Feeding the Future By Dr. Khutso N. Sebetseba

Feeding the Future: National Nutrition Strategies and What Still Needs to Change

Opinion article by Dr. Khutso N. Sebetseba

Introduction

In every clinic and classroom in South Africa, the story of nutrition is quietly unfolding – in the height of a child, the concentration span of a learner, the resilience of a mother trying to stretch one meal into two. Nutrition is not just a matter of food; it is the single most powerful predictor of a child’s health, education, and economic future.

South Africa has made commendable progress in recognising this truth. Yet the reality remains sobering: nearly one in four children under five is stunted; a figure that has barely shifted over the past decade. [1,17] Behind every number is a name, a child whose potential is being shaped by what is (or isn’t) on their plate.

Where South Africa Is Leading

There are important achievements worth acknowledging.

The National Food and Nutrition Security Plan (2018–2023) brought multiple departments; from Health to Agriculture to Education; into one coordinated framework. [2] The National School Nutrition Programme now reaches over 9 million learners every day, providing what for many is their only reliable source of protein and energy. [3]

South Africa was also among the first African nations to introduce salt reduction regulations and the Health Promotion Levy on sugary drinks, addressing the rise in diet-related diseases. [4,5] The Child Support Grant continues to serve as a vital safety net, reaching millions of households each month. [6]

These efforts reflect an undeniable truth: that food is more than sustenance. It is social protection, health policy, and future-building in one.

Persistent Gaps

Still, policy success on paper does not always translate into full plates at home. Despite strong frameworks, malnutrition remains deeply entrenched, revealing the gaps between intention and impact.

• The first 1,000 days, from pregnancy to age two, remain under-prioritised, even though this period determines lifelong health and brain development. [7]
• Implementation challenges persist, especially in under-resourced provinces where delivery and monitoring vary widely. [8]
• The food environment continues to work against families: ultra-processed, sugar-rich products are aggressively marketed to children and often cheaper than fresh produce. [10,11]
• The double burden of undernutrition and obesity is rising — children in the same household can be both stunted and overweight. [13,14]
• And, as food prices climb, climate shocks and inequality magnify the vulnerability of low-income families. [15]

Affordability of Healthy vs Ultra-Processed Diets

Even when knowledge exists, affordability often decides what families eat. The average cost of a nutritious household food basket in January 2025 was R5,433.70. [16] A diet built around cheaper, ultra-processed foods could cost R3,200–R3,500 – almost 40% less.

Studies confirm that healthier diets are between 30% and 100% more expensive than less healthy alternatives. [18–20] For many households, choosing health isn’t a question of willpower – it’s an economic calculation made under strain.

“The child may not be hungry,” a nurse at a home once told me, “But the food we can afford doesn’t help him grow.” That quiet reality plays out daily across South Africa’s clinics and classrooms.

Impact on Children

The human cost of poor nutrition cannot be overstated.
• Stunting robs children of height and potential: it limits cognitive development and future earning capacity. [13]
• Micronutrient deficiencies increase the risk of infections, anaemia, and learning difficulties. [21,22]
• Childhood overweight and obesity, rising in both urban and rural settings, heighten risks for diabetes and heart disease later in life. [14]

The result is a generation less able to learn, to compete, and to thrive – not for lack of intelligence or ambition, but for lack of adequate nourishment.

What Needs to Change

To truly feed the future, South Africa must move beyond strategy documents toward measurable, equitable outcomes:

1. Invest in the first 1,000 days – Ensure maternal health, exclusive breastfeeding, and accessible complementary feeding are prioritized. [7]
2. Strengthen food systems – Support smallholder farmers and promote climate-resilient, locally sourced produce. [15]
3. Regulate unhealthy food marketing – Protect children from manipulative advertising and promote front-of-pack labelling. [10,11]
4. Deepen multisectoral accountability – Make nutrition a shared national responsibility, across finance, agriculture, and education. [2,8]
5. Track and report transparently – Publicly report annual progress on stunting, programme reach, and food affordability metrics. [8]

Progress vs Gaps: Policy vs Reality

Stunting Trends Over Time

Conclusion

Nutrition is the quiet thread that runs through every aspect of development. It determines who learns, who earns, and who leads tomorrow.

