tag:theconversation.com,2011:/us/topics/child-malnutrition-in-south-africa-28019/articleschild malnutrition in South Africa – The Conversation2019-07-02T14:32:52Ztag:theconversation.com,2011:article/1194872019-07-02T14:32:52Z2019-07-02T14:32:52ZSouth Africa’s first SDG report card: how to move beyond ticking boxes<figure><img src="https://images.theconversation.com/files/281590/original/file-20190627-76726-1g1bfbw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>South Africa will present its <a href="https://sustainabledevelopment.un.org/index.php?page=view&type=30022&nr=1137&menu=3170">first progress report</a> on the Sustainable Development Goals at the United Nations on July 17. This report will provide a rather extensive snapshot of the country’s progress towards the 169 ambitious targets. </p>
<p>The <a href="https://sustainabledevelopment.un.org/sdgs">development goals</a> were adopted in 2015 by 193 United Nations member states. They were hailed as the first set of truly global goals, keeping both the developed and the developing world accountable to the same standards. </p>
<p>They cover a wide range of areas, from ending hunger and ensuring universal access to water and electricity; to promoting innovation and building strong institutions. The countries committed to achieving these goals by 2030.</p>
<p>But progress seems relatively slow across Africa. A recent <a href="http://unsdsn.org/resources/publications/2019-africa-sdg-index-and-dashboards-report/">report</a> by the <a href="http://unsdsn.org">Sustainable Development Solutions Network</a> shows that 72% of Africa’s national budgets do not mention the SDGs. It also points out that 82% of all African countries do not know what the financial requirements of reaching the SDGs are, and 65% have not yet assessed how far they are in reaching the targets.</p>
<p>South Africa, too, has been relatively slow in reporting progress. When presenting its official progress report later this month, it will be one of the last African countries to do so. But it did present a non-compulsory baseline report in 2017 <a href="http://www.statssa.gov.za/MDG/SDG_Baseline_Report_2017.pdf">that</a> outlined the number of indicators on which reliable national data was available.</p>
<p>South Africa’s official progress report – known in UN parlance as a Voluntary National Review – will show that the country has done quite well on some measures, and badly on others.</p>
<p>But the bigger question centres on what should be done to ensure that the SDGs actually change countries’ development trajectories.</p>
<p>A concerted effort is needed to ensure that the SDGs aren’t relegated to being merely a reporting framework. The South African SDG Hub, an <a href="http://sasdghub.org">initiative</a> hosted by the University of Pretoria has identified four good practices that could actually lead to changes in behaviour. </p>
<p>But that would require government, the private sector and civil society to be proactive. Here’s what we think they should do.</p>
<h2>Four practical steps</h2>
<p><em>1. Gather complete and reliable data.</em></p>
<p>It’s impossible to identify areas where urgent interventions are necessary without reliable and complete data. That’s why data gaps should be addressed as a matter of urgency. </p>
<p>The SDGs with the greatest data gaps in Africa are <a href="https://sustainabledevelopment.un.org/sdg8">SDG 8</a> (Decent work and economic growth), <a href="https://sustainabledevelopment.un.org/sdg11">SDG 11</a> (Sustainable cities and communities), <a href="https://sustainabledevelopment.un.org/sdg14">SDG 14</a> (Life below water) and <a href="https://sustainabledevelopment.un.org/sdg16">SDG 16</a> (Peace, justice and strong institutions). South Africa’s 2017 report on data availability showed that the country is able to report on 63% of the indicators with agreed methods.</p>
<p><em>2. Take the data seriously.</em></p>
<p>Reliable data is useless if it’s not taken seriously. In fact, the data often highlight issues that escape public attention. Take malnutrition. South Africa’s SDG progress report shows that 27% of South Africa’s children are stunted (<a href="https://sustainabledevelopment.un.org/sdg2">SDG 2</a>); 13% of the country’s children are overweight. This is high when compared to the global average of 6.1%. </p>
<p>The report also shows that without large-scale interventions, South Africa can expect a water deficit of at least 17% in 2030 (<a href="https://sustainabledevelopment.un.org/sdg6">SDG 6).</a> </p>
