South Africa’s stunting crisis deeper than thought, researchers warn

Children who have lost a biological father are at a significantly higher risk of stunting, according to new research that exposes deep structural drivers behind South Africa’s persistent child malnutrition crisis.

The findings challenge conventional approaches, showing that stunting is not only about food, but about inequality, data gaps and weak coordination across government.

A major body of research released on Tuesday by academics from Stellenbosch University, the University of Cape Town, the University of the Witwatersrand, the University of the Western Cape, the South African Medical Research Council, Nelson Mandela University and North-West University highlights how stunting is rooted in structural inequality and requires a coordinated, multi-sectoral response starting before birth.

Published in a special issue of Development Southern Africa and funded by the DG Murray Trust, the 10 peer-reviewed papers reveal that one in four children under the age of five in South Africa is stunted, a condition defined as being too short for their age due to chronic undernutrition and adverse early-life conditions.

The research warns that national averages mask stark inequalities. Children who have lost a biological father face a disproportionately higher risk of stunting, an often overlooked factor with major implications for how interventions are designed and targeted.

Beyond physical growth, stunting is closely linked to poor brain development, affecting cognitive ability, school performance and long-term productivity.

Yet the researchers argue that the true scale of the problem remains uncertain due to unreliable data. Estimates of stunting prevalence vary widely, from about 20% to over 30% for similar periods, due to missing height measurements, inconsistent survey methods and sampling biases.

The study also found that wealthier urban children are often underrepresented in datasets, potentially skewing results and obscuring the real burden in rural areas.

Despite the scale of the crisis, accountability remains fragmented. Responsibility for tackling stunting is spread across multiple departments, including health, social development and education, without a single entity clearly in charge. Existing food environment policies are also poorly enforced, further weakening the national response.

It is difficult to think of a more important investment in South Africa’s future. Without addressing stunting early, starting in-utero, we dilute the impact of spending on schools, clinics and early childhood development because we intervene too late.

—   Professor Ronelle Burger from Stellenbosch University

The research reframes stunting as a broader development challenge, driven by poverty, inequality, high rates of orphanhood, poor sanitation, dysfunctional food systems and gaps in governance.

During the state of the nation address, President Cyril Ramaphosa reaffirmed the government’s commitment to eradicating stunting by 2030, with a focus on the first 1,000 days of life and targeted interventions for pregnant women and low birth weight infants.

However, progress has been slow. Professor Ronelle Burger from Stellenbosch University said investing in early interventions offers significant social and economic returns.

“It is difficult to think of a more important investment in South Africa’s future. Without addressing stunting early, starting in-utero, we dilute the impact of spending on schools, clinics and early childhood development because we intervene too late,” she said.

Researchers point to scalable solutions, including nutrient supplementation combined with nutrition education, particularly around complementary feeding for children aged six to 24 months. They also emphasise the importance of regular growth monitoring, noting that mobile health tools could improve tracking in areas with limited healthcare capacity.

Liezel Engelbrecht, nutrition lead at the Hold My Hand Accelerator, said aligning social protection with nutrition policies, improving access to affordable healthy food, and strengthening maternal nutrition and breastfeeding support are critical.

“This requires political commitment, which we are now seeing, but also a clear national plan with measurable targets, especially given that the National Food and Nutrition Security Plan has lapsed,” she said.

Despite its long-term consequences, South Africa has struggled to significantly reduce stunting, raising urgent questions about whether current policies are sufficient to address one of the country’s most persistent and unequal health challenges.