Preventing stunting starts in the womb

PREVENTING

STUNTING STARTS IN THE WOMB WHY INVESTING IN THE

FIRST 1 000 DAYS OF A CHILD’S LIFE IS THE BEST TIME TO NIP STUNTING IN THE BUD

Given the urgency with which South Africa has to deal with what President Cyril Ramaphosa called “a massive crisis” in his State of the Nation Address in February 2026, it’s important to focus strategically on interventions that can quickly lower stunting rates, such as those specifically targeting children’s nutrition status in early life. Starting in the first 1 000 days of a child’s life — the period from conception to two years of age — is a powerful lever, as it can break the compounding effects of poor growth in the womb, suboptimal breastfeeding and not having enough nutritious food from six months old, when babies typically start eating solids.

This learning brief, the second in a series focused on childhood nutrition, looks at four practical interventions to fast-track action on stunting in the first 1 000 days and how they can work together to move the needle, based on evidence about the drivers of stunting and where efforts to curb chronic malnutrition are falling short.

START WITH THE END IN MIND

To build a better future for everyone, we have to invest in children. And investing early — in the first 1 — is akin to providing fertile soil for seeds to grow. “It’s the investment that determines the returns on all other development spends,” says Ronelle Burger, a development economist at Stellenbosch University who’s been closely involved in research efforts to help unpack the complexities of stunting in South Africa (see the previous learning brief).

But progress in lifting people out of poverty and creating a more equal society has been slow, despite these issues being central to the 2030 National Development Plan. poverty rates have been creeping down since 2006, about 56% of South Africans — only a third less than 20 years ago — still struggle to buy basic groceries and enough nutritious food in a month.

THE LINK BETWEEN FOOD SECURITY AND

DIETARY DIVERSITY

In the most recent National Food and Nutrition Security Survey (published in 2024), African households were found to be food insecure. Of these, one in six were severely food insecure, meaning that they often ran out of food, went to bed hungry or weren’t able to eat for 24 hours. In addition, food consumption scores showed that about four in 10 households had poor or borderline diversity in their diet, meaning that the food they had available didn’t give them the right mix of nutrients for good health every day.

1 National Planning Commission. 2012. National Development Plan 2030. Our future –make it work. Pretoria: Department of The Presidency.

2 Figures given here are for the lower-bound poverty line and the food poverty line. Statistics South Africa. 2025. Poverty trends in South Africa: An examination of absolute poverty between 2006 and 2023. Pretoria: Statistics South Africa.

3 Simelane, T. et al., 2023. National Food and Nutrition Security Survey: National Report. Pretoria: HSRC.

4 Galasso, E. and Wagstaff, A. 2019. The aggregate income losses from childhood stunting and the returns to a nutrition intervention aimed at reducing stunting. Economics & Human Biology 34, pp. 225–238.

Shekar, M. et al. 2017. An investment framework for nutrition: Reaching the global targets for stunting, anemia, breastfeeding, and wasting. Directions in development. Washington, DC: World Bank. https://doi.org/10.1596/978-1-4648-1010-7

Shekar, M. et al. (eds.) 2024. Investment framework for nutrition 2024. Human development perspectives series. Washington, DC: World Bank. https://doi.org/ doi:10.1596/978-1-2162-2

Akseer, N. et al. 2022. Economic costs of childhood stunting to the private sector in low- and middle-income countries. eClinicalMedicine 45, 101320. https://doi. org/10.1016/j.eclinm.2022.101320

5 Akseer, N. et al. 2022. Economic costs of childhood stunting to the private sector in low- and middle-income countries. eClinicalMedicine 45, 101320. https://doi. org/10.1016/j.eclinm.2022.101320

FROM SCIENCE TO SOLUTIONS

Improving early childhood nutrition involves not only considering what children eat but also understanding the underlying systemic complexities that lead to high stunting rates.6 These include not picking up on growth faltering before the age of two, socio-economic circumstances that hinder good maternal or infant nutrition, and the absence of responsive caregiving (on page 18).

It’s not realistic to try and pull all the levers at once, though, says Liezel Engelbrecht, nutrition lead of the Hold My Hand Accelerator,7 a national campaign to fast-track building better lives for South Africa’s children. “But we can start with what is likely to yield the fastest results, as every month and year we wait, we are failing children who could have benefitted. Some challenges will take longer to resolve, but if we can address at least a few now, we can start making a big difference.”