<p>Taking the data seriously also means noticing where South Africa has made progress. Between 2012 and 2018, for example, the country’s electricity produced from renewable energy sources increased massively from 16.1 GWh to 8 800 GWh (<a href="https://sustainabledevelopment.un.org/sdg7">SDG 7</a>). Another positive development is the continued increase in the number of researchers per million inhabitants – from 398.6 in 2007 to 475 in 2015.</p>
<p><em>3. Benchmark against others.</em></p>
<p>The SDGs provide a global framework for benchmarking a country’s progress against its peers’. The <a href="https://data.worldbank.org">World Bank’s Open Data platform</a> is a particularly helpful resource for getting a sense of the general trends. Data from Colombia and Thailand – both countries with comparable GDPs per capita and populations – make for interesting comparisons.</p>
<p>South Africa’s <a href="https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?end=2017&locations=ZA-CO-TH&start=2006">infant morality rate</a> per 1 000 births (<a href="https://sustainabledevelopment.un.org/sdg3">SDG 3</a>), for example, has declined from 36.1 in 2012 to 28.8 in 2017. But that’s still comparatively high. In 2017 the infant mortality rates in Colombia and Thailand respectively were 12.7 and 8.2. </p>
<p>There are other areas in which progress hasn’t been as strong as it should. Tuberculosis is one example. Despite major improvements, <a href="https://data.worldbank.org/indicator/SH.TBS.INCD?locations=ZA-CO-TH">tuberculosis infection rates</a> remain very high at 567 per 100 000, compared to 156 per 100 000 in Thailand and 33 per 100 000 in Colombia.</p>
<p>On the positive side, South Africa’s <a href="https://data.worldbank.org/indicator/SH.STA.TRAF.P5?locations=ZA-CO-TH">road deaths</a> – while high at 21.3 per 100 000 – are lower than Thailand’s (32 per 100 000). At 0.8% of GDP, South Africa’s <a href="https://data.worldbank.org/indicator/GB.XPD.RSDV.GD.ZS?locations=ZA-CO-TH">research and development expenditure</a> is significantly higher than that of Colombia (0.24%), and comparable to that of Thailand (0.78%) (<a href="https://sustainabledevelopment.un.org/sdg9">SDG 9</a>). </p>
<p>Interestingly, South Africa scores better than both countries when it comes to levels of corruption (<a href="https://sustainabledevelopment.un.org/sdg16">SDG 16</a>). In the most recent <a href="https://www.transparency.org/cpi2018">Corruption Perceptions Index</a>, South Africa is ranked 73rd out of 180 countries, compared to the 99th place shared by Thailand and Colombia.</p>
<p><em>4. Forge new types of partnerships.</em></p>
<p>In their work on problems that are particularly hard to solve, the environmentalist <a href="https://link.springer.com/article/10.1007/s11077-012-9151-0">Kelly Levin and her colleagues</a> identify a few characteristics of such problems. One of them is particularly applicable to the SDGs: those who caused the problem in the first place are also trying to solve it. Put in the language of the SDGs: the very institutions that gave rise to the catalogue of problems to which the SDGs respond are trying their best to solve them.</p>
<p>A rational response to this challenge would be to form strategic alliances that reconfigure the institutional landscape that created the need for the SDGs. How should this be done? In their <a href="https://www.bsr.org/reports/BSR_Rockefeller_Private-Sector_Collaboration_for_Sustainable_Development.pdf">report on this topic</a>, global non-profit organisation BSR provides practical advice. It found that transformative partnerships are typically built around a “compelling common purpose”, which puts “the right partners in the right roles”. The trick is for institutions to actually realise that they share a common purpose.</p>
<h2>Looking forward</h2>
<p>It’s not too late. There are still 11 years left until countries need to present their final SDG progress reports. But to ensure that the SDGs’ real potential are unlocked, South Africa needs significant progress on a few fronts. Emphasis should be placed on improving data quality and coverage, and using this as basis to forge partnerships that use the data to effect real change.</p><img src="https://counter.theconversation.com/content/119487/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Willem Fourie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What should be done to ensure that the SDGs actually change countries’ development trajectories? Here are four practical steps.Willem Fourie, Associate Professor at the Albert Luthuli Centre for Responsible Leadership, Co-ordinator of the South African SDG Hub, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602072016-07-05T03:52:06Z2016-07-05T03:52:06ZWhy the African food basket should be full of beans and other pulses<figure><img src="https://images.theconversation.com/files/129172/original/image-20160704-19098-1tehpre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sorghum and legumes could help children reach their required protein intake. