Stunting

SDG target: End all forms of malnutrition, including achieving, by 2025, the internationally agreed-upon targets on stunting and wasting in children under five. Target shown on chart is provisional and has been extrapolated based on existing 2025 target.

Stunting is complex. There is no single lever to pull to address it; you have to pull many at once to achieve significant progress. That may be why the global stunting rate has come down more slowly than some other indicators. But it’s also why stunting reduction is a clear indication of good development.

One way to accelerate progress is to study exemplars, the countries that have made impressive progress, like Nepal.

In 1996, two in three Nepalese children were stunted, the highest rate in the world. By 2016, it was about one in three. Underlying this progress were investments in health, nutrition, and education. For example, the percentage of pregnant women receiving prenatal care from a skilled provider has tripled since the turn of the millennium (to 84 percent), and primary school enrollment is now 97 percent.

A closer look at the data shows that although Nepal has decreased its stunting burden, it has not yet made it more equal. To the right, you see stunting plotted by wealth quintile between 1996 and 2016. Although every quintile improved—by a lot—the richest improved more than the poorest. And there is now an even bigger gap between the poorest and everyone else.

For Nepal, the priority now is to close the gap. For guidance, Nepal can look to Peru.

The same chart for Peru, an exemplar country whose stunting burden in 2000 was close to Nepal’s now, shows that the gap between the poorest and richest quintiles shrank by half in just 15 years. This progress toward equality was by design: Peru’s government created a health insurance system for the poor; implemented a conditional cash transfer program to encourage women in key areas to use health, nutrition, and education services; and targeted key health and nutrition interventions to ensure that the people who needed them most received priority.

Together, Nepal and Peru provide insights for countries at every stage of the fight against stunting.