Stunting Policy Brief: WHA Global Nutrition Targets 2025
Stunting Policy Brief: WHA Global Nutrition Targets 2025
Stunting Policy Brief: WHA Global Nutrition Targets 2025
What’s at stake
In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan
1 2
on maternal, infant and young child nutrition , which specified six global nutrition targets for 2025 . This
policy brief covers the first target: a 40% reduction in the number of children under-5 who are
stunted. The purpose of this policy brief is to increase attention to, investment in, and action for a set
of cost-effective interventions and policies that can help Member States and their partners in reducing
stunting rates among children aged under 5 years.
Childhood stunting is one of the most significant be stunted in 2025. Therefore, further investment
impediments to human development, globally and action are necessary to the 2025 WHA target of
affecting approximately 162 million children under reducing that number to 100 million.
the age of 5 years. Stunting, or being too short for
one’s age, is defined as a height that is more than Stunting is a well-established risk marker of poor
two standard deviations below the World Health child development. Stunting before the age of 2 years
Organization (WHO) Child Growth Standards median3. predicts poorer cognitive and educational outcomes
5,6
It is a largely irreversible outcome of inadequate in later childhood and adolescence , and has
nutrition and repeated bouts of infection during significant educational and economic consequences
the first 1000 days of a child’s life. Stunting has long- at the individual, household and community levels.
term effects on individuals and societies, including: Recent longitudinal studies of children from Brazil,
diminished cognitive and physical development, Guatemala, India, the Philippines and South Africa
reduced productive capacity and poor health, and associated stunting with a reduction in schooling,
an increased risk of degenerative diseases such as where adults who were stunted at age 2 completed
diabetes4. If current trends continue, projections nearly one year less school than non-stunted
7, 8
indicate that 127 million children under 5 years will individuals .
breastfeeding and complementary feeding Therefore, focusing on the critical 1000-day window
practices; and from a woman’s pregnancy to her child’s second
birthday is critically important.
2
Action can be taken across multiple areas to as standalone large-scale programmatic interventions,
reduce rates of stunting. First, improving optimal assessments of nutrition-sensitive agriculture recognize
breastfeeding practices is key to ensuring a child’s dietary diversification and income generation through
healthy growth and development. Early initiation family farming as likely pathways through which
and exclusive breastfeeding for six months provides agriculture and food systems could improve nutrition
protection against gastrointestinal infections, which and reduce stunting. Recent analyses suggest that
can lead to severe nutrient depletion and therefore households that can afford diversified diets, including
18
stunting . Breast milk is also a key source of nutrients fortified complementary foods, experience improved
11
during infection. Studies in resource-poor settings nutrient intakes and reduced stunting .a
have associated non-exclusive breastfeeding with
poorer growth outcomes, because breast milk is Thirdly, because stunting results from several
displaced, or replaced, by less nutritious foods that household, environmental, socioeconomic and
19–21
often also expose infants to diarrhoeal infections . cultural factors, reduction of stunting requires that
Similarly, continued breastfeeding in the second year direct nutrition interventions are integrated and
contributes significantly to intake of key nutrients that implemented in tandem with nutrition-sensitive
are lacking in low-quality complementary diets in interventions. For example, prevention of infections
resource-poor settings .
22–24 requires household practices such as hand-washing
with soap, the success of which depends on behaviour
Second, among the most effective interventions change to adopt the practice (culture), the availability
for preventing stunting during the complementary of safe water (water supply), and the affordability
30, 31
feeding period is improving the quality of children’s of soap (socioeconomic status) . Similarly, the
diet. Evidence suggests that greater dietary availability of high-quality foods (food supply) and
25–28
diversity and the consumption of foods from affordability of nutrient-rich foods (socioeconomic
animal sources are associated with improved linear status) will affect a family’s ability to provide a healthy
22, 29
growth . While these solutions have not been tried diet and prevent child stunting.
• improvements in the purchasing power of families through increases in the minimum wage and
expansion of cash-transfer programmes;
• improvements in the quality and quantity of food produced by small family farms.
Brazil’s success was also driven by political leadership, effective decentralization, active civil society
involvement and conditional and targeted funding. Not only has the Government of Brazil demonstrated
strong political will to combat malnutrition, it has also invested strategically in policies and programmes to
improve access to social services.
The safety of complementary foods is also an important intervention area for preventing microbial contamination due to poor hygiene and mycotoxicity
a.
from poor food handling and storage. For the latter, stunting has been linked with the ingestion of aflatoxin-contaminated cereals and nuts, which
contribute to stunting through suppression of the immune system (increasing risk of infection) and interference with micronutrient metabolism in the liver.
3
Finally, at the programme level, specific contextual programmes that have the ability to improve
factors should be taken into account in order to vulnerable populations’ access to and utilization
determine the right mix of nutrition-specific and of services achieve high reductions in the national
nutrition-sensitive interventions that are most likely average prevalence of stunting. Such programs
to succeed. Important contextual factors include the also close gaps between the wealthier and poorer
magnitude of the stunting burden, household wealth, population segments. Political commitment,
complexity of food value chains and systems’ capacity multisectoral collaboration, integrated service delivery
32
for service delivery . and community involvement in programme activities
are all common elements that contributed to success.
