When Patricia Stoffels learned she was pregnant with twins, her elation soon gave way to worry. How would she be able to afford and take care of two babies?
A friend soon visited her home in the town of Worcester in Western Cape Province, South Africa, and invited her to a prenatal support class called Flourish, overseen by the nonprofit Grow Great Campaign. Stoffels went out of a sense of obligation to her friend, but left the class feeling empowered, armed with useful information that she hadn’t known when she had her first two children.
In a country where less than 32% of mothers exclusively breastfeed their children, she learned that breastfeeding is a crucial source of nutrients for babies. Around 70% of women who attend Flourish classes are still breastfeeding their infants exclusively at 14 weeks, according to Duduzile Mkhize, communications specialist at Grow Great.
Stoffels also learned that constantly reading, talking, and singing to children can stimulate critical brain growth, and that highly nutritious vegetables and protein-rich foods like eggs should be incorporated into a child’s solid food diet for development.
These and other recommendations are part of Flourish’s curriculum, which ladders up to Grow Great’s overarching mandate: to end stunting in South Africa.
An estimated 27% of children under the age of 5 in South Africa are stunted, meaning a chronic lack of nutrients in the womb and in their first years of life have left them with reduced cognitive and physical potential. Children who are stunted are more likely to have learning challenges and are physically shorter than non-stunted children. They’re less likely to finish school and get a job later in life, and they’re more likely to suffer from health complications such as diabetes, obesity, and high blood pressure in adulthood.
Up to a third of the 6 million preventable deaths facing children under the age of 5 worldwide each year can be attributed to stunting.
Mkhize told Global Citizen that stunting is a grave injustice that harms more than just the malnourished child.
“A woman who is stunted is three times more likely to give birth to a stunted child,” she said. “It becomes an intergenerational cycle of poverty. Stunted children are more likely to not have an education [or] jobs.”
“The consequences are quite dire,” she said.
Why Is Stunting So Common?
Stunting is common in South Africa and around the world largely because of systemic poverty and inequality. The immiserating effects of apartheid are still keenly felt in the country.
The poorest 20% of South Africa’s population own 5% of the wealth, while the wealthiest 20% own 60%. This inequality reverberates throughout daily life. People living in poverty have little access to quality and nutritious food, health care, and education, which leads to children not getting the nutrients and attention they need.
Mkhize said that poor women who feed their babies formula are often forced to ration it in ways that limit how much nutrients the child gets.
“Even those that are putting their kids on formula, they cannot necessarily afford it,” she said.
Over time, this leads to chronic malnutrition and stunting.
The South African government provides food stipends to low-income families, but these grants haven’t kept up with inflation over the years.
“Sometimes it’s the only source of income in the house is the child support grant and it's way below the food poverty line,” Mkhize said. “The money will go to buy the most basic food that will keep the child full but that’s not necessarily nutritious. The food is starchy, it contains little nutritional value, and the grant is too little to fully feed the child a nutritious diet for the whole month.”
To make matters worse, pregnant women are not eligible to receive the grant, she said, even though stunting in babies starts in the womb due to lack of nutrition.
“A pregnant woman is likely to lose their job or be fired, they are likely to lose their partner or their home, they have increased medical costs as they have to buy supplements, see doctors — all of those things require extra money,” Mkhize said. “Which is why we’re asking the government to extend the grant into pregnancy.”
Grow Great is also asking the government to make the maternity support grant to be equal or above the food poverty line. If the government is serious about ending stunting, Mkhize said, then it has to help families afford the food that nourishes children.
Grow Great is a grassroots movement works closely with community health workers.
At the height of the HIV/AIDS epidemic in the country, the government dispatched thousands of health workers to educate people about the virus, how to avoid it, and how to receive proper treatment.
Since 2010, the initiative has achieved a 50% reduction in fatalities associated with HIV/AIDS, and a roughly 40% decline in new infections, according to UNAIDS.
Grow Great has been able to work with the government to transition many of these health workers into a new role — supporting mothers and children to combat stunting.
