Analysis: What can SA do about the ‘slow violence’ of child hunger and malnutrition?

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Though the coronavirus might have little physical impact on children, they have borne the brunt of its rippling consequences
Though the coronavirus might have little physical impact on children, they have borne the brunt of its rippling consequences


Last week last year’s much-anticipated edition of the SA Child Gauge, compiled by the Children’s Institute at the University of Cape Town, was released.

The theme, food and nutrition security, could not be more relevant as the country continues to cope with the devastating physical and socio-economic consequences of the Covid-19 pandemic and the lockdown.

Though the coronavirus might have little physical impact on children, they have borne the brunt of its rippling consequences.

Child hunger and malnutrition are part of South African history, and have worsened during the past year. Recent data have shown that throughout the hard lockdown last year, child and household hunger increased, and at times nearly half of households reported running out of money for food.

Devastating job losses added to this and the social lifeline of the child support grant proved to be inadequate at meeting the needs of poor families and children.

The poor became poorer, hungrier and ultimately more vulnerable. The grant, currently R450 per month, has consistently remained below the food poverty line of R585 (as of April last year – though this has certainly increased), and without supplementary income families can seldom live off of this.

The malevolent force of malnutrition

“It would take a powerful malevolent force to inflict havoc on a child in the way that malnutrition does,” writes Dr Lawrence Haddad, executive director of the Global Alliance for Improved Nutrition, in the Gauge’s foreword.

“Let’s put it plainly, malnutrition systematically destroys a child. It damages their chances of survival, their cognitive development, their immune system, their bone and muscle structure and their livelihood prospects.”

This quote is powerful, and if there’s one thing to take away from the Gauge, should you not choose to read it, it’s this.

Last year, in a six-part series Spotlight reported extensively on the pandemic and the lockdown’s impact on the nutritional status of children in the country.

For one story, we spoke to 19-year-old Butho* in an informal settlement in Makhanda, Eastern Cape. Butho’s story is one that exemplifies – literally – what experts in the Gauge have called “slow violence”.

Slow violence

The concept of slow violence is used “to illustrate how food and nutrition insecurity during childhood is a silent threat to human development that casts a long shadow across the life course and contributes towards the intergenerational transfer of poverty, malnutrition and ill-health”, states the Gauge.

For Butho, his battle against malnutrition and hunger started early in his life. He is considerably short for his age, which could signal stunting.

South Africa’s most recently reported (2016) stunting rate for children under the age of five is just over 27%, or one in four children. Stunting may well be one of the most glaring indicators of this widespread slow violence in the country.

To make matters worse, this statistic has remained largely unchanged for the past 20 years. While there is no concrete data available for last year, it would come as no surprise if this number increased because of the pandemic and the lockdown.

READ: South Africa’s lockdown policies exacerbated hunger crisis

As outlined in the Gauge, the slow violence of malnutrition starts with the mother.

“In 2012/13, 17% of mothers reported that they had experienced a depletion of food in the 12 months prior to visiting an antenatal clinic and there is increasing evidence linking food insecurity and post-natal depression, which compromises the ability of mothers to feed and care for their children,” states the Gauge.

“We need to invest early in the ante-natal period,” one of the Gauge’s co-authors, Lori Lake, tells Spotlight. “We need to make sure nutrition is prioritised within the package of antenatal care to address the warning signs of under and overnutrition.”

Exclusive breastfeeding

Exclusive breastfeeding during the first six months is pivotal during the early stages of a child’s life course. But again, the 2016 data show that only 32% of children six months and under were exclusively breastfed.

We need to pay greater attention to improving our exclusive breastfeeding rates
Lori Lake

“We need to pay greater attention to improving our exclusive breastfeeding rates. While there has been some improvement since 1998 and 2003, we’re still way below the global target of 50%. This is a critical intervention in preventing stunting, overweight and obesity,” emphasises Lake.

There is no data from the last year that show the impact of the pandemic and the lockdown on exclusive breastfeeding rates, but experts from the Centre of Excellence in Food Security, which is co-hosted by the University of the Western Cape, suggests that there could be dire consequences.

