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More work needed to tackle stunting

A young schoolboy in Bhaktapur District. Literacy remains a challenge in the mountain nation
(David Swanson/IRIN)

Stunting is a key factor holding back progress on children’s well-being, and Asia faces a significant challenge with millions of children under five stunted, says the 2012 Child Development Index (CDI) published by NGO Save the Children.

The World Health Organization says there are 100 million stunted children in Asia.

The CDI measures three indicators of children’s well-being and development - health, education and nutrition - in 141 countries globally and ranks them according to their scores in terms of a child’s chances of dying before five, of not enrolling in school, and of being underweight.

“Significant progress has been made but data shows that undernutrition [in Asia] has consistently lagged behind,” Michel Anglade, Asia campaigns and advocacy director at Save the Children, told IRIN. “More than one child in five in East Asia is suffering from stunting.”

The 2012 State of the World’s Children report said more than one third of children under five in Asia are stunted - too short for their age- while 27 percent weigh too little for their age, and 13 percent are wasted, meaning the child’s weight is too low for its height as a result of acute malnutrition.

In India and Nepal, stunting affects almost half of all children under five, while in Indonesia and Cambodia the rates are 37 and 40 percent respectively, the report said. In Bangladesh, 43 percent of children under five are stunted, with a quarter of them coming from middle-income households.

Some 59 percent of all Afghan children under five had moderate to severe stunting, while the figure for Timor Leste was 58 percent, the report said.

Dorothy Foote, nutrition and security programme specialist at the UN Children’s Fund’s (UNICEF) Asia office, said there has been modest progress but regional disparities persist.

The number of stunted children in South Asia - India, Pakistan, Bangladesh, Nepal, Sri Lanka and Afghanistan - decreased by only 10 percent between 1990 and 2010. “This is still a very high proportion of children stunted,” Foote said.

Children who are stunted are at greater risk of illness and death, impaired cognitive development and poor school performance, say health experts.

“Critical period”

Stunting generally occurs before the age of two and the effects are largely irreversible.

“In many Asian countries, children are not getting adequate nutrition during their first 1,000 days which is the most critical period to prevent malnutrition,” said Save the Children’ s Anglade. “Good nutrition between the start of a woman’s pregnancy and her child’s second birthday is critical to the future health, well-being and success of the child and can have a profound impact on a child’s ability to grow, learn and rise out of poverty.”

A mother and her child in rural Cambodia

Courtesy of Stylianos Papardelas
A mother and her child in rural Cambodia
Monday, September 17, 2012
S’attaquer au problème des retards de croissance
A mother and her child in rural Cambodia

Photo: Courtesy of Stylianos Papardelas
A mother and her child in rural Cambodia

An analysis of stunting rates and gross domestic product (GDP) in 127 developed and developing countries in the 2012 State of the World's Mothers report by Save the Children indicated that economic growth alone was not enough to prevent stunting.

For example, India has a per capita GDP of U$1,500 and 48 percent of its children are stunted, while in Vietnam per capita GDP is $1,200 and the child stunting rate is 23 percent.

“It is not only a story of resources,” said Anglade.

Action being taken

Political commitment, supportive policies and effective strategies are the key to success in improving children’s health; some countries are taking action. 

Nepal intensified campaigns to raise awareness of good feeding practices among the rural poor and prevent stunting by distributing ready-to-use therapeutic food (RUTF), but public perceptions of feeding undermine the efforts. 

Indonesia, more than one third of whose children are stunted, has taken steps to improve breastfeeding rates and promote timely complementary feeding in young children.

Other countries, such as Vietnam, have begun local production of RUTF to reduce stunting, while the Philippines has intensified efforts to boost breastfeeding among poor women.

“The causes of malnutrition are complex - some are deeply underlying, such as poverty and social norms - others are more proximate such as food intake and frequency of disease,” says UNICEF’s Foote. “We have seen some improved practices as a result of intensive education and awareness campaigns.”

However, aid workers warn that there has been very little improvement in the nutritional status of the poorest children.

“There is much more work to be done in reaching the most disadvantaged and closing the gap for the most vulnerable kids,” said Foote.


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information:

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