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

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Last week the much-anticipated 2020 edition of the South African Child Gauge, compiled by the University of Cape Town’s Children’s Institute, was released.

The theme of this edition, 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 lockdown.

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

Child hunger and malnutrition are part of South African history, and have worsened over the past year. Recent data has shown that throughout the hard lockdown period 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 (CSG) proved once again to be inadequate at meeting the needs of poor families and children. The poor became poorer, hungrier and ultimately more vulnerable.

The CSG, which currently amounts to R450 per month, has consistently remained below the food poverty line of R585 (as of April 2020 - 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, over the course of a six-part series, Spotlight reported extensively on the pandemic and lockdown’s impact on the nutritional status of children in the country.

For one story, we spoke with a 19-year-old young man named 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 percent, or over 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 2020, it would come as no surprise if this number increased because of the pandemic and lockdown. 

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

“In 2012/13, 17 percent 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 antenatal 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 (EBF) during the first six-months is pivotal during the early stages of a child’s life course, but again, 2016 data shows that only 32 percent of children six-months and under were exclusively breastfed. “We need to pay greater attention to improving our EBF rates.

While there has been some improvement since 1998 and 2003, we’re still way below the global target of 50 percent. This is a critical intervention in preventing stunting, overweight and obesity,” emphasises Lake. 

There is no data from the last year that shows the impact of the pandemic and lockdown on EBF rates, but experts from the Centre of Excellence in Food Security suggest that there could be dire consequences

Though EBF 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 resumed, 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 learners. One meal came with free stationary, while another came with free earphones.

Often we see that children’s meals come with some sort of 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 percent of children under the age of five, and over 17 percent 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 that the country’s children continue to face. In fact, the word “children” appears in the speech merely three times.

Only in Ramaphosa’s reply during the debate on his SONA last week did he 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 announcement, another co-author of the Gauge, Dr Chantell Witten, says that the government must fund an increase of the CSG, 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 (NFNSP), now that it has been costed. 

“[Government must also] establish a Treasury task team to prepare a roadmap 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,” she says. 

Adding to this, Witten says that the government must request the Financial and Fiscal Commission [FFC] to apply its mind to including food and nutrition security as an indicator in DORA (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 the 2020 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.

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