Childhood stunting also stunts SA's economy — here are five ways to fix that

Daily Maverick

12-06-2025

Make a list of the country's 10 priorities for national development. Now whittle them down to five. Does your shortlist include giving children enough nutritious food to eat? If not, you're missing an essential part of what countries need to grow their economies: children who are well nourished and ready to learn, and grow up to be skilled and productive workers who drive economic growth.
At a glance
South Africa has a high stunting rate, an indicator of chronic malnutrition that measures if a child is too short for their age, which has hovered around 25% since the 1990s.
That impacts on our per capita GDP – a sign of a country's standard of living, which is 10% smaller than it could be if our children were not physically and intellectually damaged by a lack of nutritious food.
Our Child Support Grant (CSG) has had an impact – but it's not keeping up with food inflation.
DG Murray Trust's David Harrison has five low-cost strategies we could use to boost both child health and our economy.
South Africa has a high stunting rate, an indicator of chronic malnutrition that measures if a child is too short for their age, which has hovered around 25% since the 1990s.
That impacts on our per capita GDP – a sign of a country's standard of living, which is 10% smaller than it could be if our children were not physically and intellectually damaged by a lack of nutritious food.
Our Child Support Grant (CSG) has had an impact – but it's not keeping up with food inflation.
DG Murray Trust's David Harrison has five low-cost strategies we could use to boost both child health and our economy.
South Africa has a stubbornly high stunting rate, an indicator of chronic malnutrition that measures if a child is too short for their age. It has hovered around 25% since the 1990s. Meanwhile, our per capita GDP – a measure of a country's standard of living – is 10% smaller than it could be if our children were not physically and intellectually damaged by a lack of nutritious food.
Despite tough economic circumstances, we can make a massive difference to child nutrition. Peru halved its rate of stunting among children in just eight years (2008 to 2016), and Chile has pretty much eliminated it. Social grants played a large role in those countries. Here, the child support grant (CSG) has also had a significant impact, with stunting almost a third lower among eligible children who get the grant when compared with those who don't. But the CSG is not keeping up with food inflation. That means we need to use other strategies that could be implemented immediately.
Make proteins cheaper
The 15,000 children admitted annually to hospitals with severe acute malnutrition lack protein from food like fish or lentils, energy from carbohydrates like pap and essential minerals and vitamins (micronutrients) like iron, zinc and Vitamin A, which are found in fruit, vegetables and meat. Chronically malnourished children often get enough energy, but not enough protein and micronutrients for their bodies and brains to grow optimally. This is one of the main reasons why the proportion of underweight children younger than five years is 7.7%, but stunting, which is often linked to poor brain development, is almost four times higher.
The body can convert excess carbohydrates into some amino acids – the building blocks of protein – but it can't produce nine amino acids that are essential for normal growth. Child obesity among poorer children is often linked to a shortage of protein as cash-strapped parents buy cheaper processed foods and starches. This is why we are seeing an increase in the percentage of children who are both overweight and stunted.
All of society – government, business, civil society and trade unions – must unite to make a basket of protein-rich staples far more affordable. Shoprite, South Africa's largest retailer, has begun to take up the protein challenge by making ox liver burgers available for R5.
Another protein-rich food that must be made more affordable is infant formula. Globally, the profit margin on infant formula is north of 20%. Government should cap the manufacturer and retail margins on infant formula at 10%, which is still enough incentive for stores to stock it.
This suggestion may sit uncomfortably with some, who might view it as undermining the message that 'breast is best'. The reality is that over half of all infants are not exclusively breastfed by three months of age, often related to social and workplace stresses. These babies need the protein, vitamins and minerals that breast milk substitutes provide. At the same time, the industry's predatory marketing tactics, designed to undermine breastfeeding, must continue to be confronted, and the price cap should be accompanied by full enforcement of Regulation 991 of 2012, which aims to protect breastfeeding by regulating how infant formula is marketed and sold.
Make sure minerals and vitamins are added to food
