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NUTRITION RECOMMENDATIONS FOR THE POST-2015 FRAMEWORK

THE HUMAN FACE OF EXTREME POVERTYSTUNTED CHILDREN


The Millennium Development Goals (MDGs) have galvanized unprecedented global action to tackle the challenge of poverty and have spurred progress on a number of development issues. Progress to date, however, has been uneven. While the goal of halving the incidence of extreme poverty by 2015as defined by the World Bank as the proportion of people living on less than $1.25 per dayhas been met, it can be argued that unacceptably high levels of extreme poverty persist. Relying on an income poverty measure as the barometer for broad-based development fails to adequately capture the realities faced by the worlds poor, marginalized, and vulnerable. This is particularly true when one looks at the non-income human face of povertystunted children. This brief proposes using stuntingwhich is indicative of severe, irreversible physical and cognitive damage caused by chronic malnutritionas a headline indicator for the post-2015 development agenda and global framework.

WHY STUNTING?
Stunting indicates a failure to achieve ones own genetic potential for height.i It is caused by frequent infections early in life and inadequate nutrition required to support the rapid growth and development of infants and young children during the critical 1,000 days between a womans pregnancy and her childs second birthday. The physical manifestation of stunting belies the true impact of chronic nutritional deprivation early in life: delayed neurological development, permanent cognitive impairment, weakened immune systems, and a susceptibility to chronic diseases such as diabetes, heart disease, and certain types of cancers in adulthood. Research shows that the developmental damage caused by stunting can result in lower IQ, poorer educational performance and school completion rates, and a The child on the left is stunted; she is 4 years old while the child on the right is diminished earning capacity. At a macroeconomic level, chronic malnutrition early 2 years old. Photo: Dr. Mercedes de in life can cost countries up to 11% of their GDP in terms of lower wages and lost Onis, World Health Organization. productivity.ii Chronic malnutrition also tightens the noose of intergenerational poverty. Children born to stunted women are themselves likely to be stunted. In this way, stunting reflects the persistent, cumulative effects of poor nutrition and other deficits that span across several generations. Stunting is as pervasive as it is persistent. Globally, 1 in 4 children under the age of 5 is stunted. Interestingly however, the majority (70%) of the worlds 165 million stunted children live in middle-income countries. As such, stunting as a headline indicator can provide a strong measure of the level of inequality present in a society by shining a light on the most vulnerable and marginalized in ways that income poverty metrics often fail to do. The use of stunting as a way to measure poverty is particularly powerful because addressing stunting requires action in many different sectors, a focus on systems (e.g. food systems, health systems, water and sanitation infrastructure, social protection) and the overall status of women in society. For this reason, stunting is gaining wider acceptance as a leading indicator for the post-2015 development agenda:
Stunting (height for age) is the result of many factors, some direct, such as poor nutrition, but many indirect, such as poor health, mothers education (lack of which contributes to poor nutrition, low income, and poor health), access to water and sanitation (which contributes to poor health), short birth spacing and high parity, and overall poverty. In addition, stunting is concentrated among the poorest. Thus, to reduce stunting, a multi-sectoral response . . . targeted at the poorest is needed. This would seem to be just what any postiii 2015 targets might wish to achieve.

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CURRENT GOALS & PROGRESS ON STUNTING


Recognizing that accelerated global action is needed to address the pervasive yet solvable problem of malnutrition, the World Health Assembly (WHA) agreed in May 2012 on global targetsiv to improve maternal, infant and young child nutrition. The current global target on stunting proposes to reduce from 170 million to approximately 100 million the number of children under age 5 who are stunted by 2025a 40% reduction. UNICEF, WHO and the World Bank estimated that the global prevalence of stunting will decrease to 23.8% by 2015, compared to 39.9% in 1990.v Although the prevalence of stunting has decreased, overall progress is still insufficient and millions of children remain at risk. It is crucial that the next set of goals establish a bold target to diminish stunting, which builds upon and exceeds the current WHA global target to reduce the prevalence of stunting by 40% by 2025.vi
The use of stunting as a HEADLINE INDICATOR allows for an approach to ending extreme poverty that: is focused on the most vulnerable and marginalized. helps ensure increased and equitable access to food, health, water and sanitation and other basic necessities. promotes action and progress in a range of sectors: food security and agriculture, health, education, early child development, WASH, gender equality and economic growth. helps measure a persons physical and developmental well-being.

AN ULTIMATE GOAL OF ZERO STUNTING


At the June 2012 UN Conference on Sustainable Development (Rio+20), UN Secretary-General Ban Kimoon launched the Zero Hunger Challenge,vii which called for zero stunted children less than 2 years of age by ensuring universal access to nutritious food in the 1,000-day window of opportunity between the start of pregnancy and a childs second birthday, supported by nutrition-sensitive health care, water, sanitation, education and specific nutrition interventions, coupled with initiatives that enable empowerment of women By supporting a focus on getting to zero, an important shift is underway from relative goals to absolute goals, setting minimum standards for the right of all people to food and nutrition security, health, nutrition education, and water, sanitation and hygiene (WASH), and working toward universal access to these basic necessities. It is therefore critical that future development goals are guided by a vision of sustainably ending poverty, or getting to zero, that is broader than ensuring that no one lives on less than $1.25 per day.

UNICEF: Stunting, or low height for age, is caused by long-term insufficient nutrient intake and frequent infections. Stunting generally occurs before age two, and effects are largely irreversible. These include delayed motor development, impaired cognitive function and poor school performance. http://www.unicef.org/progressforchildren/2007n6/index_41505.htm ii Economic Commission for Latin American and the Caribbean and World Food Programme: The Cost of Hunger: Social and Economic Impact of Child Undernutrition in Central America and the Dominican Republic. February 2008. http://documents.wfp.org/stellent/groups/public/documents/liaison_offices/wfp175334.pdf iii Schweitzer, Makinen, Wilson, Heymann. Results for Development Institute and Overseas Development Institute. Post-2015 Health MDGs. July 2012. http://www.odi.org.uk/resources/docs/7736.pdf iv World Health Organization. Global targets 2025 to improve maternal, infant and young child nutrition. http://www.who.int/nutrition/topics/nutrition_globaltargets2025/en/ v World Health Organization, UNICEF and the World Bank. Estimated prevalence of stunted preschool children 1990-2015 with 95% confidence intervals by UN regions and sub-regions. July 2012. http://www.who.int/entity/nutgrowthdb/jme_stunting_prev.pdf vi In keeping with the World Health Assembly global targets to improve maternal, infant and young child nutrition, established May 2012 and summarized at: http://thousanddays.org/wp-content/uploads/2012/05/WHO-Targets-Policy-Brief.pdf vii The Zero Hunger Challenge: http://www.un.org/en/zerohunger/challenge.shtml
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