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theses

The Western Cape Province of South Africa captivates tourists from all over the world who flock to the region to visit the spectacular view from Table Mountain, take in the beauty of wildlife on a safari tour, and sip some of the best wines in the world at any one of the region’s stunning vineyards. However, while the Western Cape prides itself as a vacation destination for visitors, residents are faced with social and health problems on an everyday basis as a result of the country’s complex apartheid history. The province remains socially stratified by social class, gender, age, and race in which socio-economically disadvantaged groups, specifically Black and Coloured women and children, are treated differently and live under unfavorable conditions. Maternal poverty, poor maternal nutrition and health, and maternal alcohol abuse, the three risk factors explored in this study, have resulted in malnourished infants and children. One response to this is that community-based organizations have been developed throughout the province to provide at-risk, low-income Black and Coloured mothers with income generating programs in order to lessen poverty and maternal and child health disparities, nutrition and health support groups, and early childhood development centers for young children in tandem with parenting workshops and counseling programs. Although there is significant research that indicates participating in evidence-based parenting programs can improve child health outcomes in high-income countries (Lachman et al., 2016), few studies have examined their impact in low-and middle-income countries and what constitutes effective implementation of parenting interventions in severely impoverished rural communities. This multi-program case study will examine how a community-based organization helps at-risk Black and Coloured mothers make better behavioral, nutritional, and parenting choices through a process evaluation using document analyses and 48 semi-structured qualitative interviews with staff and participants. Life Course Theory and the Social Determinants of Health are the guiding conceptual models to frame this research which stress that barriers to health, including economic disparities and health inequity in the early years of life, can have an impact on the health trajectories of children and that a mother’s social position is the main determinant of inequity, respectively.

ETD_8524

Ph.D.

Includes bibliographical references

by Simone Martin

doi:10.7282/T3DJ5JQ8

ETD doctoral

The author owns the copyright to this work.