Micronutrients are vitamins and minerals – such as iron, vitamin A and iodine – that our bodies need to grow and develop. Without them, even though we need very small amounts, we can end up with life-threatening illnesses.
An effective way of making sure children are getting enough micronutrients is to add them to food staples like maize meal and wheat flour, and fortification of specific foods has been mandatory since 2002. Yet studies show that many industry players don't do it. A 2015 study by the Global Alliance for Improved Nutrition found that 83% of maize meal in Gauteng and 69% in the Eastern Cape was unfortified or insufficiently fortified. Stricter enforcement should improve compliance, but it would be better if the industry just did it without constant policing.
There are other effective strategies to supplement micronutrients during pregnancy and the first two years of life. Instead of giving pregnant mothers iron and folate pills during pregnancy, they should get 15 minerals and vitamins combined in one daily pill. This approach works better in reducing low birth weight, preterm birth and six-month mortality among infants. It won't cost much more – perhaps even less than current tender prices for iron and folate.
Among at-risk children aged six to 24 months, small quantity lipid nutrient supplements (SQ-LNS) reduce the odds of stunting by up to 20%. These products should be made available to vulnerable babies through community health worker programmes.
Help pregnant women get healthy food through grants and supplements
Babies born with a birth weight below 2,500g, a Western Cape survey published in 2023 has shown, are three times more likely to be stunted at six to 24 months of age. The best way to lower the proportion of new cases of low birth weight is to ensure good healthcare and nutrition for pregnant women, and that includes giving either money or food to moms-to-be who are at risk. A review of 11 studies published in 2011 showed that balanced protein-energy supplementation reduces the risk of low birth weight by a third, with the effect most pronounced among underweight mothers. It also improves the ability to breastfeed.
The Western Cape government recently announced a new pilot programme to provide monthly nutritional support to underweight pregnant women, women likely to give birth to underweight babies and new mothers of low birth weight babies as a way of reducing stunting in the first two years of life. Nationally, a maternal support grant is being considered, but policymaking has been slow. This would be a highly cost-effective use of social security, reducing the healthcare costs of low birth weight while also improving infant health.
Give community health workers scales to weigh babies
Countries that have significantly reduced stunting have one thing in common: they can measure a child's failure to grow and gain weight at an expected rate. When children start crossing the weight centiles on their growth charts – which shows how a child's growth compares with other children of the same age – it becomes evident when they are falling behind their peers.
Community health workers are best placed to spot this problem because they visit families regularly, but they are not provided with basic scales to measure weight. Instead, they are issued with coloured tapes to measure mid-upper arm circumference, which detects some children with acute malnutrition. This is important, but we really want to identify and respond to problems early.
There are about 60,000 community health workers in South Africa. Equipping each with a basic mechanical scale (of about R1,000 each) and teaching them to identify children at risk will easily pay back the about R60-million in equipment costs with major health benefits. Several community health worker programmes like Philani Health and Nutrition Project and Grow Great have successfully used scales to monitor children's growth in their homes.
Limit the advertising of unhealthy foods
Parents want what is best for their children. However, the messages they are most exposed to are not from advocates of healthy living, but from the Big Food industry, which often encourages eating habits that lead to high blood pressure and diabetes in adulthood. Government should convene a meeting of the dominant food players to forge an agreement towards a healthier nation, which should include constraints on the advertising of unhealthy foods.
The five objectives outlined above are attainable even in a cash-constrained environment, but they won't happen without leadership and coordination. The National Food and Nutrition Council is yet to be constituted, but even if it were, its decisions would still need to be rolled out by departmental officials who are relatively junior in the government hierarchy.
Good nutrition is so vital to socioeconomic progress that consideration should be given to appointing a 'nutrition czar' with enough authority to drive a strong national programme that could reset the country's trajectory of development over the next decade. DM
David Harrison is a medical doctor and CEO of the