Eradicating childhood stunting should be a priority in SA

My grandfather received a single boiled egg for his 10th birthday. This story was retold many times when I was a child. He would tell us about how strange it was that he would eat the whole egg, when the rest of the family and others around him were always hungry. 

Food was scarce in Europe during World War II. His brother, born in 1942, had severe nutritional deficiencies. He only learned to walk after the war, once they had good nutrition and his bones could develop properly. These stories had a profound effect on my childhood and interests later.

When I learned in 2013 about stunting — the long-term effect of chronic undernutrition — and how many children still suffer from it in South Africa, I knew I wanted to contribute to its eradication. Stunting is identified when a child is significantly shorter than the average for their age. Along the way, I started working with Grow Great, the national campaign to galvanise South Africa towards committing to zero stunting by 2030. 

Yes, it’s a bold aim but an urgent one. Since the 1990s, the overall prevalence of stunting hasn’t reduced. Nationally, one in four (27%) children under five suffer from it. This is despite improvements in self-reported hunger brought on by the Child Support Grant, rising exclusive breastfeeding rates and South Africa being food secure at the national scale.

Growing up in a “food secure” country hasn’t benefited young children. A new report on a study of the nutritional status of children under five in Mqanduli in the Eastern Cape, shows that the biggest risk factor for stunting is being underweight. In Mqanduli, 24% of children younger than five are suffering from stunting. 

These children are more likely to have poor health throughout their lives, struggle at school and earn less as adults. In other words, suffering from stunting makes it harder to overcome poverty. With big dreams for national development, eradicating stunting should be a priority. If we continue to ignore it, other investments are undermined.

Among the children in this study, those younger than two also had a higher risk of stunting than children aged two to five. This is because younger children are more vulnerable to poor nutrition and sub-optimal environments. There are 1 000 days between conception and the second birthday, a period that is a critical window of opportunity for growth and development — and particularly laying down the architecture of optimal brain development on which all future investments into education are built. We should focus our investments on this time, when the returns are greatest, and children need good nutrition and care most.

Another issue that the study in Mqanduli identified is limited access to basic water and sanitation. Not a single child in the sample of 1 431 children had piped water to their homes. Those children without adequate sanitation had double the risk of stunting compared with their peers in households with a ventilated pit latrine. Poor basic service delivery is linked to the local children’s poor nutrition outcomes. This should be on election posters.

My grandfather – 87 this week – was old enough to be shielded from the worst effects of poor diet during World War II. His brother, whose exposure was during the critical first 1 000 days of life, experienced some of the severe effects. But they grew up under European wartime conditions, not 21st century South Africa. 

Other countries in the global south — our peers in terms of economic growth and inequality — have been successful in reducing stunting rates. Those countries have set promises to reduce intergenerational poverty into action. Without prioritising investment in early nutrition and healthy environments for children to grow up in, the government is just not delivering on its promises of a better future.

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Anna-Marie Müller
Anna-Marie Müller is a nutrition and food systems strategist at Grow Great.

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