Poor hygiene, alcohol and malnutrition are stunting our children

Some informal settlements and poorly serviced areas in South Africa have experienced repeated infections caused by unhygienic living conditions, especially among children under five.

This is according to the DG Murray Trust, a nonprofit organisation that invests in strategic initiatives aimed at human development and escaping the inequality trap.

Trust CEO David Harrison says South Africa is on a mission to end stunting by 2030 but progress will depend on decisive action across every sphere of government.

He said that stunting occurred when children were abnormally short for their age due to chronic malnutrition.

Harrison said more than one in four South African children under the age of five was stunted.

Harrison said the crisis begins in the womb and is worsened by repeated infections caused by unhygienic living conditions, particularly in informal settlements and poorly serviced areas.

“Stunting permanently damages physical growth and brain development. As a result, affected children have weaker immune systems and reduced chances of success in school and work,” Harrison said.

“If we are to end stunting, we need to do two things. First, we must ensure that children get enough nutritious food. Second, we must prevent gut damage that causes those nutrients to be lost through chronic malabsorption and diarrhea. This means we must prevent infections and treat them rapidly when they happen.”

The trust outlined strategies to ensure adequate nutrition included making staple protein foods more affordable, reducing the number of babies born underweight and supporting people who help communities grow their own food.

Harrison said the most critical time to prevent stunting was during a child’s first 1,000 days, or from conception to their second birthday.

“While healthcare clinics are vital, this period is shaped by the daily environments managed by local municipalities,” said Harrison, adding that decisions regarding water, sanitation, waste removal and town planning directly affected children’s health.

Nutrition lead from the Hold My Hand Accelerator, Liezel Engelbrecht, noted that international success stories from countries such as Chile, Ethiopia and Brazil showed how local governments could reduce stunting by co-ordinating healthcare, sanitation, food security and community support.

Engelbrecht said there were four ways South African municipalities could fight stunting, including improving water, sanitation and waste services.

“Babies born underweight often due to maternal malnutrition, alcohol use or HIV are at a much higher risk of stunting. However, the external environment plays an equally massive role,” Engelbrecht said.

She said a lack of clean water, proper toilets and trash removal damage a child’s immune system and gut health.

Engelbrecht said municipalities can reduce infection risks by improving basic service delivery, especially in informal settlements and strengthening environmental health systems.

While primary healthcare is a provincial responsibility rather than a municipal one, Engelbrecht says, local governments still hold immense power to support healthy pregnancies.

“Municipalities should explicitly include maternal and child health in their integrated development plans. By partnering NGOs and community health workers, municipalities can support vulnerable pregnant women.”

Engelbrecht said alcohol use during pregnancy contributed to low birth weight and foetal alcohol spectrum disorder (FASD).

“South Africa’s FASD rate is 10 times higher than the global average, affecting roughly one in 12 babies,” she said.

Under the constitution, local governments are responsible for securing citizens’ wellbeing.

“Municipalities can curb heavy, high-risk drinking by restricting the operating hours of liquor outlets and limiting the number of alcohol licenses granted in residential areas.”

She said South Africa produces enough food to feed its population but widespread poverty, unemployment and inflation meant many families simply cannot afford enough nutritious food.

“This is a problem of access, not supply.”

According to her, since two-thirds of South Africans live in urban areas, municipalities should establish urban agricultural hubs and community gardens.

“Following successful global models like China, local governments can clear unused municipal land for community farming. This food can directly supply households and local early childhood development centres.”

Engelbrecht said that to ensure children are safe, sheltered and well-fed is the highest duty of local leadership.

“The upcoming elections offer a vital opportunity to align national, provincial and local government agendas.”

Engelbrecht said that by putting child wellbeing at the centre of development plans, South African municipalities could ensure the next generation grew up healthy and strong.

In President Cyril Ramaphosa’s 2026 state of the nation address, he said 2030 was the target date for ending the scourge of stunting.

Ramaphosa said the government would focus on the crucial first 1,000 days of a child’s life.

“We will implement targeted interventions to ensure that pregnant women and low-birth-weight children get the protein and nutrients they need,” Ramaphosa said.

He identified excessive alcohol consumption among pregnant mothers as the prime cause of stunting.

“A major contributor to child stunting is excessive alcohol consumption, which can affect children’s development during pregnancy. Alcohol abuse also leads to violence, road accidents and crime,” he said.

TimesLIVE