HECKMAN CURVE

Interventions focused on the first 1 000 days of a child’s life can yield returns reasonably fast. Stunting is the result of compounding deficits in a child’s earliest years, from not growing well in the womb, suboptimal breastfeeding and repeated infections, to not getting enough nutritious food when complementary feeding starts, typically at six months. Acting in this critical window of development to support children’s growth, or correcting situations that cause low birth weight (under 2.5 kg) and faltering growth, can help children reach their full potential.

The “Heckman Curve”, based on evidence from economics and neuroscience, demonstrates that the greatest returns on human capital investment occur in the earliest years of life, making early action on maternal and child nutrition both economically and socially urgent.

Source: James Heckman, 2008 8

6 Black, E.R. et al. 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, pp. 427–451.

7 Hold My Hand. n.d. https://www.holdmyhand.org.za/

8 Heckman, J.J. 2008. Schools, skills and synapses. Economic Inquiry 46(3), p. 289. https://pmc.ncbi.nlm.nih.gov/articles/PMC2812935/

Supporting mothers’ nutrition is at the centre of the approach to prioritising the first 1 000 days (also see diagram below). If a pregnant woman (A) gets the right antenatal supplementation (B) and can afford (C) nutritious food (D) and transport to get to a health facility for check-ups (E), and is supported (for example, through community health workers or community peer counselling groups (F), her baby is less likely to be born with a low birth weight — under 2.5 kg (G) and, in turn, less likely to be stunted.9 Continued support after birth can help to support breastfeeding (H) and to offer nutritious complementary foods after six months. All these factors work together to help a baby’s body and brain develop well (I), setting a child up to thrive, perform well at school (J) and improve their chances of getting a good job (K). Of course, there are also structural, social and environmental factors that come into play, like proper water and sanitation infrastructure,

sustainable food systems, which may include local food production, and good housing (L), although those are bigger issues that will take longer to address. “However, for gains to last and human development to be sustained, we should keep advocating for faster progress on this, too,” says Engelbrecht.

Engelbrecht notes that deciding which interventions to focus on also depends on what the practical realities are. “It’s often not only about what the evidence says works but also about what can feasibly be budgeted for given many other needs, what timeframes seem reasonable for implementation and how things can build on or be integrated into an existing system. In other words, policymakers have to think about how to roll out an intervention, who has to do it and how it can be funded.”

Here are four things that can help to move the needle on improving children’s nutrition outcomes in the first 1 000 days:

INTRODUCING THE MATERNAL SUPPORT GRANT

“You only have as much dietary choice as your budget allows,” says Engelbrecht. And for many South Africans, money is so tight that their grocery basket contains mostly ultra-processed or starchy foods that are typically high in salt, sugar, fat and energy, and few vegetables, fruit and protein-rich items like eggs, beans, fish or dairy.10 Not being able to buy enough nutritious foods can compromise a pregnant woman’s diet at a time when her body urgently needs proper nutrients, and put her baby at risk of being born underweight or too early. Inadequate intake of nutrients during pregnancy can also increase the risk of stillbirth or of the pregnant woman developing anaemia, which would carry long-term consequences for her child’s brain development.11

It follows that offering a Maternal Support Grant (MSG) to mothers-to-be can be good for children, especially as pregnant women are the only vulnerable group falling outside the South African social protection net. The figures are sobering: about four in 10 households are female-headed12 and close to four in 10 women are not employed.13 Moreover, of those who do have a job, about one in six work in the informal sector.14 So, not only do many pregnant women struggle to make ends meet, but many new mothers are also excluded from maternity benefits after their babies are born because they work in informal jobs.15

The proposed MSG can be seen as a backward extension of the Child Support Grant (CSG), explains Engelbrecht. The idea is to provide the same monetary support as the CSG for six months during pregnancy16 and three months after birth. When the child’s birth is registered, the MSG will automatically switch to the CSG, without a new grant

application having to be processed. However, if there’s a problem with paperwork, like getting the baby’s birth certificate, the three months of post-birth cover can buy caregivers a little time to get everything in order without losing financial support.

Currently, approximately half of children eligible for the CSG only get onto the system around the age of one.17 Many are therefore missing out on better nutrition at a critical time in their development — especially where there isn't enough food at home, which makes it harder for mothers to breastfeed and to introduce the right complementary foods from six months. Because the MSG can piggy-back on the existing CSG system, it offers a simpler way to bring more children under the social protection safety net from birth.

