OPINION | Early intervention needed to prevent stunting of poor kids

SA sits with a ticking time bomb that needs everyone’s attention, from the Union Buildings to the boardrooms of big business across the country.

The recently released Thrive by 5 index, which is considered one of SA’s most comprehensive national surveys of preschool child outcomes, offers a unique, current picture of stunting data for 4-5-year-old children. Of the 5,001 children enrolled in early learning programmes (ELPs), 7% are moderately to severely stunted.

This is lower than previous national surveys (27%-29%) for children aged 0-5 years, highlighting both the protective effects of ELPs and the value in age-specific data for children.

For children not enrolled in ELPs, the difference is startling: 18% were moderately or severely stunted. Though not nationally representative, these children highlight the developmental consequences of living in conditions of deep poverty and vulnerability: 55% of non-enrolled children are falling far behind their peers and only 18% are on track for early learning outcomes; 24% experienced household food insecurity; 73% of caregivers had not finished high school; 70% lacked tap water; and 77% reported financial barriers as the main reason for non-enrollment in an ELP.

These children miss out on the learning, feeding and health interventions available through ELPs, compounding developmental risks experienced in the earliest years of life.

The Thrive by 5 Index further highlights the consequence of mild stunting. Traditionally outside the clinical threshold for stunting, mild stunting reflects suboptimal growth, placing even more children at risk for poorer cognitive development and reduced school readiness.

For enrolled and non-enrolled children, mild stunting was worryingly high: 25% for enrolled and 36% for non-enrolled children, respectively. Overall, the majority of children in the Thrive by 5 Index sample are shorter for their age than the global median, placing their development outcomes at risk.

Stunting is a preventable condition caused by chronic malnutrition during pregnancy and the early years of life. Stunted children are excessively short for their age and suffer from poor health and potentially irreversible cognitive defects that affect their learning and development. Stunting is a sign that children are not getting the food and care they need to grow, learn and thrive.

SA is one of the most unequal countries in the world. Two-thirds of people live in poverty and youth unemployment sits above 60%. In this context, stunting is both a symptom and a preventable consequence of deep inequality that limits not only children but also the country itself.

However, without accurate data, decision-makers are ill-equipped to address stunting, understand its consequences for learning and development and tackle its root causes.

Stunting sets children back an average of five months in learning. Even children with mild stunting show measurable learning lags of at least two months. For stunted children not enrolled in ELPs, the risks are even greater. These children not only miss the structured learning opportunities offered by ELPs but also the health and nutrition support frequently provided as part of ELPs.

These findings underscore that stunting is about more than just height. Stunted children are more likely to struggle with learning, entering school behind their peers and facing long-term consequences of lower school achievement, higher risks of school dropout and eventually poorer health outcomes and lower earning potential.

The Thrive by Five Index confirms that stunting remains a critical barrier to children reaching their full potential in SA. The results are a sobering call to action for parents, practitioners and policymakers working with young children. We cannot wait until children enroll in ELPs to address the consequences of stunting.

Proven interventions in the first 1,000 days (from conception to age two) offer a critical window of opportunity to ensure children’s bodies and brains grow well, preventing stunting and its lifelong consequences.

SA risks undermining its social investments in early education and youth development if the foundations of growth in the earliest years are not secured. The country cannot afford to wait until children are aged four to discover that they are already falling behind. By then, the opportunity for full recovery is already slim.

To secure the nation’s future, we must close the gap for children aged 0–2 years, acting even earlier to ensure every child gets the right start and is healthy, nourished and ready to learn.