Fifty-one-year-old Dr Chantell Witten says her journey with early childhood nutrition is one that she has been on since birth. Born in Eswatini to a 21-year-old Swati mother and a South African jazz musician father, Witten says her mom came from a rural area.

“If I really think about it from a public health perspective, I could have easily been a statistic – you know, born to a single mom, living in a rural area… I could have been one of the malnourished children I’m fighting for.”

Witten told Daily Maverick she has always felt a sense of displacement, having moved from Swaziland to Cape Town and not being able to speak a word of Afrikaans. 

She says it was when she started at Belgravia and Thornton high schools that she began developing her sense of Black Consciousness and activism that characterised many of her high school years. Witten says that by the time she began studying at the University of Western Cape (UWC), social justice was a part of the culture there. 

“Even though we were pursuing our degrees, we were also pursuing a better South Africa… equality was part of our conversations. I was fortunate to be there when Rhoda Kadalie was teaching medical anthropology,” says Witten. This was “fused” into her BSc dietetics programme. 

She says the programmes were greatly influenced by David Sanders’ work in nutrition and public health, adding that her BSc programme was different from those at other universities in that it also focused on the social factors that affect communities’ health.

“I’m proud to have been part of David Sanders’ grooming, coaching and mentoring… a lot of people forget that as early as 1996, David was already looking at malnutrition in the Eastern Cape.

“He called the then minister of social development, Zola Skweyiya, and told him, ‘these children are in hospital in Mount Frere and Mount Ayliff and they are being discharged back into households where there is no food’.”

This, Witten explained, was when they were already aware of the inventory of 10 food items that were needed in a household in order to receive adequate nutrition, and most households in the Eastern Cape at the time had five or fewer. 

She says this created an awareness that South Africa’s malnutrition problem was not clinical, but rather a “social construct” as a result of poverty.

Witten says she returned to UWC as a researcher and later went to the University of Cape Town, working on the link between formula feeding and breastfeeding of mothers who had HIV, as part of the prevention of mother-to-child transmission programme. 

She also says she is proud to have been a part of the pioneering research into the integration of vitamin A into diets after studies showed that 66% of children had a vitamin A deficiency, resulting in micronutrient research aimed at fortifying foods like biscuits, peanut butter and sweet potato, which she says never quite took off.

“Research can be cutting edge, but if that research doesn’t reach the people who need it, it’s wasted… I’m trying to think, ‘how does research become useful? How does research translate into changed lives?’” 

Speaking on adequate nutrition for children of school-going age, Witten says “we have a national school nutrition programme that feeds nine million children, but we still need to bridge that malnutrition gap”.

Breastfeeding

Witten, whose PhD focused on women’s choices when it comes to breastfeeding, says she would like to see more galvanisation around the work she is involved in around breastfeeding and a scaling-up so that their efforts can be amplified. 

Witten is a passionate advocate for breastfeeding as opposed to the use of formula and milk substitutes, as she believes it is the best source of nutrients for children and mitigates childhood obesity and issues of stunting. 

“It is the systematic breakdown of breastfeeding in a country like South Africa that’s a concern. We should have more breastfeeding mothers, given the rates of poverty in our country. We have the highest level of stunting, so we haven’t even talked about the malnutrition that comes from poor feeding.” 

She went on: “We want all our children to be exclusively breastfed until at least six months of age, because the first six months lay the foundation for children’s health into adulthood…

“Currently, our exclusive breastfeeding rate is 32% for all children under six months, which means only one in three are exclusively breastfed, and 25%, which is one in four, are not breastfed at all…

“It is worrying that South Africa’s exclusive breastfeeding rate in the first six months is way below the World Health Organization’s (WHO) target of 50% by 2025.”

Witten has been pushing for milk substitutes and formula to have proper labelling that lets mothers know what is in the products so as to understand their potential impact on their children.

Witten also points out that formula is often the first point at which children are introduced to the taste of sugar and ultra-processed foods, as opposed to the natural and nutritious milk that is produced by mothers. 

Witten is currently working on an infant and young child feeding advocacy project which she says links to the work she did while at Unicef. She says the research she has been doing shows that formula companies were speaking directly to and influencing medical professionals. 

She says that while WHO regulations address marketing tactics that could be considered violations, speaking to medical professionals is not specifically a marketing violation – “it’s not illegal for a rep to visit a health facility and say, ‘we’ve got a new product and this is how it works’… it’s not illegal to bring cupcakes to a meeting and say, ‘by the way, here’s a brochure’.” As a result, formula sales are going up.

Witten also reflects that more voices are needed in the child nutrition space, but also specifically women’s voices in the breastfeeding advocacy space. She says that would help to curb malnutrition in the country and broaden the discussion. 

When not advocating for child nutrition, Witten says in her downtime she has developed an interest in food gardening and enjoys spending time with loved ones. She has also become increasingly aware of taking care of one’s mental health, particularly as an activist where personal life and passion for the work often converge, necessitating a need to separate the two. 

She jokes that she is now known as a “lactivist” (lactose + activist) in child nutrition circles, and has to ensure that the persona does not overshadow the person. DM