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Healthy beginnings, hopeful futures: Tackling South Africa’s stunting crisis through maternal support grants

Healthy beginnings, hopeful futures: Tackling South Africa’s stunting crisis through maternal support grants
Rahima Essop and Liezel Engelbrecht
By Rahima Essop and Liezel Engelbrecht
8 Apr 2025
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With more than a quarter of our children affected, stunting is not just a health issue, it has far-reaching consequences for individuals and the economy. Financially supporting pregnant women should be an obvious decision when an estimated one in five South African households don’t have enough food on the table and resort to coping mechanisms like smaller portions, skipping meals, or even begging.

This year’s World Health Day theme, Healthy Beginnings, Hopeful Futures, challenges us to ask: Are we giving our children the foundation they need to thrive? One way to answer this is by looking at South Africa’s stubbornly high stunting rate — a powerful population-based indicator of chronic malnutrition among children under five that measures height for age. Stunting signals poor brain development in children deprived of protein and micronutrients, made worse by infections linked to their environment. 

With more than a quarter of our children affected, stunting is not just a health issue, it has far-reaching consequences for individuals and the economy. Many may not realise that its effects extend far beyond childhood, influencing school performance, workforce productivity and, ultimately, national growth. So much so that stunting is one of the reasons why, on average, a child born today will achieve just 43% of their productive potential in adulthood.

Early intervention, starting in the womb, is essential, with research showing that conditions during pregnancy contribute to a fifth of stunting cases. This underscores the need for policies prioritising a mother’s nutrition, such as the proposed Maternal Support Grant championed by the Department of Social Development, but which is yet to be approved by the government.

Financially supporting pregnant women should be an obvious decision when an estimated one in five South African households don’t have enough food on the table and resort to coping mechanisms like smaller portions, skipping meals, or even begging. Others, living in low-income communities, may consume enough calories to meet their daily energy needs, but they get it from cheaper ultra-processed foods, so their diets often lack protein and essential micronutrients like iron, zinc and vitamin A. This can result in a condition known as “hidden hunger” where people don’t get enough of the essential nutrients that their bodies need to function properly, making them more susceptible to disease and poor health. 

Beyond nutrition, the Maternal Support Grant would offer pregnant women the means to cover transport to clinics, keep the lights on, or stock up on essentials like nappies.

The introduction of the Maternal Support Grant would fill a long-standing gap in our social protection system and help address public health challenges like stunting, iron-deficiency anaemia and babies born with a low birth weight (under 2.5 kg) — all of which affect development in the first 1,000 days of life when brains are growing the fastest. 

The implications of low birth weight and anaemia


A review of pregnancy support programmes in 27 low- and middle-income countries shows that social grants help reduce maternal anaemia and prevent low birth weight deliveries. 

Whether a mother eats well and feels well affects her newborn’s weight at birth. Not having enough iron is common among women, especially during pregnancy, when iron needs are greater to support the foetus, placenta and increased blood volume. 

One in three women of childbearing age in this country is anaemic, according to a 2016 survey, with higher rates in certain provinces. Without enough iron, the body struggles to produce the red blood cells required to carry oxygen, increasing the likelihood of preterm birth and low birth weight deliveries. As a result, babies are born with compromised levels of iron necessary to grow and develop.

Currently 13% of babies are born with a low birth weight in South Africa, placing them at higher risk of dying within a month of delivery, while those who survive have an increased chance of developmental delays. The connection between low birth weight and stunting was highlighted in the 2023 Western Cape Stunting Baseline Survey, which found that the odds of stunting at six to 24 months among babies born with a low birth weight were three times higher.

All of this comes at a cost to our strained healthcare system which spends approximately a quarter of a million rand per low birth weight baby, mostly on neonatal intensive care. Globally, it’s estimated that every dollar invested in preventing anaemia in low- and middle-income countries generates 12 times that in economic returns. 

Delays in approving a draft Maternal Support Grant policy 


When the public health and economic implications of malnutrition are fully understood, the case for state-sponsored pregnancy support is even stronger. 

The Maternal Support Grant is projected to cost the government between R1.9-billion and R3.26-billion annually — roughly 0.1% of total government expenditure. But the savings would be far greater as the grant is expected to save our healthcare sector an estimated R13.8-billion by reducing complications related to low birth weight and other poor birth outcomes. 

These savings do not even include the additional social and long-term economic benefits of preventing low birth weight and stunting. The Maternal Support Grant extends the existing R560 Child Support Grant to cover pregnancy with the expectation of a smooth transition to the Child Support Grant when the baby is born. Access to the Child Support Grant has shown to reduce stunting by 31% when compared with children who are eligible to receive the grant but are not getting it.

If implemented effectively, a grant during pregnancy would boost the uptake of the Child Support Grant in the first 12 months of a child’s life — a period when child support interventions have the greatest impact but where access has declined, largely due to documentation barriers. 

So even in times of austerity, investing in a targeted intervention with a high return makes economic sense. But policymaking has been slow. It has been more than a decade since our government began looking at policy options for improving maternal and child health. Since then, a strong case has also been made by the South African Law Reform Commission for implementing the Maternal Support Grant. 

Our policymakers must connect the dots — and do so quickly — because investing in maternal health today lays the foundation for a stronger, healthier and more prosperous future. DM

You can watch a webinar about the case for supporting pregnant women here.

Rahima Essop is the Communications Director at the DG Murray Trust (DGMT), and Liezel Engelbrecht is the Nutrition Lead for the Hold My Hand Accelerator.

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