Today, health workers travel throughout communities to check in on mothers and children under the age of 5, identifying children who are not growing well so they can refer them to the health system. The community health workers often help mothers navigate government bureaucracy to receive the welfare that they’re entitled to, while also teaching best practices, providing community support, and debunking myths.
“Community health workers have become more sources of health information for everyone,” Mkhize said. “They also organize clubs, where mothers breastfeed their babies, and they just sit and chat.”
"My little Sunshine will be weaning soon and this excites me because we were also taught the goodness of fruits, vegetables and eggs in our little ones diets - I've already searched up some recipes to mix up in the blender!😅🌹"— sikunye (@sikunye) September 17, 2020
- Sakienah, Flourish Antenatal Mom@growgreatzapic.twitter.com/L8nC9GYdIm
At these gatherings, the health workers debunk myths such as the belief that baby formula is superior to breast milk.
Parents will often refuse to accept that their child is stunted, claiming instead that their reduced height has to do with genetics, and take offense at the suggestion of malnutrition.
“People assume that if you have money to buy things, it means your child can’t be stunted,” Mkhize said. “We’re trying to say that if it's not a balanced diet, if they're just eating porridge all the time, they might be suffering from a hidden hunger.”
Breastfeeding myth: The more mom breastfeeds, the faster she runs out of milk.— Grow Great Campaign (@growgreatza) August 28, 2020
Fact: The more mom breastfeeds or expresses breastmilk, the more milk will be produced by her body.#BreastfeedingMonth#GrowGreatnesspic.twitter.com/iYbCXqSB7e
The COVID-19 Pandemic
The COVID-19 pandemic has disrupted the ability of health workers to conduct outreach, while also causing hunger rates to skyrocket in the country amid the economic shutdown.
During this period, Grow Great switched to host their Flourish prenatal classes online, but not everyone in the country has access to good internet, and video chat services were sometimes difficult for people to use.
The organization has been involved in providing food assistance to pregnant women in need using food vouchers.
“We were able to give small food vouchers to the moms, even for the community health workers who were unable to make ends meet, since a lot of them are volunteers,” Mkhize said. “It’s not something we normally do to give cash or vouchers, but during COVID-19 we were able to provide some help.”
Even now as the country’s COVID-19 case load declines, people are wary of letting community health workers into their homes because of the fear of being infected with COVID-19.
“The work that they do requires them to go inside and sit and talk,” Mkhize said. “People are still very worried to allow strangers, especially those in the health system, into their houses.”
But Grow Great has strong community ties and this is important. Many of its lead advocates are people who attended Flourish classes or received help from health workers.
These women go on to become effective organizers, raising awareness of stunting, encouraging other mothers to adopt best nutrition practices, and calling for greater government assistance.
One of my favorite things to do is to read to my baby, it’s our bonding time.Reading helps with language developments,thinking skills and enhances memory.Head over to https://t.co/7QOCqIDwPU to find out more on how you can invest in your child #Flourish#GrowGreatness#Partneredpic.twitter.com/OzQMox6ndW— Zenande Mfenyana (@Zenande_Mcfen) October 2, 2020
This sort of community building could be the key to ending stunting. When people realize their interconnectedness, lift each other up, and provide mutual support, then children everywhere can receive the nutrition and care they need to flourish.
Ending stunting depends on empowering women, but its ongoing occurrence has little to do with personal responsibility. Instead, every incidence of stunting is a structural issue, an indictment of a society that neglects children. The future of a society is made possible by the potential of children; denying them nutritious food and permanently reducing their potential is a profound injustice.
Grow Great understands this dynamic and is trying to build a society that fully dignifies and invests in children and mothers. That’s why it’s calling for the government to step up and alleviate childhood malnutrition by extending the child support grant into pregnancy.
“Spending a little bit more in the budget to prevent something that will become a bigger challenge in the future is an investment,” Mkhize said. “This might seem like a [lot of] money now, but when you see the challenges later — people who are unemployable, who cannot learn, who cannot go to school — the costs will be more.”