Without proper nutrition, children will never learn – or earn – as much as they could have if they were nourished correctly in their first 1 000 days of life. There are simple ways we can start to tackle SA’s stunting crisis to help our children reach their full potential – and, in so doing, improve our prospects as a nation.

It was disheartening to read the nutrition statistics in the recently released South African Demographic and Health Survey (SADHS) 2016[1]. It shows that we have a dual problem of underweight in some children and obesity in others. However, the problems are not just weight-related, but height as well. Stunting – manifested in children who are short-for-age as a result of chronic undernutrition– is a serious yet largely unrecognised problem. The condition affects a quarter (27%) of children under five.

More poor children (36%) suffer from stunting than in the highest income quintile (13%), according to the SADHS results. Stunting is one of many ways in which South Africa’s high inequality and poverty affects the next generation, and unfortunately, that needle has hardly shifted over the past two decades.

If we are to improve education and human productivity, we must care about what children are eating, and we must support their caregivers too. There is a window of opportunity that starts in the womb and continues up to a child’s second birthday. When nutrition during this critical period – the first 1 000 days of life – is inadequate, children do not grow or develop according to their potential[2]. Stunting negatively impacts their ability to succeed at school, how much they are likely to earn as adults, and makes them more vulnerable to disease[3]. It’s costing our economy[4]. Every child deserves the best start to live a good life, and missing this window is a fundamental injustice.

A baby is measured to track their growth trajectory at Philani Day Clinic in Khayelitsha, Western Cape, July 2018. Stunting refers to children who are short-for-age as a result of insufficient nutrition over an extended period of time. Stunting can negatively affect a child’s brain function, organ development, and immune system, which can result in poor achievement at school, decreased productivity and earnings in adult life, greater risk of developing obesity and diabetes later in life, and ultimately, diminished chances of escaping the cycle of poverty. Photo by Bart Love.

Ideally, children should be breastfed until they are six months old[5]. This is the best way to make sure they get the right nutrition early on. Unfortunately, only a third of South African children breastfeed till six months. Then, as children start eating food round that age, they need a variety of food items to keep growing healthily: things like fruit, vegetables, beans and eggs for protein. Worryingly, the SADHS shows that among children younger than two years old, 44% ate salty snacks, 35% sugary snacks and 18% drank a sugary drink in the previous 24 hours. This is far from optimal nutrition.

Across the world, more and more people are eating diets characterised by high consumption of processed and sugar-sweetened foods. Many countries are undergoing the “nutrition transition”, which broadly speaking happens when diets shift along with economic development. Often this transition results in undernutrition coinciding with being overweight and obesity. To understand this paradox, the first 1 000 days period is again relevant. It appears undernutrition in early life can lead to a process of genetic and metabolic programming, which puts the child at life-long risk for obesity and chronic diseases. Yes, a possible delayed outcome of undernutrition is obesity[6]. Overall, the SADHS report indicates that 13% of children younger than five years are overweight.

The reality is that many South African families are struggling to put nutritious meals on the table. In 2019, 54% of our citizens will be unable to afford a healthy food basket, estimates the Bureau for Food and Agricultural Policy (BFAP) Agricultural Outlook 2018-2027[7]. Simply teaching people about healthy diets is therefore not enough when healthy diets remain impossible to access; the responsibility extends beyond education.

Our social protection mechanisms, like the child support grant, are not successfully reducing stunting rates[8], either. We need to innovate by adding new methods to our efforts. Scaling up coverage and increasing the monetary value of social support could be part of the solution. But we also need to be pragmatic in our context. For example, adding eggs to the diet of children older than six months is a cost-effective way to add protein, a vital food group, to their diet. Not only can eggs be useful for improving growth[9], but they hold entrepreneurship opportunities for communities as well.

If we are serious about bettering the future of South Africa, we have to commit to better outcomes for our children – starting from day one. We need to hold government and the private sector accountable for their promises and actions. We as civil society and ordinary members of the public have a role to play, too. Let us start by supporting initiatives like Grow Great, the national campaign for zero stunting by 2030. Let’s encourage pregnant women and mothers with young children to attend mother and baby groups that support them through the critical first 1 000 days. Let’s honour a mother’s choice – and her time – to breastfeed by supporting her in our homes and at work. Let us embrace the full meaning of letting children grow to their full potential – for all our sakes. By nourishing children well, we nourish the future we want.


This article was written by Anna-Marie Müller and first published by the Sunday Independent on 24 February 2019.

Anna-Marie Müller works on our strategy to keep all children on track by Grade 4.

 

References:

[1] National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), & ICF. South Africa Demographic and Health Survey 2016. 2019. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF

[2] Black, R.E., Victora, C.G., Walker, S.P., Bhutta, Z.A., et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382(9890):427–51.

[3] Victora, C.G., Adair,. L., Fall, C., Hallal, P.C., et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371(9609):340–57.

[4] Repositioning nutrition as central to development: a strategy for large-scale action. Washington DC: The World Bank; 2006 (http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf ). Gertler, P., Heckman, J., Pinto, R., Zanolini, A., et al. Labor Market Returns to Early Childhood Stimulation: a 20-year Follow-up to an Experimental Intervention in Jamaica. National Bureau of Economic Research Working Paper. 2013. http://www.nber.org/papers/w19185

[5]World Health Organisation. WHO recommendations on Postnatal care of the mother and newborn. 2014. Geneva, Switzerland. du Plessis, L., Peer, N., Honikman, S., & English, R. Breastfeeding in South Africa: are we making progress? In: Padarath A, King J, Mackie E, Casciola J, eds. South African Health Review 2016. Durban: Health Systems Trust; 2016.

[6] Uauy, R., Kain, J., & Corvalan, C. How can the Developmental Origins of Health and Disease (DOHaD) hypothesis contribute to improving health in developing countries? The American Journal of Clinical Nutrition, 2011; 94(6 Suppl), 1759S-1764S.

[7] Read the full report at https://www.bfap.co.za/bfap-baseline-2018/

[8] Devereux, S. & Waidler, J. Why does malnutrition persist in South Africa despite social grants?” Food Security SA Working Paper Series No.001. 2017. DST-NRF Centre of Excellence in Food Security, South Africa.

[9] Iannotti, L.L., Lutter, C.K., Stewart, C.P., et al. Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial. Paediatrics. 2017; 140(1):e20163459