Heather Hogan Also known as “Mandela’s children”, the Birth to Ten (BTT) project, a collaboration between several universities and organisations, has studied thousands of children for the past 10 years to gauge the effects of urbanisation and political transformation on their growth and well-being. In 1989 the project began studying 3 275 children from the last trimester of their mother’s pregnancy until their 10th birthday. Great interest lay in their development because they would grow during a time of rapid political transformation. All were born in the year of former president Nelson Mandela’s release, hence the nickname “Mandela’s children”. All the children – 78% of whom are black, 12% coloured, 6% white and 4% Indian – came from the Johannesburg/Soweto area. According to Professor Thea de Wet, BTT project manager, the project is important because: “Historically urbanisation has brought along with it complex social changes which have had both beneficial and adverse effects on communities. “The obvious benefits of this urbanisation are the improved access to health care, education and employment. In South Africa, the government has been unable to deal with the demands that rapid urbanisation has placed on its infrastructure. “The urban poor experience poor housing with overcrowding, inadequate sanitation, poor hygiene, low income and disintegration of traditional family relationships. These demands come at a time when the government and the broader South African society is grappling with the major political, economic and social changes associated with the abolition of apartheid and the necessary transformation that has followed.
“The inability of the government to adequately provide the services mentioned above has major implications for the physical and psychosocial health of poor urban communities.” All children still in touch with BTT are attending school but First World health problems have begun to mingle with Third World problems. While Third World problems such as infectious diseases and malnutrition are declining, First World tribulations like respiratory diseases, car accidents, HIV and gunshot wounds are on the increase. The problems facing BTT children are diverse because their circumstances are different. De Wet says: “It is our impression that children living in high-rise building environments like inner-city Johannesburg have the biggest problems. They live in very unsafe environments and have to stay inside their buildings for long hours. Many of them attend schools in the inner city where they have no playgrounds and have to stay inside their school buildings for the duration of the school hours.” Dr Oscar Barbarin, of the University of Michigan in the United States, and Professor Linda Richter, of the school of psychology at the University of Natal, say the survey revealed that “children in poor communities are often exposed to high levels of violence. As children growing up in poor and dangerous communities mature their lives are likely to be touched more by substance abuse, teen pregnancy, juvenile crime and premature termination of education than those of more advantaged children. “The data shows clearly that the experience of violence does not have to be direct and proximal to have a negative effect on children’s development.” But although the children are 10 years old this year, the project is only beginning. “We have recently secured funding from the Medical Research Council, National Research Foundation and the Wellcome Trust to continue with the study for at least the next two years, when we plan to look at adolescent development, including sexual and reproductive development,” De Wet says. “Our goal is to follow the BTT until 20 years of age. From next year we will call the study Birth to Twenty.” The South African Medical Research Council, the University of the Witwatersrand, the Johannesburg Metropolitan Council department of health and researchers from Rand Afrikaans University, the University of Natal and universities in the United Kingdom and the US are working on the project. BTT is funded by the Urbanisation and Health Programme of the Medical Research Council of South Africa, the Anglo American De Beers Chairman’s Fund Educational Trust, the National Research Foundation, the University of the Witwatersrand and the Wellcome Trust.