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>On December 20 2013, the 68th session of the United Nations General Assembly passed an adopted resolution declaring 2016 the <a href="http://www.fao.org/pulses-2016/en/">International Year of the Pulse</a>. <a href="http://www.pulsecanada.com/about-us/what-is-a-pulse">Pulses</a> – which include dried beans, chickpeas and lentils – are a good source of protein and amino acids and are a critical part of the <a href="https://sites.google.com/site/multitude2008/Home/economy/economical-alternatives/the-food-basket">food basket</a>. They are important for food security, health and nutrition.</p>
<p>The resolution was adopted to reap the benefits that pulses have towards the environment where they increase soil fertility. Nutritionally, they also assist in maintaining a healthy weight, prevent and manage chronic diseases. </p>
<p>Due to the increasing concerns for the environment, food security, health and nutrition, pulses are one of the best foods to feed the millions of people suffering from chronic hunger, micro-nutrient deficiencies and chronic diseases. A majority of the people suffering live in Africa. </p>
<p>These concerns are set against a background of a continent that has the ability to produce its own rich diversity of nutritious plant foods and crops like pulses that could play a far more significant role in solving malnutrition in Africa. For example, indigenous cereals and pulses such as sorghum and cowpea which grow well where other crops fail such as in the arid and semi-arid areas can be used.</p>
<h2>What are pulses</h2>
<p>Dry beans, dry broad beans, dry peas, chickpeas, dry cow peas, pigeon peas, lentils, bambara beans, vetches and <a href="http://onlinelibrary.wiley.com/doi/10.1029/2003GB002108/full">lupins</a> are all plant foods which belong to the family of legumes. The term legume is used to refer to foods enclosed in a pod and pulses are only a subgroup of the legume family which is used in its dried seed form.</p>
<p>Besides being a good source of protein, pulses are good sources of fibre, calcium, iron and vitamins B, E and K. Depending on their genetic makeup, pulses can grow in extreme climatic conditions where other foods are difficult to find. Pulses make up most of the average diet in developing countries due to their <a href="http://advances.nutrition.org/content/1/1/17.full">low cost</a>. </p>
<p>Even though the production and consumption of pulses has declined, they form <a href="https://books.google.co.za/books?id=zVz-CAAAQBAJ&pg=PA6&lpg=PA6&dq=4%25+of+the+major+crops+in+the+world+are+pulses&source=bl&ots=b3XL1DngBd&sig=HZUx_dAw1xMEuxX1HXBgDFRlvUk&hl=en&sa=X&ved=0ahUKEwidzNeWkNrNAhVIB8AKHTpGATQQ6AEISTAH#v=onepage&q=4%25%20of%20the%20major%20crops%20in%20the%20world%20are%20pulses&f=false">almost 4% of the major crops</a> grown in the world. In Africa, the term indigenous food crops does not only refer to food crops from the continent, they include crops that have been introduced and are recognised as naturalised or traditional crops. </p>
<p>An example of this are the pulses <a href="http://www.fao.org/3/a-i5528e.pdf">originally from Asia</a> now considered to be indigenous to Africa. The most <a href="http://www.nda.agric.za/docs/Brochures/Indigfoodcrps.pdf">commonly consumed pulses in South Africa</a> are cowpeas and mung bean produced in the Limpopo, Gauteng, Mpumalanga, North West and KwaZulu-Natal provinces.</p>
<h2>South Africa’s problem</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129173/original/image-20160704-19118-1eg3dpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cowpea, a nutritional food, is mostly consumed by small-holder farmers in South Africa.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In South Africa, sorghum and cowpea have good potential. They produce higher yields than less resistant crops like maize and wheat. But they are produced in smaller quantities by subsistence farmers for home consumption. The decrease in use of indigenous foods is mainly a result of dietary changes due to <a href="http://www.cpc.unc.edu/projects/nutrans/whatis">nutrition transition</a>.</p>
<p>One in four children in South Africa have also been found to be too short for their age - their growth is stunted. One in three people in the country, are also faced with <a href="http://www.hsrc.ac.za/en/media-briefs/population-health/results-sanhanes1">hunger</a> due to <a href="http://www.feedingtexas.org/learn/food-insecurity/">food insecurity</a>.</p>
