This is a moment.
For seven years, Grow Great has been saying what is now being said from the highest office in the land: child stunting is not a marginal issue. It is a national crisis. And it begins long before a child turns five.
The president’s commitment to end child stunting by 2030 is not another policy promise. It is a line in the sand.
For the first time, child stunting has been named as a national priority and embedded within the National Strategy to Accelerate Action for Children. SA has said, clearly and publicly, that we will no longer accept that one in four children is robbed of their full potential before they reach school.
Now the question is not whether we act.
The question is whether we will scale what we already know works.
What stunting really is
Children grow in two ways.
They grow outwards by gaining weight.
They grow upwards by gaining height.
Growing outwards requires calories. Almost any food will do. Porridge, rice, bread, samp, fat cakes, chips and sugary drinks fill small stomachs.
Growing upwards requires food diversity. Milk, beans, eggs, fruit and vegetables build bones, muscles and, most critically, brains.
A child who eats mostly calorie-rich foods may look chubby and cute. But when measured against other children their age, they are far shorter. Their brain development may also be compromised. This is what we call a stunted child, a child who is too short for their age.
Stunting is not just about height. It is about brain development, immune strength, school readiness, earning potential and lifelong health.
It is silent.
And by the time we see it clearly, the damage has often already been done.
The first 1,000 days decide everything
From conception to a child’s second birthday, just 1,000 days pass.
In those 1,000 days:
- The brain forms more than one million neural connections per second.
- Growth speed is at its highest.
- Nutritional deprivation has its deepest and most irreversible effects.
By the time a child turns two, most irreversible damage of stunting to the brain has already occurred.
SA’s under five stunting rate is about 28%. But at 18 to 23 months, it exceeds 42%. By 24 to 35 months, it remains above 30%. For children 48 to 59 months, the stunting average is only about 16%. The national average is driven by what happens between six and 35 months. (South Africa Demographic and Health Survey, 2016.)
Among children under five who die from malnutrition, most are between 12 and 24 months old. We cannot fix a first 1,000-day problem in preschool or Grade R.
If the only guaranteed meal some children receive is at school or an early childhood centre, we must ask a harder question: What are their youngest siblings, aged zero to two, eating?
School children are covered by the Child Support Grant and school feeding schemes.
Children aged three to five are increasingly supported through early childhood development subsidies. But the youngest children, whose brains are growing the fastest, remain the least protected.
The National Development Plan recognised the first 1,000 days as critical. Yet support has been weighted for later in childhood. If we are serious about halving stunting by 2030, the first 1,000 days must sit at the centre of national action.
What we know works at scale
For seven years, Grow Great has worked to make stunting visible and solvable. Two levers have proven powerful. Community health workers and structured parental support.
Prevention must begin before birth. SA’s health system must be equipped to protect children from the very start of life. That protection begins in pregnancy.
Micronutrient supplementation for pregnant women must be strengthened in line with National Department of Health guidelines. Women should receive multiple micronutrient supplements, not only iron and folic acid, to address deficiencies in zinc, iodine and other essential nutrients that influence foetal growth and brain development.
Low birth weight is one of the strongest predictors of early growth faltering and later stunting. When babies start life too small, they are already at a disadvantage. Protecting maternal nutrition protects children before they are born.
Targeted programmes for mothers of low-birth-weight infants, such as the Khulisa Care pilot in the Western Cape, should be scaled. Khulisa Care provides enhanced follow-up for small and at risk babies through more frequent growth monitoring, strengthened breastfeeding and feeding support, closer clinical oversight and improved linkage between facilities and community health workers. Instead of waiting for severe malnutrition, it intervenes early when growth first falters, preventing temporary vulnerability from becoming permanent stunting.
But guidelines alone are not enough.
Clinics must be properly resourced. There must be:
- No stockouts of maternal multiple micronutrient supplements.
- No stockouts of therapeutic and supplementary nutrition products for children who are not growing well.
- Functional and calibrated growth monitoring equipment to identify malnourished children.
- Trained staff who can interpret growth charts correctly and act early.
The current health system that waits for moderate or severe malnutrition is already too late.
Community health workers save lives and prevent stunting
More than 4,000 government community health workers have been trained across eight provinces by Grow Great, reaching more than 200,000 children and 80,000 pregnant women.
We have found from the evaluation of the programme that when community health workers are adequately trained and equipped:
- They identify moderate and severe acute malnutrition early, before children die.
- They detect growth faltering before it becomes moderate or severe acute malnutrition.
- Exclusive breastfeeding rates rise to nearly 80%.
- Vitamin A and deworming coverage approaches universal levels.
- Mothers access the Child Support Grant earlier.
Importantly, our data show us that children at risk of stunting who are visited and growth monitored at home by a trained and equipped community health worker four to seven times before they reach two years of age are 50% less likely to be stunted.
The cost? Marginal. Training and equipping all the about 40,000 community health worker in SA with proper growth monitoring tools would cost the Department of Health approximately R300-million once off, based on the current costing by Grow Great, and about R3,500 per year per community health worker thereafter.
This is not consumption spending. It is an investment in human capital.
When mothers are supported, children thrive
Public health services are overstretched. Nurses carry big patient loads. Community health workers cannot provide deep emotional and practical support to every mother.
