Children are starving to death: the heartbreaking reality facing SA’s youngest

One in five South African children under six lives in a home where there is not enough food. In the past two years a staggering 15,000 children were hospitalised due to severe acute malnutrition and about 1,000 lost their lives in one year to this preventable condition.

Severe acute malnutrition (SAM), stunting and wasting are the extreme outcomes of a large malnutrition challenge facing South Africa, according to the South African Early Childhood Review 2024 released on Wednesday. 

The review tracks data on the status of children under six years old and shows clearly how life for the country’s young children has worsened in many ways. 

Jointly published by Ilifa Labantwana, the Children’s Institute at the University of Cape Town, the department of planning, monitoring & evaluation in the presidency, the department of basic education, the Grow Great Campaign and DataDrive2030, the publication laid out the desperate plight of the youngest and most vulnerable in the country.

The number of starving children requiring hospitalisation has increased by 25% in five years. 

In 2022, one of five children under six years lived in households that ran out of food during the month due to a lack of money. More than a quarter lived in households forced to reduce their food range due to lack of money. 

Other household measures yield even higher rates of reported food insecurity. Food inflation exceeded 14% in early 2023, the highest rate since the 2008 global recession and more than double the upper inflation target limit. Over the same period, inflation on vegetables, which are an important source of micronutrients, was as high as 23%. 

“The Covid-19 pandemic erased gains made for young children in South Africa, presenting a massive setback we have not fully recovered from,” said Dr Katharine Hall, senior researcher at the Children’s Institute at the University of Cape Town.

She said all essential services for young children were affected in lockdown and though primary healthcare services have recovered, there were still backlogs in birth registration and early access to social grants. 

“Nearly 40% of children under age six now live in households below the food poverty line, and half a million more children are at serious risk of malnutrition than before Covid-19. Children in rural parts of the country have historically been the most vulnerable to poverty and poor nutrition, but now we are seeing a rise everywhere — even in the wealthier urban provinces of Gauteng and the Western Cape,” said Dr Edzani Mphaphuli, executive director of Grow Great. 

“And the problem is growing. New case reports of SAM are alarming, with a 33% nationwide increase between 2020/21 and 2021/22. The department of health reported that by mid-2023, the SAM incidence had increased by a further 20%, from a ratio of 2 per 1,000 children under five in 2021/22 to 2.4 per 1,000 in 2022/23.” 

Malnutrition is difficult to reverse, has lifelong consequences and can be fatal. Stunting is the result of chronic undernutrition. It is the most common form of malnutrition in South Africa, affecting one in four children under five years.

“Stunting leads to inequality because stunted children are more likely to grow up to be poor, unskilled, unemployed and suffer from chronic diseases,” said Mphaphuli.

“We will not achieve our national development goals without ensuring young children’s food security. The new administration must prioritise increased social assistance to young children and expectant mothers, as well as nutrition programmes delivered directly through health services and early learning programmes.” 

The review found that more poor children are being excluded from receiving the Child Support Grant. In 2023, 4.27-million children under the age of six received the Child Support Grant (R530 per month), representing 63% of all children in this age group.

“The Child Support Grant has received annual increases that have not kept pace with food inflation and is no longer able to cover the minimum cost of feeding and clothing a child,” said Hall.

“Worryingly, we have seen a real decrease in the grant take-up,” she added. 

A key reason for the decline is a lack of identity documentation for mothers and birth registration delays for the baby. The estimated number of unregistered infants in South Africa leapt from 190,000 in 2019 to 255,000 in 2020.

Even after a considerable recovery of birth registration rates in 2021, grant uptake for infants continued to fall.

In March 2024, nearly 200,000 fewer infants were receiving the grant than in March 2020 when the country went into lockdown. Eligible children, Hall said, must receive the Child Support Grant from birth to fully maximise the benefits of improved nutrition and health outcomes.

“This will require better linkages between the health facilities where 83% of births take place, the department of home affairs and Sassa [South African Social Security Agency].” 

The review found that by eliminating child malnutrition, South Africa's GDP per capita could increase by about 9%, meaning that ending all forms of malnutrition is in the country’s best interests.