President Cyril Ramaphosa’s powerful commitment to eradicate stunting by 2030 sets a clear national goal that must anchor National Treasury’s budget priorities over the next three years.
The president’s announcement during his State of the Nation Address on Thursday, 12 February, follows Cabinet’s approval of the National Strategy to Accelerate Action for Children (NSAAC) which sets 10 national priorities to improve the lives of children and teenagers.
The evidence is clear: the most effective way to reduce stunting is to intervene during the first 1 000 days of life — from conception to a child’s second birthday — a critical period for growth and development.
“Research shows that the risk of stunting increases when babies are born with a low birth weight (under 2.5 kg) and never catch up because their mothers were malnourished or drank alcohol while pregnant,” says David Harrison, CEO of the DG Murray Trust (DGMT).
South Africa has the highest rate of Foetal Alcohol Syndrome in the world and, over the past decade, about 800 000 babies were born underweight and brain-damaged due to alcohol exposure in the womb.
“The president is right to prioritise the reduction of heavy drinking and improved nutrition for pregnant women. Now, we must fund interventions that deliver the greatest impact and return on investment,” Harrison adds.
As Finance Minister Enoch Godongwana prepares to table his Budget, DGMT calls on National Treasury to prioritise high-impact measures in the medium term:
- Introduce a Maternal Support Grant to reduce low birth weight and childhood stunting at a cost of approximately R2 billion annually.
- Strengthen antenatal care by transitioning from iron and folic acid supplementation to multiple micronutrient supplementation (MMS) for pregnant women in the public health system to improve foetal growth. Experience from other countries indicates that MMS is worth it, as its marginally higher cost compared to iron and folic acid is offset by improved birth outcomes.
- Make protein-rich foods more affordable through collaboration between food producers, retailers and government at a cost of R4–5 billion per annum.
- Strengthen alcohol policies, including introducing minimum unit pricing, to reduce drinking during pregnancy and prevent costly health and social harm.
- Introducing a Maternal Support Grant
Pregnancy is a period of increased nutritional need, yet poor and vulnerable pregnant women in South Africa receive no targeted income support until after their baby is born and registered to receive the Child Support Grant (CSG). The current Social Relief of Distress Grant, while necessary, cannot adequately fill this gap in income support, because it is too low and doesn’t address the specific needs and vulnerabilities of expectant and postpartum mothers.
A Maternal Support Grant — to the value of the CSG and paid from the second trimester of a confirmed pregnancy until three months after birth — would reduce the risk of babies being born too small and improve early childhood outcomes.
While the CSG offers much-needed social protection to more than 13 million children each month, it has not kept pace with rising food prices and currently reaches only about 81% of eligible children. Nearly half of eligible infants miss out in their first year, often due to documentation barriers.
“For the CSG to have maximum impact, its value must rise from R560 per child per month to the food poverty line of R855, starting with young children,” says Harrison.
- Multiple micronutrient supplementation (MMS)
More than 63.5% of households in South Africa are food insecure, with 17.5% experiencing severe food insecurity, driven by higher food prices. When pregnant women can’t afford nutritious food, they become malnourished and experience micronutrient deficiencies, increasing their risk of poor birth outcomes.
“Rising food prices push many families towards cheaper, starchy and ultra-processed foods that fill stomachs but lack essential nutrients. Cutting back on protein sources like eggs, meat and dairy, and other foods making up a diverse diet such as fresh produce, can lead to hidden hunger —micronutrient deficiencies that harm foetal development, says Liezel Engelbrecht, Nutrition Lead for the Hold My Hand Accelerator, incubated by DGMT.
“MMS provides a single tablet with an effective combination of 15 vitamins and minerals, replacing iron and folate supplements for pregnant women currently being provided through public health channels. This will reduce the risk of low birth weight, preterm birth and early infant mortality,” Engelbrecht explains.
- Make protein-rich foods more affordable
Income support and MMS will make a significant difference in the lives of pregnant women and their infants, but we need to sustain these gains beyond the first 1 000 days by making protein rich foods more affordable.
A targeted double-discount on a basket of 10 protein-rich foods — supported by retailers, manufacturers and the government — could significantly reduce prices of key items like eggs, beans, tinned fish and amasi. This will have a greater impact than exempting more foods from value-added tax (VAT), because it would be directing more money to low-income households through government-funded interventions.
“It would put real buying power back into the hands of families who need it most. We cannot rely on social assistance alone to address child malnutrition. Affordability matters,” Engelbrecht explains.
- Alcohol policy reform
Maternal malnutrition increases the risk of low birth weight, as does drinking during pregnancy. Stronger alcohol harm reduction measures, including higher excise taxes and minimum unit pricing would reduce heavy drinking by raising the price of cheaper products.
Countries such as Scotland have implemented minimum unit pricing with measurable reductions in alcohol-related harm, without penalising moderate drinkers.
Reducing alcohol harm would not only protect babies’ development, but also lower long-term health and social costs.
A national programme across government departments
Achieving the president’s stunting target will require coordination across government departments. While the National Food and Nutrition Council is meant to be the coordinating mechanism for overall nutrition, it’s not functioning.
“We need the appointment of a ‘nutrition leader’ to drive a national programme across relevant departments. This programme should focus on making protein-rich staple foods more affordable; reducing the number of babies born too small; and reducing alcohol harm,” Harrison concludes.