Structured parental support fills this gap.
Since 2018, Flourish has reached more than 54,000 mothers and babies in marginalised communities through small group antenatal and postnatal sessions led by trained local women.
The curriculum is practical, grounded in lived reality and based on the Road to Health booklet and other national Department of Health guidelines. It covers nutrition in pregnancy, breastfeeding, clinic attendance, vitamin supplementation, danger signs such as diarrhoea and dehydration, immunisation, sleep, responsive caregiving, love play talk, and maternal mental health. It equips women with coping skills and reduces harmful behaviours such as alcohol use during pregnancy. It is the school of motherhood every mother longs for.
A 2022 follow-up survey of the programme found:
- 62% of Flourish mothers breastfed exclusively for six months, compared with a national average of 32%.
- Only 12% of their children were stunted at age two, compared with a national average at two years above 32%.
When mothers are supported, children grow.
Flourish is also an economic strategy. Scaling to reach 300,000 of the most vulnerable mothers would require approximately 1,875 local women. Grow Great Flourish scales an early childhood development ecosystem model working with different community-based organisations. It leverages the Social Employment Fund and can create dignified work for young women while strengthening the care economy.
Reducing stunting can generate jobs, skills and local leadership. It strengthens women economically while strengthening children biologically.
The missing piece: financial protection and affordable nutritious food
Knowledge without affordability is cruel. A mother can know what her child should eat. She can want to breastfeed. She can want to attend clinic visits. But empty cupboards erode hope quickly.
Nutritious food costs more. Transport costs money. Financial stress fuels maternal depression. Maternal mental health directly affects child growth.
Financial support is brain development policy. SA must:
- Sign off and implement the Maternal Support Grant that Grow Great and many partner organisations have been advocating for through the Maternal Support Grant Advocacy Coalition and Union Against Hunger. It will cost the government an additional R2-billion but will save more than R13-billion in health costs.
- Increase the Child Support Grant for children to at least the food poverty line, starting with those most at risk of dying from hunger and malnutrition – children aged zero to two.
- Protect the real value of grants by making nutrient-dense foods affordable.
A protected nutritious food basket should prioritise high value, brain-building foods that are affordable and widely available such as the proposed Ten Best Buys, which includes foods that combine quality protein, iron, zinc, iodine and essential fatty acids with affordable carbohydrates.
There is a precedent. Countries like Brazil combined income support, food system reform and social protection to reduce hunger and child undernutrition. SA can do the same.
The government must also strengthen the regulation of the food industry to prohibit the promotion of infant formula in ways that undermine breastfeeding and to curb the marketing of ultra-processed foods to young children. Breastfeeding is a public health intervention. It must be protected.
Connecting detection to delivery
SA produces enough food. A total of 10 million tons of good food goes to waste every year. Legislation is essential to curb waste and ensure rescued food reaches those in need through organisations like SA Harvest and Food Forward SA.
Read more: SA faces a catastrophic hunger crisis while 10m tonnes of foodstuff goes to waste every year
In partnership with Food Forward SA, Grow Great has piloted a last mile response model. When Grow Great-trained community health workers identify a malnourished child at household level, Food Forward provides a targeted food parcel to stabilise the household, which they deliver to a local clinic. Community-based screening linked to structured food redistribution is feasible and responsive.
It can move from pilot to national scale by integrating:
- Community health worker identification systems
- Provincial health coordination
- Food industry and surplus redistribution networks bringing the food parcels closest to homes
The government cannot do this alone
Ending stunting is not the responsibility of one department. It is the responsibility of a nation.
Grow Great’s mission has always been to mobilise the whole of society. Business. Government. Civil society. Philanthropy. Communities. The public. We work within the early childhood ecosystem with the government, other civil society organisations like DGMT, Hold my Hand, Union Against Hunger, Ilifa Labantwana and many others.
These partnerships reflect a simple truth. The government cannot do this alone. Nor can civil society. Nor business.
The catalytic interventions laid out in the National Strategy to Accelerate Action for Children call for coordinated, multisectoral action. What Grow Great has been doing for years is aligned with those catalytic priorities. Strengthening maternal nutrition. Equipping community health workers. Supporting caregivers. Improving food access. Mobilising public will.
This is not a new idea. It is a proven pathway.
The choice before us
SA can continue treating malnutrition through hospital beds and emergency responses. Or we can protect the first 1,000 days in the immediate term through:
- Income support in pregnancy.
- Raising the grant for children aged 0 to 2 to the food poverty line.
- Scaling already existing intervention that we know works.
If we are serious about ending stunting by 2030, as committed in by the president, the first 1,000 days cannot remain rhetorically prioritised but fiscally neglected.
The science is clear.
The data are clear.
The gap is clear.
The question is whether we will choose to protect the youngest child in the household or continue arriving too late. Because by the time a child is standing in a school feeding queue, the window to prevent stunting may already have closed.
In the first 1,000 days, biology moves fast. Policy must move faster.
If we protect children early, they will not only survive.
They will grow tall.
They will grow strong.
They will grow great. DM
Edzani Mphaphuli is the Executive Director of Grow Great campaign.