In countries such as Mexico, Brazil, Uruguay and Kenya, conditional cash transfers during pregnancy were linked to more mothers going for antenatal check-ups, fewer babies being born underweight and families having more nutritious food available.18 In Togo, unconditional cash transfers, combined with nutrition education, improved households’ food security and reduced the incidence of babies being born underweight.19 In South Africa, the Grow Great CoCare Maternal Support Study run in the Western Cape during 2020/21, was a promising proof of concept:20 it showed that among pregnant women who received a R300 cash voucher every fortnight for six months, around 50% fewer reported going hungry at the end of the study than at the start, and a quarter fewer reported feelings of maternal depression. Maternal wellbeing is one of a basket of factors that contribute to child nutrition outcomes.21

10 Pietermaritzburg Economic Justice & Dignity Group. March 2025. Household Affordability Index https://za.boell.org/en/household-affordability-index

11 Keats, E.C. et al. 2019. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database of Systematic Reviews 3, CD004905. https://doi. org/10.1002/14651858.CD004905.pub6

12 Statistics South Africa. 2023 Marginalised groups indicator report, 2024. Pretoria: Statistics South Africa.

13 This is based on results from Quarter 2 in 2025. See: https://www.statssa.gov. za/?p=18668

14 Ibid.

15 South African Law Reform Commission. 2021. Maternity and parental benefits for self-employed workers in the informal economy Project 143. Discussion Paper 153. https://www.justice.gov.za/salrc/dpapers/dp153-prj143-MaternityParentalBenefitsJuly2021.pdf

16 From the first antenatal booking, which should ideally not be later than 14 weeks.

17 UNICEF South Africa. 2023. An update study on the exclusion error rate for children who are eligible to receive the Child Support Grant. Johannesburg: UNICEF. https:// www.unicef.org/southafrica/media/7971/file/%20ZAFupdate-study-exclusion-errorchildren-eligible-receive-child-support-grant-June-2023.pdf

18 Hold My Hand. 2025. Closing the protection gap: the case for a Maternal Support Grant. Policy Brief 04. Cape Town: Hold My Hand. https://holdmyhand.org.za

19 Ibid.

20 Grow Great. 2024. CoCare Maternal Support Study https://growgreat.co.za/ow/wpcontent/uploads/2024/03/GG-MSG-HANDOUT2-final-revised-PRINT.pdf

21 Berejena, T., Malongane, F. and Metsing, T.I. 2025. Social protection programs and their support for promoting access to nutrient-dense foods for vulnerable communities in South Africa. Current Developments in Nutrition 9(6), 107452. https://doi. org/10.1016/j.cdnut.2025.107452

GIVING PREGNANT WOMEN A MULTI-

MICRONUTRIENT SUPPLEMENT

Not getting enough vitamins and minerals during pregnancy can harm both a mother and her developing baby. The World Health Organization (WHO) recommends that pregnant women take a supplement of 15 micronutrients and vitamins.22 However, currently, South African public health guidelines refer only to extra iron, folic acid and calcium.23

The WHO's recommended multi-micronutrient supplement (MMS) has been shown to improve intrauterine growth and reduce the risk of undernutrition in babies compared with iron and folic acid (IFA) alone — and it would also cost the country less. Modelling shows that switching from IFA to MMS in South Africa is highly cost-effective even in conservative scenarios, with substantial reductions in child deaths and strong long-term economic returns to be expected. The greatest benefits come with higher programme coverage and lower MMS procurement costs, although even shorterduration or higher-cost scenarios remain economically favourable. If MMS procurement costs can be negotiated close to the price at which IFA is currently supplied, the transition could become cheaper or close to cost-neutral from a procurement perspective, while still generating substantial health and economic gains.24 In addition, says Engelbrecht, considering that women are already taking an antenatal supplement and clinics are geared for handing it out, the intervention won’t require behaviour change, making it easier to adopt within the existing care system.

While there is growing support for MMS, introducing a new supplement into the public health system requires multiple regulatory, policy, procurement and implementation steps. These include product registration, guideline development, cost and feasibility assessments, and securing sustainable supply. Under current processes and procurement timelines, large-scale rollout would likely only be feasible from around 2029, although this could possibly be accelerated with sufficient political commitment and prioritisation.

Did you know?

