For nine years I have worked as a child protection specialist at the United Nations Children’s Fund (Unicef). One phrase defines my experience in this work: stark contrasts.
Encouraging and life-inspiring moments, which foster a renewed belief in humanity, have come from people exhibiting extraordinary compassion and the miraculous ability to stretch meagre resources for the increasing number of orphaned children.
Thousands of community-based organisations support children — some volunteers responding to children’s needs and others professional services ensuring children in remote areas are not neglected.
Alongside this, one learns of increasing numbers of orphans as mothers continue to die every day.
The growing disparity in our society not only reflects vast economic discrepancy, but discrepancy in accessing basic rights, more specifically the right to parenting.
South Africa’s progressive legislative framework and prolific number of plans are strategic attempts to ensure that children’s rights are met.
Vulnerability
Research shows that children orphaned by Aids are considered particularly vulnerable and Unicef research shows that factors such as poverty levels and access to education are also significant indications of vulnerability.
Unquestionably, progress has been made.
Birth registration has enhanced access to social assistance, which has in turn decreased income poverty and improved nutrition and education levels of vulnerable children.
Fee-free schools and school feeding schemes have improved school enrolment and school attendance.
South Africa has embraced the African Union’s roadmap on shared responsibility and global solidarity for the Aids, TB and malaria response.
The turnaround strategy in South Africa earmarked a national campaign to provide free treatment to all eligible people living with HIV, coupled with a massive programme of testing and counseling for HIV and screening for TB.
South Africa’s national Aids investment is the second highest in the world and we currently have the largest antiretroviral therapy (ART) programme in the world reaching more than two million people.
Access to treatment (particularly prevention of mother to child transfer of HIV) has strongly contributed to reduce child mortality in South Africa.
However, maternal mortality rates are still high, particularly in relation to per capita GDP. Research shows that HIV-positive pregnant women often do not enter long-term care and treatment, or do not adhere to ART.
The reasons are not clear, but may include distance to clinics, post-partum depression, physical and socio-economic challenges and problems related to the treatment itself.
The department of social development, in their analysis of vital registration data, reports that a total of 1.38-million children had lost their mothers in 2012.
Although the numbers of mothers dying each year has decreased since 2008 from 158 390 to 114 275, the cumulative effect of the total number of children without living mothers is distressing.
A similar analysis of paternal mortality is not possible, since fathers’ identities are not consistently recorded upon the registration of the birth of children.
However, the Children’s Institute regularly analyses data from General Household Surveys and report that paternal mortality is higher, with 2.28-million paternal orphans in 2011.
This is because of higher mortality rates of men in South Africa, as well as the frequent absence of fathers and their status being unknown.
Furthermore, the total number of total orphans has doubled since 2002, with the result that 21% of all children in South Africa have lost a mother, a father or both parents.
The large numbers of children who are still losing their parents is disturbing, even more so because children losing their parents in South Africa are mostly living in the poorest 20% of households.
Research also tells us that children orphaned through Aids-related deaths are more likely to experience long term depression, anxiety and post-traumatic stress disorder, and are more susceptible to emotional and physical abuse.
Strategies to care and support children and families affected by HIV have led to an abundance of programmes.
Nation-wide training
Communication between state and civil society organisations in this field has been established through the National Action Committee for Children affected by HIV and Aids and with the help of this forum, nationwide training to strengthen families and organisations has taken place. However, the service delivery model for social services in South Africa is complex, requiring effective partnerships across public, private and civil sectors.
This complexity has found many national and local organisations falling out of funding parameters, leading to the closing down of pivotal services. Cluster foster care programmes are a case in point.
What needs to be done?
• Greater efforts to keep mothers on HIV treatment and to reduce maternal and paternal mortality, and
• Simplification of the social service delivery model, including a plan for sustained and effective reach of these services to all areas, particularly areas of need.
This article forms part of a supplement paid for by Nedbank and Old Mutual. Contents and photographs were supplied and signed off by Nedbank and Old Mutual