It's easy to assume it comes down to genetics, but the reality is far more alarming: chronic undernutrition during their most critical early years.
Picture: Brenton Geach/Gallo Images
A child’s height can look like a family trait, a harmless variation or simply “the way children are”. But when a child is too short for their age because their body has not received enough of the right nutrients over time, the problem runs deeper than the measuring tape.
Nearly one in three South African children under five (28.8%) is affected by stunting, a severe chronic undernutrition crisis.
Health minister Aaron Motsoaledi submitted these figures, which are well above the global average according to WHO, to the South African Human Rights Commission’s (SAHRC) inquiry into food systems recently.
StartWell Foundation, a non-governmental organisation working on child nutrition, says the country does not face only a shortage of food, but a shortage of nutritional quality in children’s diets.
“South Africa does not have a food shortage problem. We have a nutrition problem,” the organisation’s Tshimbi Mokgele told The Citizen.
Common misconceptions among South African communities include the belief that stunting stems purely from food shortages or that affected children will simply catch up later in life.
A child can eat until their stomachs are full without receiving the protein, vitamins, and minerals needed to build a growing body and developing brain.
Filling stomachs, missing growth
In many communities, a morning bowl of porridge starts with steam rising from the pot, spoons scraping the sides, and children left with something warm in their stomachs.
But not every full stomach contains what a growing child needs.
Mokgele says many feeding programmes at early childhood development centres (ECDs) or creches do vital work by ensuring that children receive regular meals, but some struggle to provide enough high-quality protein and key nutrients within tight budgets.
The National Department of Basic Education (DBE)’s subsidy of R24 per child per day doesn’t cover all the costs it needs to run, said Jean-André Butcher from Legal Resources Centre, especially becoming a problem when they don’t pay.
“What concerned us most was that many feeding programmes focused primarily on alleviating hunger rather than addressing the underlying nutritional deficiencies that drive stunting,” Mokgele said.
The DBE’s 2026 budget review shows that it spends more than R10 billion a year on the National School Nutrition Programme to provide 9.7 million meals per day.
However, Mokgele argues that feeding programmes should measure more than the number of meals served. They should also track children’s growth, nutrition status, and reductions in stunting.
Its own intervention is a ready-to-eat cereal made with chickpeas, peanuts, sorghum, oats, and milk powder developed to provide a mixture of plant-based ingredients and dairy protein, rather than relying mainly on a single grain or a basic soy-and-wheat blend often seen in other programmes.
“StartWell currently nourishes more than 21 000 children every day across South Africa,” Mokgele said.
The body must absorb food
There is, however, a complication that a nutrient-dense meal cannot solve by itself.
Microbiologist Thulani Makhalanyane and health economist Ronelle Burger argued that food alone will not fix childhood stunting.
They said that repeated exposure to infections, unsafe water, poor sanitation, and unhygienic environments can be factors.
In simple terms, a child may eat nutritious food, but an inflamed or damaged gut, caused by harmful environmental factors, may struggle to absorb and use those nutrients properly. The child’s body may receive food without receiving its full benefit.
“The gut microbiome plays a complementary role by breaking down complex carbohydrates that our bodies cannot digest on their own, converting them into forms that may be absorbed and used for growth and development,” said Makhalanyane.
“Children living in informal settlements, where sanitation is generally poor, are exposed to microorganisms through dirt, toxic dust, and sewage.
“This exposure may lead to a condition called environmental enteric dysfunction. This is when an inflamed intestine impairs the absorption of nutrients, including fats, proteins, and vitamins.
“The result is stunting. This may remain undiagnosed but can affect health negatively across a lifetime.”
Therefore, “it appears that putting calories into mouths is not enough to prevent stunting.”
More than a food problem
Mokgele agreed, saying that stunting rarely has a single cause.
A child’s height can reflect the conditions surrounding them – not simply what they ate yesterday.
“Even when food is available, repeated infections, poor sanitation or inadequate feeding practices can prevent children from absorbing the nutrients they need,” said Mokgele.
Other factors include undernourished pregnant women who have a higher chance of giving birth to low-birth-weight babies, which increases the risk of stunting. Alcohol use during pregnancy and fetal alcohol syndrome also contribute significantly to the problem.
“That is why stunting should be viewed as both a nutrition challenge and a broader development challenge.”
A child who repeatedly suffers diarrhoea, for example, may lose nutrients and appetite.
A household without safe water may battle infections that keep returning.
A caregiver may understand the value of a diverse diet but lack the money, time, fuel, or refrigeration needed to provide it consistently.
The height we do not notice
Stunting often hides in plain sight.
When an entire community has faced poverty and poor nutrition for years, short stature can begin to look normal. Adults may describe a child as “small like the family” and carry on, said Mokgele.
But routine growth monitoring can identify children whose height is falling behind before the problem becomes harder to address.
StartWell says its trained community-based ‘Local Champions’ visit early childhood development centres each month to measure children’s height. The measurements are entered into digital platforms and compared with internationally recognised height-for-age standards to identify growth trends and children who may be at risk.
A bowl is not a complete solution
So, if South Africans appear shorter than expected, the explanation is not simply genetic – and it is not simply that children are not eating enough, explained Burger.
The answer lies both inside and outside the bowl.
President Cyril Ramaphosa’s February State of the Nation Address set a firm goal for the government to eliminate child stunting by 2030.
The Presidency has recently set up a joint task team from different government departments, chaired by Saul Musker, its head of strategy and delivery support.
“What’s needed are integrated approaches that simultaneously tackle sanitation, infection control, nutrition quality, and early childhood stimulation,” said Makhalanyane.
