(John McCann/M&G)
The government declared the first Saturday of November as National Children’s Day to highlight progress made towards the realisation and promotion of the rights of children.
Section 28(1)(c) of the Constitution provides children “the right to basic nutrition and basic health care services”. In addition, article 14 (2)(c) of the African Charter on the Rights and Welfare of the Child says that state parties shall take measures “to ensure the provision of adequate nutrition”.
At the annual International Social Justice Conference and Summit held in Cape Town recently, high-level discussions took place among policymakers, government officials and civil society representatives. Justice Edwin Cameron said in his keynote address that “Our Constitution is a beautiful document, but we have not fulfilled it. In Section 27, it says that everyone in this country has the right of access to sufficient food, but this has not been realised.” He made these remarks against the backdrop of statistics about child malnutrition and food insecure households in the country. In 2022, 20% of children lived in households that reported running out of food because they could not afford it, while 25% lived in households that had been forced to cut the range of foods they could afford to buy.
So, despite the right to adequate food, the nutritional status of children has remained an ongoing public health concern. More than a quarter of children below the age of five are stunted, which means they are too short for their age. Stunting is a result of chronic undernutrition and deprivation, and this condition has detrimental effects on a child’s health and wellbeing, including on cognitive development. The adverse effects of stunting are difficult to reverse after age two. In contrast, 13% of children below the age of five are overweight or obese, a condition ascribed, in part, to excess intake of ultra-processed, nutrient poor food high in fat, sugar and salt and sugar-sweetened beverages.
The first 1000 days of a child’s life (conception up to a child’s second birthday) is the most critical period for nutritional interventions. In addition, evidence shows that the second 1000 days, when children are between the age of two and five years, remain important in terms of development, and correspond with the age when many children attend some form of an early learning programme (ELP) in South Africa.
A census of the early childhood development (ECD) services in 2021 showed that more than 42 000 children below the age of five have access to ELPs. During this age period, children explore new foods and acquire new tastes. Dietary patterns established during childhood continue into adulthood and can increase or mitigate the risk of chronic disease late in life. Early childhood development centres are therefore perfectly positioned to reach vulnerable children and influence their food intake and food preferences, because many children spend up to eight hours a day in these childcare facilities.
Meals are served to children at almost all ECD centres. Well-designed menus can ensure that children are provided with at least a third and up to a half of their recommended daily nutritional needs while in care. For many children this may be the only meal they receive a day, underscoring the potential to address children’s basic nutritional needs and other nutritional services provided at ECD centres.
To provide direction to ECD centres, the department of health developed nutrition guidelines, which provide information on adequate and appropriate meals, menu planning, food preparation, hygiene and safety aspects. Unfortunately, these guidelines are not enforceable and the extent of implementations is unsure.
A further concern is the actual nutritional value and dietary diversity of food served at these centres, especially the provision of fruit and vegetables as part of the meals served. A lack of financial resources and the availability and cost of these healthier food options would explain this.
Without additional support, especially for early learning programmes serving children in poorer communities, it will be difficult to serve meals that adhere to the nutrition guidelines. Registered ECD centres that qualify can apply for the ECD subsidy of R17 a day per child. Forty percent (R6.80) of this subsidy is intended for nutrition. This is simply not enough to ensure the provision of nutritionally adequate meals. The problem is further exacerbated in that only 40% of early learning programmes are fully or conditionally registered and only a third receive the government subsidy.
Food provisioning at ECD centres can contribute, at least, to the immediate relief of hunger and nutrition insecurity among children. But the funding model for ECD centres requires urgent revision. Failure to increase the ECD subsidy will violate the rights of these children to adequate nutrition. Training of ECD staff based on the existing nutrition guidelines and monitoring and support by government and non-government organisations should also be prioritised.
The coordination of ECD services, which shifted to the department of basic education, provides new opportunities to strengthen nutrition programmes at ECD centres. It can address malnutrition in preschool children by drawing on successes of the National School Nutrition Programme, which reaches nine million children, including children in grade R. Meals served at schools provide a safety net for vulnerable children and have been shown to also improve school attendance.
As we celebrate National Children’s Day on Saturday, 2 November, let us also remember that the provision of ECD services is a public good, based on the recognition that these centres contribute to the realisation of rights, development and outcomes of the child, and to the growth and development of society.
Dr Yolande Smit is a lecturer and Lisanne du Plessis an associate professor in the Division of Human Nutrition in the Department of Global Health in the Faculty of Medicine and Health Sciences at Stellenbosch University.