A multi-micronutrient supplement was previously available in parts of the South African public health system for selected patient groups between 2010 and 2016 but was later discontinued. This was reportedly due to a lack of clear international guidelines at the time, and not enough being known about the evidence for MMSs.25

22 World Health Organization. 2020. WHO antenatal care recommendations for a positive pregnancy experience. Nutritional interventions update: Multiple micronutrient supplements during pregnancy. Geneva: WHO. https://www.who.int/ publications/i/item/9789240007789

23 National Department of Health. 2024. National Integrated Maternal and Perinatal Care Guidelines for South Africa. Pretoria: Department of Health. https:// knowledgehub.health.gov.za/system/files/elibdownloads/2024-10/

24 Wits RHI. 2026. Evaluating the health and economic impact of MMS vs IFA in South Africa: cost–benefit analysis and scenario. Report prepared for DGMT.

CURBING EASY ACCESS TO ALCOHOL

Changes to alcohol regulations can also help to give mothers a better chance of delivering a healthy baby. Drinking during pregnancy can hinder the development of a foetus and is linked to pre-term delivery and low birth weight which is a key driver of stunting.

South Africa is a nation of heavy drinkers. Figures show close to half of people who use alcohol are considered to be heavy drinkers — meaning they have at least five standard drinks a day26 — and four out of 10 drinkers report bingeing on alcohol.27 With more than 80 out of 1 000 children in South Africa being born with foetal alcohol spectrum disorder — about 10 times higher than the global average — it’s clear that pregnant women, especially in poorer communities,28 need more protection.29

Kashifa Ancer who leads DGMT’s project for reducing alcohol harms, Rethink Your Drink, says the idea behind alcohol reforms as part of the strategy to curb stunting is to create an everyday environment that can help people drink less. Making cheap, strong drinks more expensive by introducing a minimum unit price (i.e. a base price per unit of alcohol) has been shown to work well in countries including Scotland and Australia. A local modelling study shows that setting the base cost for the amount of alcohol in a standard drink at R10 per unit of pure alcohol can raise prices for something like a can of beer or a shot of liquor by almost 20%, and that the greatest reductions in use can be expected in heavy and binge drinkers, especially in poorer communities.30 “Eliminating high spends and cheap alcohol, especially in low-income communities, is probably one of the biggest levers we have to help protect mothers and their babies against alcohol harms,” says Ancer.

But, she adds, alcohol reforms have to work as part of a bigger picture: “We can’t just remove alcohol and then not deal with

26 A standard drink is a beverage that contains 15 ml of pure alcohol and works out to roughly 125 ml of wine, one 330 ml can of beer, or about 40 ml of hard liquor.

Vellios, N.G. and Van Walbeek, C.P. 2018. Self-reported alcohol use and binge drinking in South Africa: Evidence from the National Income Dynamics Study, 2014–2015. South African Medical Journal 108(1). https://doi.org/10.7196/samj.2018.v108i1.12615

27 Binge drinking means having five or more drinks in one sitting.

World Health Organization. 2024. Global status report on alcohol and health and treatment of substance use disorders. Geneva: WHO.

28 Research shows alcohol harms disproportionally affect poorer communities.

Probst, C. et al. 2018. The socioeconomic profile of alcohol-attributable mortality in South Africa: A modelling study. BMC Medicine 16, 97.

29 Louw, J.G. et al. 2024. A multi-year, multi-site study of the prevalence of fetal alcohol syndrome in South Africa. Alcohol Clinical & Experimental Research 48:867–879.

30 Gibbs, N. et al. 2021. Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: A modelling study. BMJ Open 11:e052879. https://doi.org/10.1136/bmjopen-2021-052879

Gibbs, N. et al. 2022. Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa. BMJ Global Health 7:e007824. https://doi.org/10.1136/bmjgh-2021-007824

the fact that mothers don’t have money to buy food. Similarly, we can’t focus exclusively on awareness programmes and think that it will be enough. We have to understand what else is happening in a community to help people make the best choices for themselves and their families.”

“Preventing

stunting altogether should be the first

prize. Aiming for catch-up doesn’t even come in second; it’s the third or fourth option when you look at return on investment.”