South Africa has the knowledge, frameworks, and resources to change this story. What is needed now is sustained implementation and political will. Feeding the future is not an act of charity – it is a strategic investment in human capital.
If we can nourish the smallest citizens among us, we strengthen the whole nation.

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References

1. UNICEF/WHO/World Bank Group. Joint Child Malnutrition Estimates, 2023 edition. https://data.unicef.org/wp-content/uploads/2023/05/JME-2023-Levels-and-trends-in-child-malnutrition.pdf

2. Republic of South Africa. National Food and Nutrition Security Plan (2018–2023). https://www.nutritionsociety.co.za/wp-content/uploads/2021/02/National-Food-and-Nutrition-Security-Plan-2018-2023.pdf

3. Statistics South Africa. Investment in school feeding schemes. 27 Sep 2024. https://www.statssa.gov.za/?p=17681

4. Hofman KJ, et al. South Africa’s Health Promotion Levy: findings to April 2021. Glob Health Action. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8349837/

5. Department of Health. Regulations relating to the reduction of sodium in certain foodstuffs (R.214 of 2013; amendments 2016/2017). https://www.gov.za/sites/default/files/gcis_document/201710/41164gon1071.pdf

6. South African Social Security Agency (SASSA). Annual Report 2022/23. https://www.sassa.gov.za/annual%20reports/Documents/SASSA%20ANNUAL%20REPORT%202022-23.pdf

7. Black RE, et al. Maternal and child undernutrition and overweight in LMICs. The Lancet. 2013. https://www.thelancet.com/pb/assets/raw/Lancet/pdfs/nutrition-eng.pdf

8. Department of Planning, Monitoring & Evaluation (DPME)/Genesis Analytics. Implementation Evaluation of the National Food and Nutrition Security Plan (2018–2023). 2023. https://static.pmg.org.za/240223_Genesis_DPME_NFNSP.pdf

9. Tyabashe-Phume BP, Swart R, Zembe-Mkabile W. The relationship between food insecurity, childcare arrangements and the CSG. Social Work (Stellenbosch). 2024. https://www.scielo.org.za/scielo.php?pid=S0037-80542024000100006&script=sci_arttext

10. Khan AS, et al. Child-directed marketing on packaged breakfast cereals in South Africa. Public Health Nutrition. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10564615/

11. World Health Organization. WHO recommends stronger policies to protect children from the harmful impact of food marketing. 3 Jul 2023. https://www.who.int/news/item/03-07-2023-who-recommends-stronger-policies-to-protect-children-from-the-harmful-impact-of-food-marketing

12. UNICEF South Africa. Quantitative analysis of the impact of the Child Support Grant. 2008. https://www.unicef.org/southafrica/reports/quantitative-analysis-impact-child-support-grant

13. Victora CG, et al. Maternal and child undernutrition: consequences for adult health and human capital. The Lancet. 2008. https://www.thelancet.com/article/S0140-6736(07)61692-4/fulltext

14. Popkin BM, Corvalán C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet. 2020. https://www.thelancet.com/series/double-burden-malnutrition

15. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2023. https://openknowledge.fao.org/server/api/core/bitstreams/1f66b67b-1e45-45d1-b003-86162fd35dab/content

16. PMBEJD. Key Data from January 2025 Household Affordability Index. 29 Jan 2025. https://pmbejd.org.za/wp-content/uploads/2025/01/PMBEJD_Key-Data_January-2025_29012025.pdf

17. Wand H, et al. Preventing stunting in South African children under 5. Int J Environ Res Public Health. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11033229/

18. Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more? BMJ Open. 2013;3:e004277. https://bmjopen.bmj.com/content/3/12/e004277

19. Temple NJ, Steyn NP. The cost of a healthy diet: a South African perspective. Nutrition. 2011;27(5):505–508. https://pubmed.ncbi.nlm.nih.gov/21074973/

20. Temple NJ, Steyn NP. Price and availability of healthy food in rural South Africa. Nutrition. 2011. https://pubmed.ncbi.nlm.nih.gov/20381314/

21. WHO. Anaemia – fact sheet (updated Feb 10, 2025). https://www.who.int/news-room/fact-sheets/detail/anaemia

22. Stevens GA, et al. Micronutrient deficiencies among preschool-aged children and women of reproductive age. Lancet Glob Health. 2022. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00367-9/fulltext