the postnatal period we considered depression risk among mothers with children less than 12 months of age (132/265). Of these mothers, 6.8% (9/132) were identified as being at risk of postnatal depression. Among 133 mothers with a child aged between 12- 35 months, 13 mothers scored high on the EPDS (13/133; 9.8%). There was no significant difference between depression risk among mothers in the postnatal period compared to mothers with older children (p=0.38). Results were similar using the alternative Whooley Score, where a slightly higher percentage of mothers (40/265; 15.1%) were identified as at risk of depression. Again, prevalence of depression risk was similar among mothers with children under 12 months (21/132; 15.9%) and mothers with older children (19/133; 14.3%).
A small number of participants expressed thoughts of self-harm. Using EPDS, 12 mothers (4.5%) reported they had thought of harming themselves in the past 7 days, as compared to Whooley where 10 mothers (3.8%) reported they had thoughts about self-harm in the past two weeks.
Factors associated with high depression risk
In order to determine the relationship between food insecurity and depression, we dichotomised the food insecurity variable as no or mild food insecurity versus moderate or severe food insecurity.
Using the EPDS score as a continuous variable, Table 6 shows after adjusting for possible risk factors there is a significantly higher risk of postnatal depression among mothers living in households where there is moderate or severe food insecurity. However, receiving financial support from the child’s father and working regular hours were associated with a lower average EPDS score. In our study there was no association between risk of depression and HIV status.
Table 6. Factors associated with depression risk with EPDS score as continuous variable
N=265
|
Mean post-natal depression score
|
Bivariable
|
Multivariable
|
|
n
|
mean
|
sd
|
OR
|
95%ci
|
p
|
OR
|
95%ci
|
p
|
Mother's age
|
|
|
|
|
|
|
|
|
|
< 30 yrs
|
138
|
5.34
|
4.94
|
ref
|
|
|
|
|
|
30-47
|
126
|
5.73
|
4.86
|
1.07
|
(0.8-1.4)
|
0.58
|
na
|
|
na
|
Mother’s education
|
|
|
|
|
|
|
|
|
|
< grade 12
|
131
|
6.16
|
5.39
|
ref
|
|
|
|
|
|
≥grade 12
|
134
|
4.88
|
4.28
|
0.79
|
(0.6-1.0)
|
0.07
|
0.85
|
(0.7-1.1)
|
0.18
|
Mother in a relationship with child’s father
|
|
|
|
|
|
|
No
|
57
|
6.65
|
4.96
|
ref
|
|
|
|
|
|
Yes
|
208
|
5.20
|
4.84
|
0.78
|
(0.6-1.1)
|
0.11
|
0.93
|
(0.7-1.3)
|
0.67
|
Father gives money to support the child
|
|
|
|
|
|
|
|
No
|
84
|
7.30
|
5.09
|
ref
|
|
|
|
|
|
Yes
|
181
|
4.69
|
4.58
|
0.64
|
(0.5-0.83)
|
<0.001
|
0.73
|
(0.6-0.9)
|
0.03
|
Mother receives Child Support Grant
|
|
|
|
|
|
|
|
No
|
57
|
5.84
|
5.01
|
ref
|
|
|
|
|
|
Yes
|
208
|
5.42
|
4.87
|
0.93
|
(0.7-1.30)
|
0.63
|
na
|
|
|
Monthly earning
|
|
|
|
|
|
|
|
|
|
< R1000
|
79
|
6.27
|
5.26
|
ref
|
|
|
|
|
|
R2000-2999
|
149
|
5.34
|
4.75
|
0.85
|
(0.6-1.1)
|
0.26
|
0.90
|
(0.8-1.3)
|
0.93
|
≥ R3000
|
37
|
4.59
|
4.53
|
0.73
|
(0.5-1.1)
|
0.13
|
1.03
|
(0.7-1.5)
|
0.88
|
Salary
|
|
|
|
|
|
|
|
|
|
Not fixed
|
164
|
5.52
|
5.03
|
ref
|
|
|
|
|
|
Fixed
|
101
|
5.50
|
4.69
|
0.90
|
0.8-1.3)
|
0.98
|
na
|
|
|
Working hours
|
|
|
|
|
|
|
|
|
|
Irregular
|
64
|
6.39
|
5.41
|
ref
|
|
|
|
|
|
Regular
|
201
|
5.23
|
4.70
|
0.82
|
(0.6-1.1)
|
0.17
|
0.75
|
(0.6-0.9)
|
0.03
|
Stable work
|
|
|
|
|
|
|
|
|
|
< 4 yrs
|
207
|
5.57
|
4.72
|
ref
|
|
|
|
|
|
≥ 4 yrs
|
58
|
5.29
|
5.52
|
0.95
|
(0.7-1.3)
|
0.74
|
na
|
|
|
Self-reported HIV positive
|
|
|
|
|
|
|
|
Negative
|
117
|
4.91
|
4.59
|
ref
|
|
|
|
|
|
Positive
|
131
|
6.19
|
5.19
|
1.26
|
(0.9-1.6)
|
0.08
|
0.97
|
(0.8-1.2)
|
0.80
|
no answer/no test
|
17
|
4.41
|
3.99
|
na
|
|
|
|
|
|
Household Food Insecurity Access Scale(HFIAS)
|
|
|
|
|
|
|
Secure/Mild insecure
|
150
|
3.67
|
3.93
|
ref
|
|
|
|
|
|
Moderate/severe insecure
|
115
|
7.91
|
5.00
|
2.15
|
(1.7-2.8)
|
<0.001
|
2.09
|
(1.6-2.6)
|
<0.001
|
Significant findings in bold type. Only significant factors in bivariate analysis were included in the multivariate model