—

Ronelle Burger, development economist at Stellenbosch University

SUPPORTING MOTHERS TO BE RESPONSIVE CAREGIVERS

Plans to end stunting are part of a bigger drive towards optimal child health and development, says Chantell Witten, director of Health Systems Strengthening at Ilifa Labantwana.31 “We have to ask what systems can support mothers to feed their children well, and central to that is financial protection,”32 she says. If mothers’ incomes or budgets aren’t protected, especially in the first 1 000 days, they are less likely to breastfeed exclusively for six months and buy nutritious complementary foods. Income insecurity and poor mental health associated with financial strain are barriers to breastfeeding.33

31 https://ilifalabantwana.co.za/

32 Pereira-Kotze, C. et al. 2023. Access to maternity protection and potential implications for breastfeeding practices of domestic workers in the Western Cape of South Africa. International Journal of Environmental Research and Public Health 20(4), 2796. https://doi.org/10.3390/ijerph20042796

33 Witten, C. et al. 2020. Psychosocial barriers and enablers of exclusive breastfeeding: Lived experiences of mothers in low-income townships, North West Province, South Africa. International Breastfeeding Journal 15, 76. https://doi.org/10.1186/s13006020-00320-w

It’s a question of strengthening systems to support responsive caregiving — what Witten describes as “connecting and communicating with your child in a positive disposition”.34

Nutrition is central to building that connection. From the day a child is born, feeding is a constant act of what early childhood development experts call "serve and return" — a caregiver responding to her child's cues.

However, less than a quarter of infants are exclusively breastfed in their first six months in South Africa,36 less than halfway to the United Nations’ target of 60%.37

Witten says it’s important to get the messaging right about breastfeeding as responsive caregiving in action, to help improve breastfeeding rates in South Africa: “Breastfeeding is fundamental to ending stunting.”

Engelbrecht adds: “Maternal food insecurity and undernutrition are major barriers to healthy pregnancy outcomes and breastfeeding in South Africa. Breastfeeding alone increases maternal energy requirements by 500 kJ per day, while local evidence shows that hunger is strongly associated with reduced breastfeeding rates and poorer maternal wellbeing.”

org/10.1007/978-1-4020-9173-5_2

Luque, V. et al. 2015. Early programming by protein intake: The effect of protein on adiposity development and the growth and functionality of vital organs. Nutrition and Metabolic Insights 8(S1), 49–56. https://doi.org/10.4137/NMI.S29525

Helping mothers breastfeed effectively requires community-based support — which is where Grow Great's Flourish hosts fit in. The Grow Great Flourish programme is a national network of pregnancy and parenting support groups, led by a mother from the community who has been trained by Grow Great to share evidence-based information and encouragement with new moms. To date, Grow Great has trained 400 Flourish hosts.38

National Food and Nutrition Security Survey

World Health Organization and UNICEF. 2025. Global nutrition targets 2030: . Geneva: WHO/UNICEF. https://doi.org/10.2471/B09382

KHULISA CARE: A PILOT PROJECT TO SUPPORT MOTHERS

“Khulisa Care: Healthy Moms, Thriving Babies” is a collaborative effort between the Western Cape Department of Health, the Department of the Premier, DGMT, Grow Great and Shoprite. This proof-of-concept project is aimed specifically at reducing a mother’s risk of having an underweight baby and, in cases where babies are born with a low birth weight, at helping them to catch up. (It is different from the proposal for the Maternal Support Grant, which is pitched as social protection for all eligible pregnant women.)

The project is based on a “cash-plus-care” model.39 Once entered into the programme, mothers of babies born under 2.5 kg and those at risk of having a baby of low birth weight, based on clinical entry criteria, get a food voucher to the value of R525 loaded onto their Shoprite loyalty card once a month until the baby is six months old. The voucher can be used to buy any of the items included in a list of “10 best buys”, such as eggs, long-life full-cream milk, amasi, pilchards, tuna, peanut butter, dried or canned beans, lentils, soya mince and fortified maize flour.40 This is the “cash” component.

The “care” component is equally important. As part of the programme, community health workers also visit women’s homes at least once every two weeks to check on their health and their baby’s growth, counsel them on breastfeeding and share information on how the vouchers can best be spent for healthy eating. Community health workers also educate mothers on health-seeking and risk-reducing behaviours, such as knowing the danger signs during pregnancy or infancy, not missing antenatal appointments, and avoiding harmful substances. Importantly, their visits provide a layer of support many women don’t have during this critical time.

The programme, launched in July 2025, was rolled out in phases across Worcester, Khayelitsha and Mitchells Plain, areas identified as having high rates of underweight births and stunting. In February 2026, Western Cape Premier, Alan Winde, reaffirmed the province’s commitment to the pilot this year, as part of the sustained effort to tackle malnutrition and reduce

child stunting,41 and by the end of April, nearly 1 400 participants had already been enrolled. Findings from an internal midline evaluation of the programme suggest positive early signals that the combined cash-plus-care model is feasible, valued by beneficiaries and frontline workers, and has potential to improve maternal food security, programme engagement, and breastfeeding support when delivery systems function well.

