Refocusing on equity in our pursuit of stunting reduction

The importance of addressing stunting for children, their families and their communities, is receiving increasing attention and recognition. In 2012, at the World Health Assembly, national governments committed to achieving a 40% reduction in the number of children under 5 years of age who are stunted by 2025. Stunting is also likely to be reflected in the new Sustainable Development Goals.

So, what is the current state of progress towards the reduction of stunting?

Stunting — when a child is too short for his or her age — represents much more than just growth failure. During the first 1,000 days of life — spanning the period from the initial stage of pregnancy to a child’s second birthday — nutritional deficits can irreversibly damage health, growth and development.

More and more evidence links nutritional deprivation in childhood with limited physical growth, brain development, and reduced income earning capacity in adulthood. For example, a study published in the medical journal The Lancet showed that stunting is associated with 2.9 deficit in school grades (even higher in the context of poverty), which can translate to a 22% loss of yearly income in adulthood.

Also, nutritional deprivations early in life may have long-term health consequences — increasing the risk of becoming overweight and developing non-communicable diseases later in life.

Fortunately, progress is being made. As we highlighted in our UNICEF report, Improving Child Nutrition: The achievable imperative for global progress, several countries have been able to demonstrate success in stunting reduction, and at scale. We have an arsenal of high-impact interventions that can rapidly bring about improvements in nutritional status.

Globally, the prevalence of stunting among children under the age of 5 is steadily declining (from 40% in 1990 to 25% in 2013); and this decline in prevalence has occurred across all regions. The number of stunted children is also decreasing globally, although in Sub-Saharan Africa the number of stunted children is actually increasing.

Yet, despite global improvements, we see concerning trends in inequalities in stunting: the poor remain much more likely to be stunted than their wealthier counterparts. When we look at trends over time, relative inequalities in stunting are actually declining in only a handful of countries. As shown in the visualization below, and on our website at, in most countries stunting inequalities persist or are actually increasing over time.

The interactive data visualization platform shows stunting data across wealth quintiles from 249 national surveys in 105 countries. The patterns of inequalities vary greatly between countries and across time. In many countries, success in stunting reduction is being driven by more rapid declines in stunting among the rich.

What does this mean for our current and future efforts to reduce stunting?

First, we need a better understanding of how improvements in stunting are being achieved and which interventions or changes are contributing to stunting reduction. Importantly, we need to be more systematic in using disaggregated data to understand whether the most disadvantaged are benefiting at the same or greater rate compared to those that are better-off.

Second, we need to maintain an equity-focused approach to stunting reduction. As we pursue our global and national stunting targets, we also need to think more carefully about equity, and how we can achieve results more fairly. Breaking the cycle of malnutrition and poverty will require us to refocus, and keep focused, on the most disadvantaged.

To do this, we need equity-focused situational analyses for nutrition that identify disadvantaged groups, by wealth and other markers of disadvantage. These analyses should be used to inform the design of programme strategies across relevant sectors that seek to reach these groups with appropriate interventions. By using an equity-focused approach to monitoring and evaluation, which identifies and removes bottlenecks, programme performance can be continuously improved—ensuring that target populations are effectively reached, and benefit.

Third, we need to consider why inequalities exist and address the determinants and drivers of inequalities. Inequalities in stunting matter because they are unfair: they result from unjust social arrangements and distribution of resources in societies. We need to find and implement strategies that can systematically address these problems.

Stunted children start off on a track that perpetuates inequity and disadvantage—affecting their future wellbeing and crippling the development of nations. By investing in child nutrition early in life, we can break the cycle of inequity and we can stop these injustices extending into adulthood and across generations.

Improving child nutrition early in life, especially for the most disadvantaged, is the key to giving every child the best possible—and fair and equal—start in life.

Werner Schultink is Chief of Nutrition based at UNICEF HQ in New York.

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