A quarter of South Africa’s children fail to get out of the starting blocks to life, damaged by chronic malnutrition. Between 15 000 and 20 000 children experience severe episodes of acute malnutrition that lead to recurrent illness, hospitalisation and — for over a thousand a year — death.
On Friday, 28 November, Parliament will focus on how effectively our country is protecting children from hunger and malnutrition, with MPs scrutinising past failures in coordinating and implementing interventions. In doing so, they will need to confront both long-term insufficiency of nutritious foods and the urgent crisis of severe acute
malnutrition (SAM).
Stunting due to chronic malnutrition affects more than a quarter of children under the age of five in South Africa, costing the country billions in economic growth. Stunting is preventable. Yet, our country has neither a defined target nor a roadmap to eliminate it. It occurs when a child is too short for their age. It is linked to poor brain development, which limits a child’s ability to learn, and later, to contribute fully to the economy.
“Stunting is the result of cumulative setbacks from conception through the first years of life, when babies are born too small and young children lack the protein and micronutrients needed for their brains and bodies to grow,” says Dr David Harrison, CEO of the DG Murray Trust (DGMT).
“When MPs discuss this issue, they must recognise that one of the biggest obstacles to reducing stunting is the lack of a clear national goal, leadership and implementing mechanisms. The National Food and Nutrition Council is meant to play such a role but has yet to function. Still, the council is not equipped to drive a focused strategy over the next 10 years,” Harrison explains.
“What we need is the appointment of a ‘nutrition czar’ to drive a national programme across government departments.”
This programme should focus on three main goals: making protein-rich staple foods more affordable; reducing the number of babies born too small; and supporting smallholder farmers and households to grow their own fresh food.
1. Make protein-rich staple foods more affordable
As President Cyril Ramaphosa has recently stated, South Africa will not be able to address food affordability without the active involvement of the food industry. DGMT and Grow Great have proposed both to government and business the “double-discounting” of a basket of protein-rich staple foods. The plan relies on collaboration between the state and food sector. Manufacturers and retailers would forgo their profit on one product label, and government would match that discount. Together, a retail subsidy and industry contribution could lower prices of these items by 20-25%. This intervention is estimated to cost the fiscus around R4-5 billion per annum.
“These foods were picked because they offer the most nutrition for the least money, and have a long shelf life, which matters for families living in food poverty,” says Dr Edzani Mphaphuli, Executive Director of Grow Great. “Children also need fresh fruit and vegetables, so this plan is not a full solution to the food affordability crisis. But it would give parents more spending power and make it easier for them to buy protein-rich items like eggs and tinned fish,” Mphaphuli explains.
2. Introduce a Maternal Support Grant to reduce low birth weight deliveries
Food insecurity during pregnancy increases the likelihood of giving birth to a baby that is too small (under 2.5 kg), and these infants face a three times higher risk of becoming stunted. Evidence shows, however, that providing income support to pregnant women can significantly reduce low birth weight and stunting. Introducing a nine-month Maternal Support Grant would cost the state approximately R2 billion a year, but it could save roughly R13.8 billion in averted public health costs for
babies born each year, by preventing complications related to poor birth outcomes.
3. Support families to grow their own food
There is a growing network of NGOs providing support to communities to grow their own fresh food. There have been some successful partnerships between environmental extension services (EES) and these NGOs, but generally coordination is poor. There must be a stronger partnership between the two with EES providing seedlings, water tanks and fencing, and NGOs offering training and support. An allocation of R5 million per “agrihub” could support up to 200 smallholder farmers or household gardens.
The above strategies will start to reshape the long-term trajectories of children in South Africa. But they need to be supported by immediate steps to identify all those on the brink of acute malnutrition and implement urgent remedial action. This includes the restoration of the National Therapeutic Programme for children under two years of age who are failing to thrive, which has been operating poorly in many provinces. “With the right plans, leadership and implementation in place, there would be no need for parliamentary debates over past failures — stunting could be prevented and children protected from hunger and death from malnutrition,” Mphaphuli concludes.
