The situation of young children has worsened but there is now an important window to change course 

The South African Early Childhood Review 2024 (Review) found that young children are more likely to live in poverty and suffer from food insecurity than they were before the Covid-19 pandemic. The Review also finds that there are green shoots with regard to South Africa’s primary healthcare service delivery recovery and new approaches to early childhood development (ECD).  

The Review is a joint publication and unique collaboration between the government, academia and civil society, namely Ilifa Labantwana; the Children’s Institute at the University of Cape Town; the Department of Planning, Monitoring and Evaluation in the Presidency; the DBE; the Grow Great Campaign; and DataDrive2030.  

It provides a comprehensive analysis of the state of ECD in South Africa by tracking data on children under six years old, offering crucial insights into the challenges and progress in this critical area of national development. Key findings from the 2024 Review paint a concerning picture: young children in South Africa are more likely to live in poverty and suffer from food insecurity and malnutrition than before the Covid-19 pandemic. However, there are also signs of hope, with primary healthcare service delivery showing recovery and new approaches to ECD emerging.  

Children’s long-term development is a function of a package of interrelated and integrated services covering the period from conception to six years of age.  

These five services are collectively known as the Essential Package in Early Childhood Development (Essential Package). The Review examines each of these areas, highlighting challenges, progress and opportunities for improvement. 

Maternal and child health services  

The Covid-19 pandemic significantly disrupted primary healthcare services, which are crucial for the first 1 000 days of a child’s life. Nearly 90% of children under six in South Africa rely on public healthcare and thus the development of young children was directly disrupted by the pandemic.  

Despite substantial disruptions in maternal and child health services, there has been a partial recovery. Antenatal attendance, postnatal follow-up and immunisation rates, which dropped during the pandemic, had mostly recovered or improved by 2022. The HIV/Aids treatment programme remains successful, with over 95% of eligible pregnant women receiving antiretrovirals, resulting in very low rates of mother-to-child transmission of HIV. 

Unfortunately, under-five and infant mortality rates have increased since the pandemic, reversing previous improvements. Preliminary estimates by the Medical Research Council indicate that 30 out of every 1 000 infants born alive did not live to their first birthday in 2022, while the under-five mortality rate rose by just over a third from 2020 to 2022. The underlying reasons for rising mortality are unclear, but increased poverty and malnutrition are likely contributing factors. The pandemic underscored the urgent need to strengthen systems to ensure continuity in maternal and child health services even in times of crisis. 

Nutrition and food security 

Malnutrition remains a major challenge affecting young children, with poverty and food insecurity on the rise in South Africa. The Review found the following disturbing circumstances: 

• Nearly 40% of children under six live in households below the food poverty line 
• 20% of children under six lived in households that ran out of food in 2022 
• One in four children under five is affected by stunting 
• Exclusive breastfeeding rates declined from 49% in 2019/20 to 44% in 2021/22.  

Children in rural parts of the country have historically been the most vulnerable to poverty and poor nutrition, although this is becoming a growing phenomenon even in wealthier urban provinces like Gauteng and the Western Cape. Poverty affects dietary diversity, which is key to good nutrition. While the child support grant (CSG) is helpful, it is substantially below the food poverty line, affecting its efficacy in ensuring adequate nutrition to address malnutrition and stunting, which are difficult to reverse and have lifelong consequences, including poverty, unemployment and being susceptible to chronic diseases. 

Community healthcare workers (CHWs) play a crucial role in monitoring and improving children’s nutritional status through home visits, administering vitamin supplements and screening for malnutrition. Their efforts have shown positive trends to reduce malnutrition and improve children’s health. 

Support for primary caregivers 

The wellbeing of caregivers significantly impacts children’s development. South Africa faces challenges in this area, including high levels of poverty, unemployment and perinatal depression. Supporting caregivers through comprehensive services is essential to building an environment where both caregivers and children can thrive. 

The mental health of caregivers is crucial as it influences their responsiveness to their children’s needs. In South Africa, approximately 40% of women experience perinatal depression, which can have intergenerational effects, including pre-term birth and low birth weight. 

Fathers and other male figures can play significant roles in childcare, promoting gender equity in caregiving. However, in South Africa, fewer than 40% of children live with their biological fathers, but nearly 80% live with at least one adult male. Improving men’s involvement in caregiving can reduce the maternal burden and provide practical and emotional support, enhancing child development outcomes. 

A constellation of services is needed to support caregivers, including access to quality, timely and relevant parenting information through various channels; quality home visits by CHWs for healthcare, nutrition and parenting counselling; clinic-based support for caregivers; linkages to job opportunities; and reducing the cost of nutritious foodstuffs, among other needs. 

What is needed: If South Africa is to achieve its national development goals and ensure young children’s food security, social assistance to young children and expectant mothers, and nutrition programmes delivered directly through health services and early learning programmes must be prioritised. 

Access to quality early learning  

The DBE has taken charge of ECD since 2022, leading to new data collection efforts to measure and address gaps, including the 2021/22 ECD Census, the Thrive by Five Index Report 2021, and the ECD Baseline Assessment 2022 of pre-primary learning. The data shows that access to early learning is unequal.  

It was revealed that children from wealthier families or households are 1.6 times more likely to attend an early learning programme (ELP) than those from poorer ones. Over 1 million children aged three to five years are not enrolled in any ELP, losing out on important early learning opportunities and potentially making it difficult for them to transition successfully into school. 

The quality of learning in ELPs is also of concern, as the Thrive by Five Index Report shows that only 46% of four-year-olds attending ELPs are developmentally on track for their age. Meanwhile, the value of the government’s early learning subsidy has been severely eroded by inflation. Until there is a significant increase in funding and support for ELPs, children’s outcomes may suffer. 

Social assistance: The Child Support Grant  

The CSG is a crucial tool for supporting young children, but challenges remain. In 2023, 4.27 million children under the age of six received the CSG (R530 per month), representing 63% of all children in this age group. More poor children are being excluded from receiving the grant. In March 2024, nearly 200 000 fewer infants were receiving the grant than in March 2020 when South Africa went into lockdown.  

The CSG has received annual increases, although the grant value has not kept pace with food inflation and is, therefore, insufficient to cover the minimum cost of feeding and clothing a child.  

Disturbingly, we have seen a notable decrease in the grant take-up among infants due to mothers lacking identity documentation and delays in birth registrations. The estimated number of unregistered infants in South Africa rose from 190 000 in 2019 to 255 000 in 2020. Even after a substantial increase in birth registration rates in 2021, the uptake of grants for infants continued to decline. 

Eligible children must receive the CSG from birth to fully maximise the associated developmental benefits, such as improved nutrition and health outcomes. Achieving this will require improved linkages between health facilities, where 83% of births take place, the Department of Home Affairs and the South African Social Security Agency.  

Enhancing initiatives to ensure the wellbeing of all young children 

ECD is central to reducing socioeconomic inequality. Despite the many achievements of the post-apartheid period, progress across the various domains of ECD is unacceptably slow. 

The high rates of poverty, malnutrition and exclusion from services are long-term challenges that preceded the pandemic and were exacerbated by it. While South Africa faces significant challenges in ECD, there are also opportunities for transformative change. Recovery requires finding different and better ways of ensuring that a holistic package of services and support reaches all young children. 

Leadership on ECD by the DBE, National Planning Commission and social partners is already showing progress. Building on this, the new Government of National Unity presents an unmissable opportunity to improve coordination among the national and provincial departments responsible for ECD and accelerate the expansion of essential and quality ECD services.