Boxes 1-4 summarize experiences from four countries
suggesting that equity-driven nutrition-sensitive
WHO/PAHO/Carlos Gaggero
4
Box 2: Progress on Reducing Child Undernutrition in Peru
In Peru, CRECER (“grow”) – the National Strategy against Child Malnutrition – had an initial target of 9%
35
reduction in stunting between 2005 and 2011 . Under the Prime Minister’s leadership, the strategy
was implemented at national, regional and district levels and involved various sectors including health,
education, water and sanitation, housing, agriculture and nongovernmental partners. An associated
programme, JUNTOS (“together”), is a conditional cash-transfer programme targeting the poorest
municipalities, with the aim of improving resources at the household level, educational opportunities and
the utilization of health and nutrition services. Stunting among children aged under 5 years dropped from
22.9% in 2005 to 17.9% in 2010. Improvements in poor rural areas were larger than the national average,
36, 37
thanks to targeting through JUNTOS . Following more than a decade (1995–2005) when the national
average rate of stunting remained unchanged (rural prevalence of stunting stagnated at 40% while urban
stunting dropped from 16% to 10%), the dramatic improvements in Peru between 2005 and 2010 highlight
the positive effect of a policy reform that integrated nutrition into social-protection strategies.
5
As illustrated by these examples, multisectoral prevention of stunting and acute malnutrition,
approaches are required to effectively address supported by social protection programmes where
stunting. For example, education policies that keep feasible.
girls in school throughout adolescence may also have
an impact on delaying marriage and childbearing • Promote a holistic view of malnutrition through
and are associated with positive economic and health the understanding that stunting, wasting and
outcomes. Similarly, laws curtailing the marketing of micronutrient deficiencies can occur in the same
breast-milk substitutes, and labour laws that provide child, family and community, and ensure services
maternity protection in support of exclusive and for undernutrition are implemented in a more
continued breastfeeding, including in the workplace, cohesive fashion.
can improve the health of the mother and her 2. Enact policies and/or strengthen interventions
children. Additionally, agriculture and food policies to improve maternal nutrition and health,
and innovations designed to improve household food beginning with adolescent girls.
security, food diversity and food safety and can also
help contribute to the reduction of stunting. • Implement programmes that deliver weekly
iron and folate supplementation, as well as the
Actions to drive progress in reducing prevention and treatment of infections and
stunting nutrient supplementation during pregnancy.
In order to achieve the global stunting target for 2025, • Enact labour policies, including maternity
countries should begin with a situation analysis to protection, in support of exclusive and continued
determine how many under-5 children are stunted breastfeeding.
and assess the determinants of stunting in specific
geographical and social contexts, so that actions are • Apply regulatory instruments such as the Code
43
tailored to address contextual needs. A deliberate of Marketing of Breast-milk Substitutes and food
equity-driven policy targeting the most vulnerable safety regulations in compliance with the Codex
44
populations is an effective strategy for reducing Alimentarius , to protect infant and young child
national stunting averages. nutrition.
Animal-source foods are the best sources of high-quality nutrients. In vegetarian diets where cereals and legumes are the main sources protein, nutrient
b.
6
World Health Organization Nutrition Tracking Tool
To assist countries in setting national targets to achieve the global goals – and tracking their progress toward
them – the WHO’s Department of Nutrition for Health and Development and partners have developed a web-
based tracking tool that allows users to explore different scenarios to achieve the rates of progress required to
meet the 2025 targets. The tool can be accessed at www.who.int/nutrition/trackingtool.
Additional resources
These series identify effective actions, costing, and policy and programmatic
Lancet series 2008; 49, 50
considerations for addressing maternal and child malnutrition .
2013
Global nutrition policy review. What does it take to scale up nutrition action? Geneva:
World Health Organization; 2013 (http://www.who.int/nutrition/publications/policies/
Global nutrition global_nut_policyreview/en/, accessed 21 October 2014).
policy review
This review provides an overview of the status of nutrition policies and programmes,
52
especially what it takes to scale up nutrition action .
Changing food systems for better nutrition. SCN News 2013;40 (http://www.unscn.
org/files/Publications/SCN_News/SCNNEWS40_final_standard_res.pdf, accessed 21
Issue 40 of SCN October 2014).
News
Papers reflecting on how to change food systems for better nutrition, with examples of
53
countries and cities that are integrating agriculture and nutrition .
7
The state of food and agriculture 2013. Rome: Food and Agriculture Organization of the
United Nations; 2013 (http://www.fao.org/docrep/018/i3300e/i3300e.pdf, accessed 6
State of food and October 2014).
agriculture 2013
This report provides a very good analysis of nutrition problems by level of development
54
of countries, as well as of food value chains by level of development .
Acosta AM, Fanzo J. Fighting maternal and child malnutrition. Analysing the political
and institutional determinants of delivering a national multisectoral response in six
IDS – Fighting countries. Institute of Development Studies; 2012 (https://www.ids.ac.uk/files/dmfile/
Maternal and Child DFID_ANG_Synthesis_April2012.pdf, accessed 6 October 2014).
Malnutrition
This report analyses the political and institution determinants of delivering a national
57
multisectoral response in six countries – 2012 .
© WHO/2014
8
Acknowledgments
This work was coordinated by the World Health Organization (WHO). The WHO would like to acknowledge
contributions from the following individuals (in alphabetical order): Dr Elaine Borghi, Dr Carmen Casanovas
and Dr Adelheid Onyango. The WHO would also like to thank 1,000 Days for their technical support, especially
Rebecca Olson.
Financial support
The WHO would like to thank the Micronutrient Initiative and the Bill & Melinda Gates Foundation for providing
financial support for this work.
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