How COVID has added to the stress of South Africa’s most vulnerable young women
In 2021, the unemployment rate in South Africa was 44%. About 55.5% of South Africans lived in poverty. Figures show that in 2021, 10 million people, including 3 million children, lived in a household affected by hunger.
Poverty is a key factor in poor mental health. People who also experience precarious income, housing and food supplies are particularly vulnerable.
The burden of mental illness in South Africa is high. Nearly half of the population (47.5%) is at risk of developing a psychiatric disorder during their lifetime. Despite this heavy burden, access to mental health care in South Africa is very limited. Only 27% of patients with serious mental illnesses receive treatment.
The South African public health system was under-resourced and overburdened even before the COVID-19 pandemic. Health care in the publicly funded system is provided by 35% of the country’s doctors for 84% of the population.
Major depressive disorders and anxiety disorders have increased dramatically during the pandemic, with 2020 figures suggesting that 24% of the population have depressive symptoms.
Adolescents and young people who grow up in unemployed households and lack income and a regular supply of food are known to be even more stressed and anxious than young people in less resource-constrained households. Adolescent girls and young women from the poorest communities in South Africa also face additional mental health challenges. These include a lack of social support, financial insecurity, and gender-related vulnerabilities. But services specifically for adolescents and young people are woefully inadequate.
The HERStory2 study
In our recent study, we examined the socio-economic and mental health impacts of COVID-19 on South African adolescent girls and young women. The aim was to understand how the additional challenges brought about by COVID-19 had added to the existing risks faced by this population group.
Between November 2020 and March 2021, we conducted a survey and interviews with adolescent girls and young women aged 15-24 in six districts in South Africa. The young women in our study came from communities with some of the highest rates of HIV, teen pregnancy, and socioeconomic hardship in the country. We found that COVID-19 restrictions led to increased experiences of stress and anxiety. But despite the many challenges, some of the young women showed signs of emotional resilience.
Understanding the strategies some young women have used to cope with the uncertainty of COVID-19 could point to better ways to meet their needs.
Our results show that the COVID-19 pandemic and lockdown restrictions, introduced by the South African government in March 2020, have exacerbated situations of poverty, unemployment and food insecurity, adding to health stressors mental.
Young women in our study described how loss of household income, economic and food insecurity, fear of infection, and death of family members led to feelings of frustration, anxiety, and depression. . Almost three-quarters (71.8%) of young women reported financial problems during COVID-19 and lockdowns.
Hunger was a major issue, with 75.4% of young women saying they feared running out of food due to lack of money. A quarter said they had gone a day and a night without food.
This food supply anxiety had a negative effect on mental health, with 69% of young women saying they had become more distressed and anxious during COVID-19 and the lockdown.
Poor mental health was further compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress, and food insecurity. Respondents described feeling bored, frustrated, isolated, alone, scared and hopeless.
The young women had been unable to get the emotional support they needed during the lockdown. They spoke of their experiences of heightened tension in the home environment, with strained family relationships due to confinement, and family members feeling stressed, frustrated and confined to close quarters.
Fear was a predominant emotion in the accounts of respondents in our study: fear of infection, fear for family health and safety, fear related to economic insecurity and future prospects, and fear of leaving home during lockdown due to concerns about police brutality.
Respondents described an overwhelming sense of hopelessness about their current situation and the future. The young women said their dreams for the future had been shattered. Some shared desperate stories of their friends being unable to cope and choosing to end their lives due to a loss of hope that things would ever get better.
On a positive note, some respondents expressed emotional resilience, describing how they managed to cope in healthy ways and remain hopeful. Some described taking things one step at a time, accepting their situation and being patient, hoping things would get better. Respondents also described sources of psychosocial support that enabled them to cope. These included parents, grandparents, and community or faith groups.
The South African government must urgently recognize child and adolescent mental health services as a health priority and develop appropriate interventions. These must be innovative, cost-effective, scalable and evidence-based. Working through schools and community services could be a cost-effective way to increase access.
Strengthening the skills and capacities of lay mental health providers and frontline workers, including community health workers and teachers, could help reduce the mental health treatment gap.
Support could also be offered through accessible and dataless mobile health apps, digital technologies, virtual support solutions and online platforms. Telephone counseling services and safe community spaces are also options.
Mental health is not possible if basic needs are not met. Therefore, it is essential to strengthen social protection responses and social safety nets.
Read more: COVID-19 holds lessons for the future of social protection
Finally, efforts must be made to create an environment conducive to hope among adolescents and young people in South Africa.