<p>All these signs of growth faltering begin in early childhood. More so, a considerably larger proportion of South Africa’s population has been said to experience what is termed, <a href="http://www.unicef.org/republicadominicana/english/survival_development_12473.htm">hidden hunger</a>. This kind of hunger is characterised by growing numbers of overweight, obesity and micro-nutrient malnutrition, which can easily be solved by providing a cheaper, yet good source of nutrition from plant foods like pulses.</p>
<p>The desire for convenience, driven by urbanisation and nutrition transition has increased the consumption of highly processed, less nutritious foods. The high processing and refining of foods unfortunately come at a higher cost to consumers. </p>
<p>The availability of convenient <a href="http://www2.warwick.ac.uk/newsandevents/pressreleases/the_influence_of/">westernised type of diets</a> has led to the neglect of locally available healthier and less expensive food options. These western types of diets offer high levels of energy and a low micro-nutrient content leading to overweight, obesity and micro-nutrient malnutrition.</p>
<p>Foods indigenous to Africa, however have the ability to provide adequate nutrition. Currently, indigenous foods use is slowly diminishing. Indigenous foods are mainly used by small holder farmers for their own consumption, hence they are produced in smaller quantities.</p>
<h2>Sorghum and cowpea – lost food resources</h2>
<p>There is need for greater creativity in identifying ways to assist government interventions for the malnutrition problem. Pulses like cowpea can be used as a cheaper source for nutrition. South Africa’s government are currently using some interventions like <a href="https://www.health-e.org.za/2015/06/04/strategy-roadmap-for-nutrition-in-south-africa-2013-2017/">supplementation of vitamins, fortification</a> of processes flour and bread and <a href="http://www.gov.za/services/child-care-social-benefits/child-support-grant">child support grants</a> to deal with the issue of malnutrition. </p>
<p>In a recent <a href="http://repository.up.ac.za/handle/2263/51189">study</a> we found that 40% of children between the ages of two and five could get their required protein intake in a ready-made meal which included sorghum and cowpea. Proper marketing and re-introducing indigenous foods in the diet can help to increase the use of such foods. The same mix could also provide essential amino acids like lysine that is typically missing in maize. Lysine is an essential amino acid because it cannot be synthesised by the body, but can only be obtained through the diet. It can also provide children aged two to five with the recommended iron and zinc.</p>
<p>Africa needs to make use of indigenous foods. As the year of the pulse, 2016 is the year that they are made use of in more creative ways. To add to that indigenous foods are climate resilient and have a <a href="http://www.greeneatz.com/foods-carbon-footprint.html">low carbon footprint</a> because they can be produced locally with minimal inputs.</p><img src="https://counter.theconversation.com/content/60207/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nokuthula Vilakati is a Post doctoral fellow at the University of Pretoria's Institute of Food Nutrition and Wellbeing (IFNuW). She receives funding support from the Office of Agricultural Research and Policy, Bureau for Food Security, U.S. Agency for International Development, under the terms
of Cooperative Agreement No. AID-OAA-L-14-00003, the South African National Research Foundation (NRF) and University of Pretoria's Institute for Food, Nutrition and Well-being (IFNuW).</span></em></p>Pulses – or grain legumes – are indigenous foods that can play a massive role in tackling food security on the African continent.Nokuthula Vilakazi, Researcher at the University of Pretoria, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602242016-06-02T15:03:09Z2016-06-02T15:03:09ZWhy child malnutrition is still a problem in South Africa 22 years into democracy<figure><img src="https://images.theconversation.com/files/124935/original/image-20160602-23302-1nk1gti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An unacceptably high proportion of children in South Africa live in poor conditions.</span> <span class="attribution"><span class="source">Megan Trace/Flickr</span></span></figcaption></figure><p>High rates of malnutrition translate into poor child outcomes. Preventing this should start early: good nutrition and health of mothers and their children during the first 1,000 days – from conception to about two years – is described as a unique window of opportunity for later human development. By the age of five years the outcomes of any deprivation experienced during this stage of growth may be irreversible.</p>
