South Africa’s children are dying of hunger

Soon street poles will be adorned with election posters, and smiling party leaders will exhort us to choose them in this year’s general elections. It will be the time of faux caring engagements for photo ops as politicians hopscotch across the country, telling stories of glorious yesteryears. The perpetually neglected rural hinterlands will be cynically spruced up and flooded with grand promises, meagre food parcels, and one-wash T-shirts.

In the swirl of the posturing and promises, uncomfortable truths about our ruling party and nation will be temporarily suspended because epic failures like hunger and poverty, even children dying of malnutrition, must only be found in manifestos as future crises to be solved.

But let’s be clear. The ANC government is failing millions of children. Many suffer from and are dying of malnutrition. Their bright futures are being downgraded to junk status.

We are a nation in crisis with a silent epidemic of hunger that a food parcel cannot cure, and South Africans, particularly children, have been abandoned by the very government tasked with ensuring their right to food and good nutrition enshrined in the Constitution.

Equally culpable is the food industry, which seems to view food as a profit-making commodity unfettered by the responsibility of ensuring food for all in a wealthy country with the productive capacity to feed every person.  In the absence of sufficient industry conscience, it is incumbent on the government to define and enforce this responsibility.

The South African Human Rights Commission’s 2023 report on Child Malnutrition and the Right to Food in the Eastern Cape lays bare in 94 devasting pages the avoidable tragic consequences of malnutrition.

All the statistics confirm what has been described as the slow violence of hunger in South Africa.

The Department of Health, answering a parliamentary question last year, admitted that every year, over 15 000 children are diagnosed with severe acute malnutrition, with 1 000 dying directly from it. A 2022 research study showed that malnutrition is the underlying cause of death in a third of child deaths in South Africa – another 10 000 deaths a year. A quarter (27%) of children under five are stunted due to chronic malnutrition.

These are not random incidents, and for this to happen, a set of adverse circumstances or factors have come together to create what has been described as the slow violence of hunger in South Africa.

What, then, are the systemic failures and challenges that have brought us to a place where urgent action to safeguard the lives of children is not only demanded but is vital?

While the World Bank defines South Africa as a middle-income country with a gross national income per capita of USD 7,055, it also describes it as the world’s most unequal nation. In 2022, the World Bank called the inequality of opportunity in South Africa exceptional, meaning that most citizens are born into a poverty trap that neither they nor their children are likely to escape. This means that lives are still informed by the legacy of apartheid and further entrenched because of a lack of post-apartheid transformation.

In 2016, South African economist Anna Orthofer calculated that the top 10% of the population held 90–95% of all wealth while the poorest 50% of the population, who earn about 10% of all income, own no measurable wealth. According to the World Bank’s Human Capital Index, children born today can expect to attain only 43% of their potential by age 18, mainly due to stunting and poor learning outcomes.

This makes a mockery of the words of former president Nelson Mandela when he accepted the Nobel Peace Prize in 1993 and promised that “children must, at last, play in the veld, no longer tortured by the pangs of hunger or ravaged by disease, or threatened with the scourge of ignorance, molestation and abuse, and no longer be required to engage in deeds whose gravity exceeds the demands of their tender years”.

Thirty years later, children are yet to be released from the torture of hunger pangs, and malnutrition is a key driver of their deaths.

In its November 2023 Household Affordability Index, the Pietermaritzburg Economic Justice and Dignity Group (PMEJD) showed the difference between the unemployment rate for African and white South Africans, which stood at 36% and 7.6%, respectively.

This kind of inequality breeds and perpetuates intergenerational poverty, with 62.1% of children experiencing multidimensional poverty, confronting deprivations in areas such as housing, nutrition, and education. Poverty, race, and geographical location emerge as the main reasons for child poverty, with children from poor households, African children, and those residing in rural areas facing a higher likelihood of multidimensional poverty.

Consider the statistics from PMEJD: 55% of South Africans live below the upper-bound poverty line of R1 558, with over 29 million African South Africans falling into this category. Add to this figure the 25.2% or 13.8 million South Africans living below the Food Poverty Line of R760 (as set by Statistics South Africa in March 2023) and an unemployment rate of 31,9%.  Over a third of children live in households with income below the official food poverty line.

The PMEJD calculates a child’s average monthly cost of a basic nutritious diet. In November 2023, it was set at R946.98, showing that the R510 Child Support Grant (CSG) is below the cost of a nutritious diet and the Food Poverty Line of R760.