39 Khulisa means “to grow” in isiXhosa.

40 Shoprite. 2025. Khulisa Care Best-Buy Foods, Western Cape, 23 Dec. 2025–28 Feb. 2026. https://specials.shoprite.co.za/deals/ wckhulisacarebestbuyfoods23dec28feb2026/2/index.html

41 DGMT. 2026. The Khulisa Care pilot continues in 2026. https://dgmt.co.za/the-khulisacare-pilot-continues-in-2026/

“I’m forever grateful for your lifechanging support. Thanks to your programme, I received the care and guidance I needed during my pregnancy. I'm thrilled to share that my baby girl is healthy, and I credit the team that supports me at the clinic for their dedication. Your work is truly making a difference in our community, and I'm honoured to be one of the beneficiaries.”

— Khulisa Care beneficiary

LESSONS LEARNT

Tackling stunting is an urgent priority for South Africa. Here are five things to know about interventions that can help get us there:

1

SUSTAINED, EVIDENCE-BASED ADVOCACY YIELDS RESULTS

The idea of income support for pregnant women was first introduced by the Department of Social Development almost 15 years ago. Since then, many role-players, including other government departments, public watchdog bodies like the South African Law Reform Commission, research groups like the Children’s Institute and PRICELESS SA, and civil society organisations like DGMT, Grow Great and Ilifa Labantwana, have continued to build the evidence base for what introducing an MSG in South Africa would involve and how it could work. Now, for the first time since the idea was initially raised, it looks like there could be real policy progress, says Engelbrecht. “President Ramaphosa’s framing of stunting reduction alongside existing social protection infrastructure such as the Child Support Grant, combined with an explicit commitment to resource allocation through the Medium-Term Budget Policy Statement, signals growing recognition within government that maternal and child nutrition requires sustained political attention, financing and system-level support.” To shift towards preparing to implement, social partners would need to contribute evidence, share expertise and support the government in interventions that would yield results.

2

COMBINED INTERVENTIONS CAN MULTIPLY EFFECTS

Improving children’s nutrition status fits into a bigger system, which has many levers. For example, reducing access to alcohol alone won’t move the needle if mothers don’t have financial support to help them make better choices. Similarly, closing food gaps through measures like the MSG, making nutritious food more affordable, or preventing low birth weights must be accompanied by a parallel push to improve breastfeeding rates. But by seeing solutions as part of a system, different interventions can multiply effects. “The whole is greater than the sum of its parts,” says Witten.

3

IMPLEMENTATION TAKES TIME

Policy change is a long process, even with a lot of preparation or a system geared for roll-out. The process of changing from an iron–folic acid supplement to a combined multimicronutrient formulation is an example of this. Knowing how long different steps may take, and forecasting where bottlenecks might occur, can help to make the process more efficient. Integrating a new intervention in an existing system can also help by leveraging prior efficiencies and know-how.

4

PUBLIC HEALTH INTERVENTIONS NEED TO ENGAGE THE AUDIENCE WHERE THEY ARE

Good child nutrition start with an emphasis on exclusive breastfeeding. “Every mother understands what breastfeeding means, and that’s a message we all have to make central to engaging with pregnant women,” says Witten. The messaging should be consistent and supported by systems that enable mothers to optimally breastfeed their infants, she adds, so that interventions work together rather than separately.

5

ENDING STUNTING SHOULD BE EVERYONE’S BUSINESS

Improving children’s nutrition status is a big undertaking, and the government can’t do it alone. The private sector, civil society, academics and policymakers should all contribute to making interventions work. But partners should also hold one another accountable, says Engelbrecht. The Khulisa Care pilot project is a good example of how different stakeholders can combine their strengths and work together to drive change.

WHAT’S NEXT?

As an immediate next step, civil society and social partners should work with government to secure approval and implementation of the MSG. Advancing the process for multi-micronutrient registration and roll-out, tracking results from the Khulisa Care pilot, and continuing to build community support systems for responsive caregiving will also help to further the fight against stunting. Continued advocacy and action to improve the affordability and accessibility of nutritious foods for vulnerable households will be equally critical.

This is the learning experience of: