Maternal and Child Nutrition (MCN)

Special Issue: Promoting Healthy Growth and Preventing Childhood Stunting, September 2013 (Volume 9, Issue Supplement S2 Pages 1–149)

Promoting healthy growth and preventing childhood stunting: a global challenge (editorial)

Adelheid W. Onyango

The World Health Assembly has set a target to reduce the number of under-five stunted children by 40% (2010 to 2024). There have been significant global political, technical and academic efforts to address this including the Global Nutrition for Growth Compact which defines countries commitments and mobilises resources for nutrition. The Maternal and Child Nutrition Lancet Series outlines interventions expected to have the largest impact on tackling undernutrition and overweight, their cost, the importance of nutrition-sensitive interventions and how to leverage current political momentum. At the same time, WHO is implementing the Promoting Healthy Growth and Preventing Childhood Stunting project with the aim to develop tools and a framework for countries to set and implement stunting reduction agendas and shift the national focus from underweight to stunting. This special supplement is a collection of papers that reflect on multiple aspects of the challenges presented by the stunting reduction goal and ways to address them.

The economic rationale for investing in stunting reduction

John Hoddinott et al.

While there is a clear intrinsic rationale for investing in reducing stunting, the rationale for public investments that reduce stunting is strengthened if it can be shown that these have substantive economic returns. This paper outlines the economic rationale for investments that reduce stunting with an aim to generate credible estimates of benefit-cost ratios for a plausible set of nutritional interventions.

The authors present a framework that illustrates the consequences of stunting throughout the lifecycle. An important feature of this framework is that it separates the underlying causes of stunting into those that reflect private/family decisions and those that reflect public policy decisions to undertake or not undertake investments that mitigate the risk factors for stunting.

Stunting can have several outcomes throughout the lifecycle. During the first 1,000 days, they are classified as physical, cognitive skills, socio-emotional skills and executive function/self regulation. Later in the lifecycle, outcomes also include labour force participation, wage earnings, marriage market outcomes, involvement in crime and violence, adult health and nutritional status, and fertility and parenting of the next generation. The framework points to a number of potential positive impacts over the life cycle of investments that reduce stunting.

The key empirical research around stunting outcomes including loss of physical growth potential, cognitive impairments and increased risk of chronic disease are presented and gaps are identified.

Estimates of benefits associated with each nutritional intervention to reduce stunting (outlined in the Lancet Maternal and Child Health Series) are presented. Consensus on their effectiveness and their costs are discussed. The benefit: cost ratios associated with implementing these interventions exceed one in all countries considered in their study (which is larger than many development interventions).

The authors conclude by suggesting that countries that want to generate and sustain broad-based wealth are likely to find that scaling-up these identified nutrition interventions are some of the best investments that they can make.

Additional articles in the MCN Supplement:

• The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions
• Contextualising complementary feeding in a broader framework for stunting prevention
• Multi-sectoral interventions for healthy growth
• Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study
• The economic rationale for investing in stunting reduction (summary above)
• The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction
• Key principles to improve programmes and interventions in complementary feeding
• Designing appropriate complementary feeding recommendations: tools for programmatic action
• Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam

Free access available for all articles http://onlinelibrary.wiley.com/doi/10.1111/mcn.2013.9.issue-s2/issuetoc