So what happens when children aren’t getting enough nutritious food to eat?

The Children’s Institute at the University of Cape Town calculates that before the COVID-19 pandemic, one in 10 children lived in households where they were reported to go hungry at least sometimes because there wasn’t enough money for food.

Deaths caused by severe acute malnutrition were the leading causes among under-fives from 2015-2019 (apart from 2018), with 5 336 deaths recorded by the Department of Health. Half of all child deaths in hospitals in 2018 had malnutrition as a contributing cause.

South Africa’s stunting rate of 27% among children under five is unacceptably high for a middle-income country. Stunting occurs when children suffer long-term nutritional deprivation and are defined as a height-for-age <-2 standard deviations in the WHO Child Growth Standards median. It often results in delayed mental development, poor school performance and reduced intellectual capacity. In turn, this affects economic productivity at the national level.

A 2023 report by the Children’s Institute analysed the impact of the Child Support Grant and found that if the SA government sticks to the low value of the grant, then child food poverty is likely to increase. This, in turn, will lead to increased child inequality, deprivation, malnutrition and stunting. International treaty bodies and South African courts will view Increases in these child-centric indicators as “evidence that the state is not achieving progress in realising children’s right to social assistance and is unjustifiably violating the basic nutrition rights of over seven million children,” the report states.

The DG Murray Trust believes there is no need for the status quo to remain. It is not preordained that children in South Africa must die of hunger.

The Child Support Grant (CSG) has been rightly hailed as a successful intervention in child poverty. But, it is just not enough.

In its 2022 submission to the Human Rights Commission’s inquiry, UNICEF South Africa called for an increase in the CSG, saying that it is insufficient to cover children’s basic nutritional needs. They argued that the long-term consequences of malnutrition, such as stunting, are more expensive than the short-term cost of raising the CSG. UNICEF supported using cash-plus programmes, which combine cash transfers with other interventions like nutrition education and access to healthcare, as effective measures to reduce malnutrition and enhance child development.

The Children’s Institute, in its 2023 report on the CGS, advocates a phased-in approach “that does not shock the national budget but still achieves substantial poverty reduction effects for children within five years, with the potential to transform the prospects for a current cohort of children, and with benefits that will flow forward to future generations”.

The SAHRC believes the CSG amount is inadequate, saying, “The paramount concern lies in the grant’s value, which does not provide sufficient financial support to ensure that all eligible children receive the nutrition essential for their growth and development”.

It called for a top-up nutrition grant. “Such an enhancement would align with the state’s constitutional obligation to ensure that children receive the nutrition they require, thereby bridging the gap between the current grant value and the minimum threshold necessary for basic nutrition”. The Commission also urges a phased-in approach to increasing the value of the grant.

There has been an equally urgent call to extend the grant into pregnancy.

In its December 2023 “Investigation into maternity and parental benefits for self-employed workers” report, the South African Law Review Commission advocated “that the existing Child Support Grant be extended to all eligible poor and vulnerable pregnant women, including self-employed workers in both the formal and informal economy, who fulfil the criteria for child support grant and that the maternity support should be provided for six months of pregnancy and be registered in the name of the expectant mother. The maternity support should be converted into a CSG after the child’s birth by section 6 of the Social Assistance Act, 2004”.

The SA government urgently needs to address the lack of coordination and a single focus on nutrition and give real effect to the most recent National Food and Nutrition Security Plan, starting with establishing a National Food Council that will become a central mechanism for leadership and alignment of government action. The Committee on Morbidity and Mortality in Children recommended improving nutritional data collection at the hospital and primary levels for targeted intervention.

There is an acknowledgement that civil society organisations and the private sector have become essential actors in the food security and nutrition space, and these partnerships can be strengthened considerably through government collaboration.

President Cyril Ramaphosa has made two critical public statements about the role of nutrition, poverty and the well-being of children.

In February 2021, he stressed that “maternal health, child nutrition and early childhood development are vital to the transformational programme of this government”.

In September 2022, he said: “Child malnutrition is one of the greatest impediments to the well-being of our people and the development of our society… The fight against child poverty is, therefore, one of the priorities of this administration”.

Yet, while the ANC’s 2019 Manifesto mentions children 11 times, nothing is said about child hunger and nutrition. Hunger is mentioned only once in the context of land reform. Malnutrition is never mentioned.

Phylicia Oppelt is the Project Lead for DGMT Change Ideas.

TimesLIVE first published this article on 28 January 2024. See it here.


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