The first 1000 days of our lives – from when we are conceived until we turn two – are the most crucial for our development. If we (and our pregnant mothers) don’t get enough nutrition during this time, this damages the development of our brains and stunts our bodies. This undermines our ability to learn, weakens our immune systems and predisposes us to various diseases later in life.

There are no second chances. We don’t ever get this time back. That is why the South African Early Childhood Review released last week, has some statistics that are hard to swallow. For a start, over three-quarters of South African children under the age of two – 77 percent to be precise – are not getting “a minimum acceptable diet”.

[quote float = right]Early childhood is a very sensitive period of development, with the brain and body growing very quickly. The development that takes place at this time will affect all future health, behaviour, and learning.”

The malnutrition candle burns at both ends. On the one end, one in five children under five is stunted as a result of a lack of food. On the other end, over one in 10 pre-school child under five are overweight or obese as a result of getting the wrong food. Both have lifelong effects on health, with stunted kids often having learning difficulties, while overweight kids are predisposed to diabetes and heart disease in later life.

Difficult to catch up

“Early childhood is a very sensitive period of development, with the brain and body growing very quickly. The development that takes place at this time will affect all future health, behaviour, and learning,” says Colin Almeleh, executive director of Ilifa Labantwana and co-author of the review. “Children require certain essential services during this time to develop. If they don’t receive them, it is very difficult to help them catch up later.”

Children in rural areas, particularly in the Eastern Cape and Limpopo, are getting poorer services, which can have “lifelong consequences on their health, learning ability, and earning potential”, warns the review.

Statistics SA has determined the “upper poverty line” – the minimum needed to buy adequate food and basic non-food items – as R965 per person. The food poverty line – just enough money for food – is R415 per person (2015 prices).

WATCH: The impact of a mother’s poor diet on her baby

Millions below poverty level

Four million children under six (62 percent of this age group) live below the upper poverty level, while almost one-third live below the food poverty line, and are at extreme risk of malnutrition. There are big differences between provinces. Almost eight out of 10 Eastern Cape children live in poor households, and almost half live below the food poverty line. Three-quarters of the children in Limpopo and KwaZulu-Natal also live in poor households.

There has been an improvement since 2003, however, when 79 percent of children lived in poor households, but the improvement has been largely thanks to the expansion of social grants rather than any upturn in the economy. Around 12 million children get Child Support Grants (CSG).

Sadly, however, the very poorest children who need the CSG the most are often the least likely to get it. Unusually, rural provinces appear to deliver the grant more efficiently than urban areas.Only around half of the poorest kids in Gauteng and the Western Cape were getting the grant. In contrast, about three-quarters of Eastern Cape kids who needed the grant were getting it.

[quote float = right]Children should start receiving the grant from as early as possible. But only two thirds of babies under a year receive the grant, and the share is even lower in the urban provinces.”

“Early access to the CSG is associated with improved nutritional, health and education outcomes for children,” says Katharine Hall, senior researcher at the Children’s Institute and co-author of the review. “That means children should start receiving the grant from as early as possible. But only two thirds of babies under a year receive the grant, and the share is even lower in the urban provinces.”

Sexual abuse most common crime against kids

Shockingly, the review reports that the most common crime against children is sexual abuse – a third of our children can expect this before their 18^th birthday. Around 51 child sexual abuse cases are reported to the police every day. In 2015/6, over a third of rape cases in the North West involved children. There are also high levels of physical abuse of children.

Another big gap in children’s development is access to early learning opportunities, which are essential for cognitive development – but as there is no government subsidy, only the wealthier children can attend. So by the time children start Grade 1, the poorer children are already disadvantaged.

“Young children need quality early learning programmes from the time they turn three. Without it, they are not prepared for school,” says Sonja Giese, executive director of Innovation Edge and co-author of the report.

“Our poorest children aren’t accessing quality early learning,” says Giese. “This is consistent across all provinces. A four-year-old from a low-income household has only a 50 percent chance of being enrolled in an early learning programme, compared to a wealthier child who has a 90 percent chance. As a result, South Africa’s poorest children are starting school on the back foot.”

The 2017 review analysed recent data from South Africa’s first population level preschool assessment tool, Early Learning Outcomes Measure (ELOM), and found that children in the bottom income quintiles performed a lot worse than wealthier children, especially in emergent literacy and language, as well as cognitive and executive functioning.

Sadly, a South African child’s place of birth – still largely engineered by apartheid – is entrenching inequality, with rural poor children being significantly disadvantaged.

* The review is produced jointly by Ilifa Labantwana, the Children’s Institute at the University of Cape Town, the Department of Planning, Monitoring and Evaluation in the Presidency, and Innovation Edge.

An edited version of this story was published in Daily Maverick.

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