Malnutrition contributes to half of all child deaths under 5 globally. Malnourished children who do not receive essential nutrients during the first 1,000 days from conception to their second birthday are at extreme risk of stunting, defined as low height for age. Stunting has lifelong and irreversible negative consequences on cognitive development and earning potential—studies have estimated that child undernutrition can reduce a country’s GDP by as much as 12 percent. Stunting represents the most severe form of chronic malnutrition, and today, nearly 160 million children are stunted globally.
There has been broad recognition by the global community that nutrition is foundational to development. The United Nations recently ratified the Sustainable Development Goals (SDGs), which provide a common set of goals for the world to follow to end all forms of poverty by addressing health, education, social protection, climate change, and environmental protection needs. Nutrition has been recognized as a foundational need, and the SDGs have set a goal to reduce the prevalence of stunting by 40 percent, or roughly 63 million children by 2025, and all forms of malnutrition by 2030. The United States has ratified the SDGs, and through its multisectoral nutrition strategy, has made the commitment to reduce stunting by 20 percent by 2020 in focus countries.
Achieving these ambitious goals will be difficult, but is possible. The nutrition evidence base has expanded in recent years, and it is now known that scaling up a set of targeted interventions, including vitamin A supplementation and multiple-micronutrient supplementation, dietary diversity, access to complementary foods, promotion of exclusive breastfeeding, and access to clean water and hygiene practices are essential for reducing stunting.
The greatest challenge with meeting the stunting targets is that interventions need to be scaled up across health, agriculture, education, and other social sectors. Financing for nutrition is also fragmented across multiple sectors, and accountability for nutrition outcomes is weakened as a result across countries and donors, including the United States. Countries like Ethiopia have made great strides against stunting and malnutrition through strong multisectoral coordination across governments, donors, and partners, and successful scale-up of targeted, evidence-based interventions. These positive examples demonstrate that rapid progress is possible when resources, skill, and political will converge.
The U.S. government has a long history of pioneering innovation in nutrition and applying new knowledge in successful implementation. U.S. investments in nutrition have supported path-breaking research on the life-saving effects of vitamin A and other micronutrients, and work that identifies linkages between malnutrition and cognitive impairment. These findings have formed the foundation of basic nutrition interventions, and, through widespread implementation, have contributed to saving millions of lives. The United States has continued to use its rich experience, knowledge, and reach to innovate around better and more efficient ways to encourage multisectoral cooperation and drive down stunting. Feed the Future, a flagship multisectoral program to combat global hunger, food insecurity, and malnutrition primarily through agriculture programs, has seen rapid reductions in stunting of 2–4 percent per year on average within zones of influence where programs are implemented.
However, these successes in stunting reduction cannot be taken for granted. The United States currently spends less than 1 percent of overseas development assistance (ODA) on basic nutrition, and U.S. disbursements for global nutrition have been declining since 2013. These trends in reduced financing and nutrition prioritization put previous hard-fought gains at risk, and, if allowed to continue, will result in missed opportunities in the fight against stunting and malnutrition.
The U.S. government has renewed its engagement in nutrition by committing to the Scaling Up Nutrition (SUN) movement, setting targets to reduce stunting by 20 percent in 19 focus high-burden countries, and pledging $1 billion for nutrition at the Nutrition for Growth (N4G) gathering in 2013. The U.S. Agency for International Development (USAID) has also developed a multisectoral nutrition strategy, aiming to coordinate efforts across multiple agencies to scale up priority interventions and increase capacity to meet the United States’ goal of reducing stunting by 20 percent by 2020 in its priority countries; however, the N4G pledge by the United States did not include new money for nutrition, and only $318 million was allocated toward nutrition-specific interventions across all of U.S. government in 2014.
Implementing the multisectoral nutrition strategy and meeting targets, however, will require more resources, strong leadership, and commitment from across the whole of government to make reducing stunting a development priority for the United States.
There is now an urgent need for the next administration to maintain the current momentum, protect the gains made against stunting and malnutrition, and capitalize upon the opportunity to save and improve even more lives by implementing the multisectoral nutrition strategy, and creating a better resourced and stronger enabling environment for nutrition within the U.S. government. Reducing stunting is a winnable development battle with enormous benefits, not only for health, but also for economic prosperity.”
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