Resource insecurity leaves ‘silent scars’ on women’s health in South Africa

Chronic shortages of water, electricity, and food are leaving deep and lasting marks on women’s mental and reproductive health in South Africa, according to new interdisciplinary research that frames resource insecurity as a public health crisis rather than a purely environmental or infrastructure challenge.

The study shows that daily struggles to secure basic resources are not isolated hardships but interconnected stressors that shape women’s bodies, emotional well-being, and survival strategies over time. In communities facing persistent service failures and economic marginalization, women bear the brunt of scarcity through unpaid labor, psychological strain, and heightened exposure to violence and health risks.

The findings are detailed in a paper titled Silent Scars in the Water–Energy–Food Nexus: How Resource Insecurity Shapes Women’s Mental and Reproductive Health in South Africa, published in the International Journal of Environmental Research and Public Health.  

The water–energy–food Nexus as a determinant of mental health

The research is based on the water–energy–food nexus, a framework typically used to examine how resource systems interact in the context of sustainability and development. The authors extend this framework into public health, arguing that when access to water, electricity, and food breaks down simultaneously, the combined effects generate intense psychological pressure that accumulates over time. Rather than episodic stress, women experience a constant state of vigilance driven by uncertainty over the next meal, the next electricity outage, or the availability of clean water.

Fieldwork conducted between 2022 and 2024 in Lorentzville, an informal settlement in Johannesburg, and Mqanduli, a peri-urban area in the Eastern Cape, reveals how scarcity structures daily life. Women report spending significant mental energy planning meals with limited food, managing debts for electricity, walking long distances to collect water, and negotiating household expectations in the absence of stable resources. This ongoing burden produces symptoms associated with anxiety, emotional exhaustion, and depression-like states, even when women do not describe themselves using clinical language.

The study finds that resource insecurity erodes mental well-being through both material deprivation and social pressure. Women often feel shame, guilt, and fear when unable to provide food or maintain household routines, particularly in contexts where caregiving is culturally expected. The mental toll is compounded by uncertainty, as irregular service delivery and fluctuating prices prevent long-term planning. In this environment, psychological distress becomes normalized, rendering it largely invisible to formal health systems.

Mental health impacts cannot be understood in isolation from broader structural forces. Historical inequality, unemployment, weak governance, and urban planning failures shape who experiences scarcity and how intensely. Women in informal settlements and peri-urban communities are especially vulnerable due to limited political influence and restricted access to services. 

Reproductive health risks embedded in everyday scarcity

The study also documents significant reproductive health consequences linked to chronic shortages of water, energy, and food. In both research sites, women describe how lack of clean water and sanitation complicates menstrual hygiene management, increasing discomfort, stress, and infection risk. Electricity shortages disrupt food storage and cooking, contributing to poor nutrition during pregnancy and postpartum periods.

Food insecurity emerges as a critical driver of reproductive strain. Women report skipping meals so children can eat, leading to nutritional deficiencies that weaken physical resilience. Physical exhaustion from unpaid labor, including water collection and caregiving, is associated with miscarriages, prolonged recovery after childbirth, and reproductive fatigue. These outcomes are not framed as isolated medical events but as cumulative effects of sustained deprivation.

Access to reproductive healthcare is further limited by economic barriers, distance to facilities, and inconsistent service provision. The study highlights widespread challenges in accessing contraception, prenatal care, and safe abortion services, particularly for young women and undocumented migrants. In some cases, women rely on informal or unsafe reproductive health practices due to lack of alternatives, increasing both physical and psychological risk.

The authors also identify a strong link between reproductive health and power dynamics shaped by scarcity. Economic dependence on partners or informal income sources limits women’s autonomy over reproductive decisions. Negotiating contraception or healthcare becomes more difficult when women lack financial independence or fear violence and abandonment. In this context, reproductive health outcomes are inseparable from broader social and economic constraints.

The study challenges policy approaches that treat resource provision and health services as separate domains. The findings show that reproductive health risks intensify when basic services fail, underscoring the need for coordinated interventions that address both material access and healthcare delivery.

Gender-based violence and survival strategies in conditions of insecurity

The study finds a relationship between resource scarcity and gender-based violence. Economic stress and dependence increase women’s exposure to intimate partner violence, coercion, and emotional abuse. In both urban and peri-urban settings, women describe how lack of income and resources reduces their ability to leave abusive relationships or negotiate safer conditions.

Scarcity also shapes survival strategies that carry significant health risks. Some women engage in transactional or survival sex to secure food, rent, electricity, or transport. These practices are not framed as voluntary choices but as responses to structural constraint. The study shows how transactional relationships increase exposure to unintended pregnancy, sexually transmitted infections, and psychological distress, while simultaneously reinforcing cycles of dependence and vulnerability.

Young women and migrants face heightened risk due to limited access to formal employment and social protection. Without documentation or stable income, they are often excluded from public services and support programs, pushing them toward informal networks that offer short-term relief but long-term harm. The authors emphasize that these dynamics cannot be addressed through individual behavior change messaging alone, as they are rooted in systemic inequality.

Despite these challenges, the study also documents forms of resilience and collective coping. Women rely on informal support networks such as food sharing, communal cooking, savings groups, and emotional solidarity. These networks provide temporary relief and social connection, helping women navigate scarcity on a day-to-day basis. However, the authors caution that such strategies are fragile and insufficient substitutes for systemic solutions.

The research argues that women’s bodies absorb the consequences of policy failure, economic exclusion, and environmental stress. The concept of “silent scars” is used to describe the cumulative mental and physical impacts that remain largely unrecognized by formal institutions. These scars do not always manifest as acute crises but shape long-term health trajectories and life opportunities.

Policy implications for health, infrastructure, and gender equity

The study calls for integrated policy responses that recognize the water–energy–food nexus as a determinant of health. Addressing resource scarcity requires more than technical infrastructure upgrades; it demands gender-responsive planning that centers women’s lived experiences. Health systems, in particular, must account for the psychological and reproductive impacts of chronic deprivation rather than focusing solely on acute illness.

The authors note that mental health services should be embedded within community-based resource programs, enabling early identification and support for women experiencing chronic stress. Reproductive healthcare must be made accessible, affordable, and responsive to the realities of women living in informal and peri-urban contexts. This includes addressing barriers faced by migrants and young women, who are often excluded from formal systems.

Importantly, the study highlights the need to address gender-based violence as part of resource policy. Economic empowerment, reliable service provision, and social protection are identified as key levers for reducing dependence and vulnerability. Without addressing underlying scarcity, efforts to prevent violence and improve health outcomes are likely to fall short.