More than food needed to counter inequality

Chris Desmond and Agnes Erzse, researchers at the South African Medical Research Council/University of the Witwatersrand Centre for Health Economics and Decision Science, write that scaling up nutrition interventions will yield productivity returns if children's schooling, health and employment prospects are also addressed.

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Interventions to improve nutrition, especially for children and pregnant women, can be critical for health, physical growth and cognitive development, enabling better lives and futures. Reams of policy papers will attest to the fact that if a government or a donor spends substantially on nutrition, the return on their investment, in lives improved or saved, will be high.

Less well known is that the full rewards of nutrition support for the neediest children don’t always materialise. Nutrition interventions on their own are not fulfilling their full potential for all who receive them.

This is because context influences an intervention’s value at the time and in the future. The children who need help most tend to experience adversity throughout childhood. That continuing adversity muffles the benefit of improved early nutrition.

In South Africa, malnutrition exacts a heavy toll: 15% of babies are born with low birthweights; 27% of children under five are stunted; 61% of children under five are anaemic. Among the poorest onefifth of children, 36% are stunted; among the richest one-fifth, 12,5% are stunted. But at the same time, 68% of women in their childbearing years (and 13% of children) are overweight or obese. A third (31%) of women are anaemic, and 9,1% of pregnant women have gestational diabetes. These conditions all contribute to higher risks for their infants. There can be birth complications, prematurity, diabetes later in life for the baby, or disrupted physical and cognitive development.