The Global Crisis You’ve Never Heard Of: Stunting

Chronic malnutrition affects children's bodies and brains and has received far too little attention for too long

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Rajanish Kakade / AP

A volunteer weighs a malnourished child at the Apanalay center in Mumbai.

Suppose I asked you to imagine a courtroom in which a stern judge peers with indifference at a baby — and off-handedly condemns the infant either to death or a life shorter than her peers, with poorer cognitive capacity, more likelihood of disease and less ability to learn at school and earn as an adult.

Of course, you would say this is unimaginable. What judge, or human being, would do such a thing? But this is what is happening to an estimated 180 million children under the age of 5, children whose bodies and minds are limited by stunting. Stunting, or stunted growth, is the result of chronic nutritional deficiencies. A stunted 5-year-old is four to six inches shorter than a non-stunted peer. But lost height is the least of concerns: a stunted child, for instance, is nearly five times more likely to die from diarrhea than a non-stunted child because of the physiological changes in a stunted body. Stunting is also associated with impaired brain development. A typical stunted brain has fewer cells. The cells themselves are somewhat smaller, and the interconnection between them is more limited. This means lasting impaired functioning, which leads in turn to significantly reduced learning. Considering the severe effects, stunting has received far too little attention for far too long.

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But if you haven’t heard of it, you’re not alone. When I recently mentioned stunting at a meeting of hundreds of medical experts, I could see a large number of puzzled faces in the audience. To my astonishment, less than half the audience, in a show of hands, had even heard of it. The physical and cognitive damage caused by not receiving enough of the right type of nutrients, especially in the first two years of life and also in utero, is permanent. It cannot be treated. But it can be prevented — and at relatively little cost.

Stunting is so common in some areas that it is sometimes mistaken for a genetic heritage, rather than a preventable condition. Just 21 countries straddling the globe account for more than 80% of the problem around the globe. In six countries — Afghanistan, Burundi, Ethiopia, Madagascar, Timor-Leste and Yemen — 50% or more of all children under age 5 suffer from this condition. In Afghanistan, a staggering 59% of children under age 5 are stunted.

How can a community, a nation or a continent ever hope to develop to its full capacity if its children cannot? In all conscience, how can those of us in societies not so afflicted withhold our help to combat stunting in the developing world? We know how to address the problem by providing expectant mothers, newborns and very young children nutrients such as proteins, fat and vitamins and minerals such as vitamin A, iron and zinc.

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In 2008, the Copenhagen Consensus of leading economic experts ranked providing young children with micronutrients as the most cost-effective way to advance global welfare. Thanks to the leadership of many governments, economic growth in some countries and the Scaling Up Nutrition movement, there has been progress. The prevalence of childhood stunting in the developing world decreased from 40% in 1990 to 29% in 2008. In just the last year, the number of countries starting to implement national strategies to reduce stunting has increased. But we have a long way to go. Suppose the 180 million young children who are stunted all lived in one region. Wouldn’t we see this as one of the greatest emergencies in the world?