Double-duty solutions for optimising maternal and child nutrition in urban South Africa: a qualitative study

Objective:To obtain a community perspective on key nutrition-specific problems and solutions for mothers and children.Design:A qualitative study comprising nine focus group discussions (FGD) following a semi-structured interview guide.Setting:The township of Soweto in South Africa with a rising prevalence of double burden of malnutrition.Participants:Men and women aged ≥18 years (n 66). Three FGD held with men, six with women.Results:Despite participants perceived healthy diet to be important, they felt their ability to maintain a healthy diet was limited. Inexpensive, unhealthy food was easier to access in Soweto than healthier alternatives. Factors such as land use, hygiene and low income played a fundamental role in shaping access to foods and decisions about what to eat. Participants suggested four broad areas for change: health sector, social protection, the food system and food environment. Their solutions ranged from improved nutrition education for women at clinic visits, communal vegetable gardens and government provision of food parcels to regulatory measures to improve the healthiness of their food environment.Conclusions:South Africa’s current nutrition policy environment does not adequately address community-level needs that are often linked to structural factors beyond the health sector. Our findings suggest that to successfully address the double burden of malnutrition among women and children, a multifaceted approach is needed combining action on the ground with coherent policies that address upstream factors, including poverty. Further, there is a need for public engagement and integration of community perspectives and priorities in developing and implementing double-duty actions to improve nutrition.