Though exclusive breastfeeding and stunting are two aspects of the poverty nutrition cycle and the perpetuation of slow violence, from a commercial perspective, there are other issues that also play a role, notably, the advertising of unhealthy and fast foods to children and adolescents.

The double burden of under and overnutrition

Earlier this month before schools reopened, in one of Cape Town’s popular suburban shopping malls at more than one fast food restaurant, flashy posters advertised a range of incentives targeting pupils. One meal came with free stationary, while another came with free earphones.

Often we see that children’s meals come with a toy, which is widely advertised on television followed by the classic gimmick of “collect them all!”

Part of slow violence is the “double burden” of malnutrition, which comprises both under and overnutrition. The Gauge reports that overweight and obesity affect 13% of children under the age of five, and more than 17% of adolescents in the country.

The marketing of unhealthy foods and beverages to children has been identified as a key driver in the global childhood obesity pandemic.

According to the Gauge frequent exposure to food marketing influences children’s food knowledge, preferences, consumption, diet quality and health.

Lake says that focus is often on the high proportion of children who are stunted, and how this undermines and undercuts physical growth, health and cognitive development. But, she says that greater attention must be paid to the growing burden of overweight and obesity. “Overnutrition escalates rapidly across the life course, especially among adolescent girls and women, it affects 28% of adolescent girls and 64% of South African women,” states Lake.

Powerful words, limited action

In 2014, policy was put in place to address this with draft regulations (R429) relating to the labelling and advertising of foods which aim to restrict the marketing of unhealthy foods to children, yet, according to the Gauge, these draft regulations have not yet become law.

So, what’s next for South Africa’s children and their families, Mr President?

In President Cyril Ramaphosa’s state of the nation address (Sona), little mention was made of the slow violence the country’s children continue to face. In fact, the word “children” appears in the speech merely three times.

READ: Analysis | Unlike the global trend, South Africa’s children are too short and too fat

Only in his reply during the debate on his Sona last week did Ramaphosa state that children would be put first, and that by improving the economic position of women, child hunger, poverty and inequality can be reduced.

But these powerful words are nothing without action. Of course, one of the most obvious places to look when assessing government’s commitment to addressing this “slow violence” is the budget.

Immediate steps for South Africa’s children

Ahead of Finance Minister Tito Mboweni’s budget speech on Wednesday, another co-author of the Gauge Dr Chantell Witten, says that government must fund an increase of the child support grant, and extend the grant to pregnant women.

She says that a commitment must also be made to finance the National Food and Nutrition Security Plan, now that it has been costed.

We need that National Food and Nutrition Security Council in place to provide the leadership and coordination necessary to hold all of these different government departments accountable,
Lori Lake

“[Government must also] establish a National Treasury task team to prepare a road map to achieving Section 28(1)c [children’s constitutional right to basic nutrition, shelter, basic health care services and social services] that shows how existing policies, plans and programmes will be resourced, including blueprint guidelines for those that fall within the mandates of the provincial and municipal spheres,” Witten says.

Adding to this, she says that government must request the Financial and Fiscal Commission to apply its mind to including food and nutrition security as an indicator in the Division of Revenue Act, the annual bill that divides resources between the spheres of government.

Collectively, Lake and Witten echo calls made in the Gauge to establish a National Food and Nutrition Security Council.

“In order to implement these critical interventions we need a ring to bind them all, we need that National Food and Nutrition Security Council in place to provide the leadership and coordination necessary to hold all of these different government departments accountable,” says Lake.

“It requires political will at the highest level to make sure children are put at the centre of our efforts to respond to the Covid-19 pandemic and to crisis, and to drive economic recovery,” she says.

  • Kathryn Cleary is the winner of last year’s Isu Elihle awards for child-centred journalism, for the six-part series titled When kids go hungry.
  • This article is published by Spotlight – health journalism in the public interest. Sign up for our newsletter.


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