<p>Globally, it is estimated that a third of the six million preventable deaths of young children in poor and middle-income countries each year can be ascribed to undernutrition. </p>
<p>Of those who survive, an <a href="http://www.who.int/mediacentre/factsheets/fs178/en/">estimated 200 million</a> children under five fail to reach their potential in cognitive development because of poverty, poor health and nutrition, and deficient care.</p>
<p>Two reports have been released in South Africa that show the unacceptably high proportion of children in poor living conditions. The first is Statistics South Africa’s <a href="http://www.statssa.gov.za/?p=6395">profile of the youth</a> and the second is the <a href="http://www.ci.org.za/depts/ci/pubs/pdf/resources/general/2016/SA_ECD_Review_2016.pdf">South African Early Childhood Review</a>, published by the University of Cape Town’s Children’s Institute as well as an early childhood development non-governmental organisation <a href="http://www.ilifalabantwana.co.za">Ilifa Labantwana</a> and the South African goverment’s Department of Planning, Monitoring and Evaluation. Both focused attention on the plight of young people in South Africa.</p>
<p>They show that South Africa’s stunting rate lies well above the trend for most countries that are at a similar level of economic prosperity. This is despite the improvement in the prevalence of stunting as a result of policy interventions in the two decades since the end of apartheid. The reality is that the bulk of South Africa’s children continue to live in households that are below the poverty line. </p>
<p>This means that, while inequities in nutritional status may have been mitigated through the existing suite of social protection policies, children remain at risk in South Africa. </p>
<h2>Poverty</h2>
<p>The <a href="http://www.ci.org.za/depts/ci/pubs/pdf/resources/general/2016/SA_ECD_Review_2016.pdf">South African Early Childhood Review</a> shows that children are more likely to be living in poor households than adults. About 53% of children under six live in poor households. The vast majority of these children are African and live in rural areas. The figures can be compared with just less than 33% of households and 45% of individuals categorised as poor in terms of South Africa’s official <a href="http://www.statssa.gov.za/publications/Report-03-10-06/Report-03-10-06March2014.pdf">upper-bound poverty line</a> of R779 ($50) per month. </p>
<p>South Africa’s high levels of inequality are well documented. In terms of income, the <a href="http://www.statssa.gov.za/publications/Report-03-10-06/Report-03-10-06March2014.pdf">bottom 20% of the population</a> receives less than 5% of income while the wealthiest 20% <a href="http://www.statssa.gov.za/publications/Report-03-10-06/Report-03-10-06March2014.pdf">receives more than 60%</a>. This situation has hardly changed over the past two decades and translates into dramatic differences in expenditure patterns.</p>
<p>Statistics South Africa has shown that <a href="http://www.statssa.gov.za/publications/Report-03-10-06/Report-03-10-06March2014.pdf">poor households spend</a> about R8,485 per year (US$540 at current rates) on food. This makes up 34% of their total household expenditure. Non-poor households spend R14,020 ($894) on average per year on food. It makes up only 10% of their total household expenditure. </p>
<h2>Stunting</h2>
<p>For infants, one consequence of poverty is stunting: having low height-for-age. Stunting results from failure to grow at an adequate rate. It is considered a long-term indicator of undernutrition that reflects the cumulative effects of poor socioeconomic, environmental, health and nutritional conditions.</p>
<p>Nutritional status is important both during the period prior to a child being born, as it develops in the womb, as well as during the first two years of the child’s life. </p>
<p>Child nutritional status has long been identified as an important concern in South Africa. And the food security and nutritional status of infants under the age of two years is of particular concern. </p>
<p>In 1993, about <a href="http://www.tandfonline.com/doi/abs/10.1080/0376835X.2014.952896">30% of children under five</a> suffered from stunting. The data that exists prior to 1993 suggests this level was maintained and perhaps exceeded in some parts of South Africa, for at least a decade.</p>
<p>Most <a href="http://www.ci.org.za/depts/ci/pubs/pdf/resources/general/2016/SA_ECD_Review_2016.pdf">studies</a> now agree that this prevalence has declined. It currently sits at about 25%. And there are differences across groups and areas. Stunting is highest among the coloured population (at 28%) and higher in rural areas than in urban areas.</p>
