In 1920, American women were finally recognised as legitimate citizens when they were given the right to vote. In that same year, the first ever Miss America pageant took place. So while on the surface they were empowered with equal rights to men, that empowerment was diluted by a timely reminder that they must not forget to be women. They were still going to be judged according to who had the loveliest waist or the prettiest hair.
A similar phenomenon occurred in South Africa in 1994, with the collapse of apartheid, which enshrined systems not just of race, but also of gender discrimination. For the first time, black women could (theoretically, at least) be whatever they wanted to be. In the same year, South Africa's first case of anorexia in a black woman was recorded. Black South Africa has since seen a surge in the number of cases of anorexia and bulimia.
At one time, eating disorders were thought to be the domain of white, middle-class girls, but a recent joint study by the University of Zululand and Northumbria University of body perception among 40 British and 40 Zulu girls found that more of the Zulu women appeared to suffer from eating problems than their British counterparts. More than half appeared to have erratic eating behaviour, either not eating for periods of time or vomiting after food. Many of them said it was because they wanted to look less like their mothers and more like western girls. Today, almost 10 years after that first case, there are thought to be as many black as white women with eating disorders in urban areas.
Empowerment brings with it a new set of problems for women. "If your position in society changes, what happens to your identity," asks Professor Christopher Szabo, principal psychiatrist in the eating disorders clinic at the state-run Tara hospital, Johannesburg. "There is an inverse relationship between empowerment and self-acceptance. At a time when women are experiencing such a high level of empowerment, there is a very low level of self-acceptance. It's a contradiction. Someone can be whoever they want to be and yet they choose to squeeze into stereotypes of eating, shape and physical size." For many young women the words "You can be whatever you want to be" are read as "You have to be everything you can be and you must be the best at it."
Graham Alexander is a clinical psychologist who specialises in the treatment of eating disorders at the privately run Crescent clinic in Cape Town. He treats mainly white, middle-class girls who, he says, are also feeling the effects of the social change: "There has been an increase in pressures in our society. We get anxious with any change, even if it is for the better. There are university quotas and there is no guaranteed employment like there was before. Young people leave school and then struggle to get into university and struggle to find a sustaining career."
Interestingly, white men are also adding to the phenomenon. While a black male has never been recorded as having an eating problem, white males account for 10% of all cases of eating disorders in South Africa. Although no definitive studies have been done, Szabo says affirmative action is a possible cause. It has affected white men by negatively labelling them as bastions of the old ways.
But it is black women who are feeling the change the most. Traditionally they have cherished a curvy figure: this is a social group that has always thought a big bum the sexiest thing a woman could have. And studies have found that in societies where plumpness is celebrated, there are none of the associated health problems seen in the west. In countries where weight has been medicalised - where being overweight is considered a curable illness - the health problems begin. Of course, it is not quite as curable as people like to think. Ninety-nine per cent of people who lose weight pile it back on as soon as they take their eyes off the scales and, hardly surprisingly, 70% of dieters are found to be depressed.
Researchers discovered that in rural areas many women still say they wish they were bigger. But in cities, where western culture has taken hold, black women, like white women, always want to be slimmer. Being thin connotes success, self-control and self-discipline and, in a pattern that has also been seen in the US, as non-whites become integrated into white, urban culture and try to get ahead within that environment, they feel the need to slim down.
The pressure does not just come from within themselves. Young black women now have access to careers and education because their parents engaged in a long and painful struggle. They are keen for their daughters to embrace these new paths to wealth and success and as a result encourage them to strive for a "European body", believing it will help them to be taken seriously.
At Waverly high school for girls in Johannesburg, every student in the two classes of girls I spoke to could tell me a story about either or both of her parents telling her she was physically unacceptable. One 14-year-old said: "Your parents want you to look like someone else. My mother teases me when I want food and calls me a giant. I never eat at home because of my mother." A 17-year-old's grandmother told her to make herself sick after eating so that she didn't put on weight. Another mother buys her daughter outsize clothes and tells her that if she continues eating, she will soon be able to fit into them.
Out of a class of 25 students at Waverly high, two girls admitted to eating almost nothing. One 14-year-old told me that she eats one piece of bread a day. She has asked her mother to take her to hospital so she can have the fat cut off her body. "You see models on television, you want to be like them and it hurts."
Another is sustained by a single orange a day; if she feels hungry, she drinks water. That is fewer calories than people suffering the ravages of famine consume. (None of the girls wanted to be named.) The irony is that a survey by the teenage health awareness group, Lovelife, recently found that 32% of South African teens did not have enough to eat because their families could not afford it.
All the while the girls are reminded of their duty. A teacher at Waverley admitted that when she grows exasperated with her class of unruly girls she berates them for wasting the chances they now have. They are the ones to take the country into a new era, she tells them. It is an enormous amount of pressure for already anxious teenagers to be under.
In the end, unsurprisingly, it often comes down to boys. As one student pointed out, "Fly guys only want skinny girls. A fat girl might like a fly guy but he would never go out with her." Jameson, a recent graduate and migrant from a rural area to the city, says that when he was growing up he admired bigger girls. Now, though, he says he would never go out with "a woman who walks with a rumble". His girlfriend is slim and he would not have it any other way. Then, in the same breath, he points out that if he were to marry, his wife, in addition to having a delicate frame, would need to be able to plough and carry 20kg of water on her head.
There is little wonder that many of the girls are confused. Caught between the old and the new, and required to embody both with equal panache, they are left not quite sure what they are meant to be. And the depressing result is that being the future of a "new" country is wreaking havoc on their health.
