Putting Children First: Identifying solutions and taking action to tackle poverty and inequality in Africa. Addis Ababa, Ethiopia, 23-25 October 2017 This three-day international conference aimed to engage policy makers, practitioners and researchers in identifying solutions for fighting child poverty and inequality in Africa, and in inspiring action towards change. The conference offered a platform for bridging divides across sectors, disciplines and policy, practice and research.

1. How many malnourished children
are there in South Africa?
Why?
What can be done?
Stephen Devereux
Julian May
Coretta Jonah

2. A food security paradox
• More than enough food at national level
• Declining child hunger
• Social protection for children
• Free primary health care for children and
mothers
BUT
• Unchanged or possibly worsening of child
stunting

3. • How many malnourished children are
there in South Africa?’
• Why are 1 in 4 children in South Africa
stunted?
• What can be done?

4. How many?

5. Context
• The dramatic decline in pediatric AIDS has meant that the
the context of maternal and child health has changed
• 1 million babies born in South Africa each year, 30 000 of
which die before reaching one year of age
• 15.5 per cent of births have low-birth weight, of which 3.5
per cent can be attributed to maternal under-nutrition
• Diarrhoea is the leading cause of death for these children
• Underweight contributed to 12 per cent of attributable
deaths in <5 children
• Sub-optimal feeding practices estimated to be responsible
for 10 per cent of DALYs of <5 children

6. Stunting prevalence
0
10
20
30
40
50
60
100 1,000 10,000
%unver5stunted
GNI ($PPP) per capita
0
10
20
30
40
50
60
100 1,000 10,000
%under5stunted
GNI ($PPP) per capita
Global SSA

7. Not availability
Food supply in South Africa,
1991–2011 (kcal/capita/day)
Dietary energy supply (DES) adequacy in
South Africa, 1991–2015 (%)

8. Not hunger
Children experiencing hunger in South Africa, 1994 to 2015

9. Not exclusion
Child Support Grant recipients in South Africa, 1998–2014

10. Not declining
0
5
10
15
20
25
30
35
PSLSD 1993 SAVCG 1994 NFCS-1
1999
SADHS 2003 NFCS-2
2005
NIDS 2008 NIDS 2012 SANHANES
2012
NIDS 2014 SADHS 2017
%stunted

11. Why?

12. Explaining the paradox
• “Not availability”
Availability of food ≠ Access to food

13. Explaining the paradox
• “Not availability”
Availability of food ≠ Access to food
• “Not hunger”
Food security ≠ Nutrition security

14. Explaining the paradox
• “Not availability”
Availability of food ≠ Access to food
• “Not hunger”
Food security ≠ Nutrition security
• “Not exclusion”
Social protection coverage ≠ adequacy

15. Availability of food ≠ Access to food
Enough food at national level
does not mean enough food
at household/individual level.
Stats SA 2017

16. Availability of food ≠ Access to food
Enough food at national level
does not mean enough food
at household/individual level.
Stats SA 2017
Children are most at risk
of poverty in South Africa
– including food poverty.

17. Pathways to malnutrition:
e.g. adequate access to food
– but the wrong kind of food
(undiversified, obesogenic)
Food security ≠ Nutrition security

18. Pathways to malnutrition:
e.g. adequate access to food
– but the wrong kind of food
(undiversified, obesogenic)
– or no exclusive breast-feeding
Food security ≠ Nutrition security

19. Social protection coverage ≠
Social protection adequacy
Social protection floor:
Guaranteed income security for all

20. Social protection coverage ≠
Social protection adequacy
Social protection floor:
Guaranteed income security for all
‘Dilution’ of social grants:
Multiple uses & multiple users

21. What to do?

22. Learning from Brazil
Child stunting in Brazil and South Africa

23. Learning from Brazil
Education of
women
Better educated mothers:
Rising access + quality
of education services

24. Learning from Brazil
Rising incomes of poor families:
Economic growth
+ rising minimum wage
+ Family Agriculture
Programme
+ cash transfers
(e.g. Bolsa Familia)
Rising income
= improved
access to food

25. Learning from Brazil
Improving maternal and child health care:
free health services +
Family Health Strategy
Improved
mother and
child health

26. Learning from Brazil
Wider coverage of water supply and sanitation services:
more households
served by public
water supply and
public sewage system
Access to clean
water and
sanitation

27. Conclusion
Nutrition–sensitive social protection requires ‘CASH +’ or …
CASH
+
+ +
Food and
nutrition
security
CASH
+
+
+
CASH +3

28. THANK YOU
With thanks to our funders and collaborators, without
whom our work would not be possible
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Facebook: FoodSecuritySA/CoEinFs
Website: www.foodsecurity.ac.za