<p>In the context of such extreme inequalities, differences in the prevalence of stunting across income groups might also be expected.</p>
<p>But the trend of height-for-age status of children diverges from that of other forms of inequality when mapped against income. In 1993, almost 50% of children in the poorest tenth were stunted, compared with 15% of children in the richest tenth. </p>
<p>The most recently available data shows that although inequalities have persisted, they are far lower. Today, 26% of under-five children in the poorest quintile are stunted compared with 14% of children in the richest quintile. The implication is that there has been a <a href="http://jutaacademic.co.za/print/academic_products/AcademicProduct/1893">significant decline</a> in terms of inequality in health outcomes for children since 1993.</p>
<h2>A change of direction</h2>
<p>This reduction – in the face of little change in the prevalence of income poverty and widening income inequality – points to the impact of polices that have provided a “social wage” to the poor. This refers to the package of services and grants intended to reduce the cost of living of the intended beneficiaries. The social wage is a component of South Africa’s <a href="http://www.gov.za/sites/www.gov.za/files/Executive%20Summary-NDP%202030%20-%20Our%20future%20-%20make%20it%20work.pdf">National Development Plan</a>. </p>
<p>Currently, close to 60% of <a href="http://www.treasury.gov.za/documents/national%20budget/2013/review/chapter%206.pdf">government spending</a> is allocated to the social wage. Expenditure on these services has more than doubled in real terms over the past decade. Social wage policies that are relevant for nutritional status of children include:</p>
<ul>
<li><p>free clinic-based primary health care for women and children under six; </p></li>
<li><p>subsidies on housing, electricity, water, sanitation and solid waste management; and</p></li>
<li><p>the child support grant, most importantly.</p></li>
</ul>
<p>But addressing this challenge will require more than spending additional money by increasing the child support grant, or extending it to older age groups. Alternative interventions must be found to achieve greater progress in improving the food security and nutrition of children. </p>
<p>This includes strategies to support better diets for infants, such as the promotion of breast-feeding, which has been shown internationally to improve nutritional status. It is concerning that the United Nations Children’s Emergency Fund <a href="http://www.unicef.org/southafrica/media_10469.htm">reports</a> that South Africa has one of the lowest rates of exclusive breast-feeding in the world.</p>
<p>Strategies must also provide access to adequate water and sanitation where children are living. Unhygienic conditions, including those that arise when toilets are shared by a number of households, have been <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002010">linked to</a> moderate to severe diarrhoea in children. This in turn leads to malnutrition. </p>
<p>Finally, there is a role for the delivery of other forms of social protection to children, including prenatal care for prospective mothers. </p>
<p>Interventions such as these need to be included in the implementation strategies of policies such as the recent <a href="http://www.nda.agric.za/docs/media/NATIONAL%20POLICYon%20food%20and%20nutrirition%20security.pdf">National Policy on Food and Nutrition Security</a>, and in provincial and municipal strategies for food security. </p>
<p>In addition, civil society organisations concerned with food security and the right of children to adequate nutrition should consider broadening the pathways through which they try to influence policy.</p><img src="https://counter.theconversation.com/content/60224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian May receives funding from the National Research Foundation, Mellon Foundation, Western Cape Government, International Development Research Centre, German Academic Exchange Service, Office of the President, Statistics South Africa, KwaZulu-Natal Government, National Department of Social Development, Economic and Social Research Council, World Bank.</span></em></p>Inequalities in the nutritional status of poor and rich have been mitigated through various social protection policies, but children in South Africa remain at risk of malnutrition.Julian May, Director DST-NRF Centre of Excellence in Food Security, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.