South Africa has one of the highest rates of stunting among upper-middle income countries globally, with little change in the last three decades despite government’s efforts to tackle poverty and expand access to social grants.
More than a quarter of children under the age of five is stunted, meaning they are too short for their age. This is a sign of chronic malnutrition made worse by other deficits in a child’s early years, beginning before birth.
Stunting is not just about a child’s physical development, it is also highly correlated with poor brain development which affects their ability to learn, school performance and future productivity.
Despite its long-term social impact and the high prevalence, South Africa has struggled to move the needle on stunting.
“Research shows extraordinary social and economic returns when investing in the eradication of stunting. It’s difficult to think of a more important and socially advantageous investment to make in the future of South Africa,” says Ronelle Burger, Professor in the Department of Economics at Stellenbosch University.
“Without addressing stunting first, beginning in-utero and when children are very young, we dilute the impact of the money spent downstream on early childhood development (ECD) centres, schools and clinics because we reach children too late,” Burger explains.
Researchers and civil society practitioners have released a comprehensive body of evidence on the drivers of stunting — and a clear set of recommendations to shift outcomes for young children.
The special issue of Development Southern Africa comprises 10 peer-reviewed papers spanning data collection, determinants of stunting, interventions and governance. Its central finding is unambiguous: stunting originates in structural inequality which requires a multi-sectoral approach, starting early, before a child is born.
Funded by the DG Murray Trust (DGMT), this special issue brings together experts across disciplines to bridge the fragmented and siloed nature of research, programme development and policy on stunting.
Among the contributors are researchers from Stellenbosch University, University of Cape Town, University of the Witwatersrand, University of the Western Cape, the South African Medical Research Council, Nelson Mandela University and North-West University. The contributors also include policymakers from national and provincial government and NGOs such as Grow Great, Heala, Do More Foundation and Zero2Five Trust. To maximise public access, this special issue has been made open access until the end of the month.
The research exposes several uncomfortable truths: South Africa needs standardised, nationally representative surveys for better data collection to reliably track stunting rates, and to hold policies and programmes accountable. But before we can fix the problem, we need to be able to measure it reliably.
One of the most striking findings from this research is that South Africa’s nationally representative surveys have produced stunting estimates ranging from around 20% to over 30% for the same period — a gap so wide it makes it difficult to know whether the problem is getting better or worse.
Standard programmes are also missing the most vulnerable: research shows that children who have lost a biological father face a higher stunting risk, a distinction that matters when it comes to how programmes and policies are implemented.
Food environment policies exist but are poorly enforced. And responsibility for reducing stunting is spread across government departments of health, social development and education, meaning no single department is clearly accountable.
But the research also points to what works and can be scaled.
Firstly, nutrient supplements combined with nutrition education — particularly around complementary feeding — can reduce stunting in children aged 6–24 months.
And while the research highlights that interventions such as small-quantity lipid-based nutrient supplements (SQ-LNS) in targeted populations, and nutrient-rich foods like eggs can improve aspects of diet quality and micronutrient intake, a broader approach that includes dietary diversity, nutrition education, and improved access to affordable foods is necessary to ultimately achieve linear growth.
Secondly, since regular growth monitoring is essential for tracking whether children are stunted, the use of mobile health tools, particularly in areas where primary healthcare capacity is uneven, can help to improve the accuracy and coverage of growth monitoring efforts.
This is important considering ongoing challenges in consistently monitoring young children’s growth through the Road to Health Book. While height-for-age is a key indicator of stunting, it is not always recorded as reliably as other measures, which can limit early identification and responses.
“Aligning social protection measures for mothers and their children with nutrition policies, making nutritious food more affordable, and prioritising maternal nutrition, breastfeeding support and growth monitoring in the first 1 000 days of life all matter in the country’s efforts to end stunting,” says Liezel Engelbrecht, nutrition lead for the Hold My Hand Accelerator, incubated by DGMT.
“This requires political commitment, which we are now seeing, but it also needs a clear national plan with targets. This is especially important considering that the National Food and Nutrition Security Plan has lapsed,” says Engelbrecht.
Researchers are, therefore, calling for a dedicated cross-departmental stunting policy with clear ownership, district-level targets and regular public reporting.
“We look forward to the finalisation of the new National Food and Nutrition Security Plan, and the establishment of a Food and Nutrition Security Council to provide the oversight and coordination needed to effectively align policies and drive implementation,” Engelbrecht explains.
While the government has a major role to play, the research also implicates the private sector.
A civil society case study of the 2021 Not Today Nestlé campaign shows how aggressive marketing of infant formula and ultra-processed foods actively undermines breastfeeding and optimal nutrition — particularly in low-income communities where cheap, calorie-dense foods become the default.
South Africa has had regulations on formula marketing in place since 2012, but enforcement is inadequate, and industry self-regulation has not been sufficient.