Child Stunting: The Unabated Global Malnutrition

Apr 1 , 2023
By Bjorn Lomborg

Of all our global promises for development that we are on track to fail by 2030 — one of the most tragic and infuriating is our limited progress on ending global malnutrition. Yet, achieving a drastic reduction in hunger is certainly within our grasp.

We measure chronic malnutrition in stunting; children are so underfed that they are much shorter than their peers of the same age. Stunting decreases children's survival chances, with 2.7 million globally dying yearly from malnutrition. Stunted children also develop more poorly and become less productive with a lower income over their entire lifespan.

The rich world has reduced stunting to deficient levels. China has achieved a drop to rich-country levels for the past three decades. Global stunting has almost halved since 1990, but more than one-in-five children is still stunted globally. The World Bank estimates that 37pc of children under five in Ethiopia were stunted in 2019.

Economists estimate the annual global cost of malnutrition to be one trillion dollars.

This year, we are halftime of the UN Sustainable Development Goals (SDGs), including promises on nutrition and everything else to be achieved by 2030. Yet, we are far from halfway. Based on trends before COVID-19, we will only reach the goal of zero hunger in the year 2116, 86 years late.

This global failure has motivated the Copenhagen Consensus, a think tank, to work with some of the world's best economists to identify which promises should be prioritized for the most significant impact.

Their new, peer-reviewed research shows that one of the most effective approaches to addressing malnutrition is to focus on pregnant women. For a small cost, they can be provided with micronutrients that could feed their growing foetus better and avoid some malnutrition later.

Most governments follow WHO recommendations to provide pregnant women with iron and folic acid supplementation to prevent anaemia in the mother and the newborn's neural tube defects. Switching to a pill that includes more micronutrients will only require minor education and training in the healthcare sector, adding only a small cost to the new drugs governments hand out.

These new mass-produced pills contain 13 vitamins and minerals beyond iron and folic acid, including vitamins A, B1, B2, B6, B12, D and E, plus zinc, copper, iodine and selenium. They cost so little that for 180 days, the additional cost for each mother is just over a dollar. Helping 36 million women in low and lower-middle-income countries in a year, along with healthcare training and education, would cost just 84 million dollars.

Multi-micronutrient supplements help to avoid about seven percent of almost 700,000 stillbirths, 21pc of all low-birth weights, and five percent of all preterm births yearly. Avoiding low birthweight and preterm birth means children are less likely to become malnourished, with 1.6 million steering clear of stunting each year and making them more productive as adults. In economic terms, they will become so much better off that the benefits add up to three billion dollars in today’s money. Thus, each dollar spent will deliver an astounding benefit worth 38 times the cost.

Calcium tablets are delivered separately from other micronutrients since they are quite large, and two to three are needed daily for the last 20 weeks of pregnancy. The cost is six dollars per pregnancy or 216 million dollars for the 36 million pregnant women taking iron and folic acid. This reduces the number of stillbirths by almost twice as much as multi-micronutrients, and it avoids an additional 1.1 million early births and births of low birthweight.

Calcium also reduces pre-eclampsia and eclampsia, the rare but serious condition where high blood pressure results in seizures during pregnancy or childbirth. The calcium may prevent up to 8,500 maternal deaths each year. The benefits of almost four billion dollars are 19 times larger than the costs.

Micronutrient supplementation for pregnant women is a fantastic policy but not a silver bullet. The economists identify several other very efficient policies. Helping parents in lower-income countries to feed their children better is costly, but it also improves the children's nutrition. The investment can deliver benefits worth 16 times the costs.

We should also invest much more in research to improve agricultural yields. This will generate more food at a lower price, reducing malnutrition and increasing growth. Each dollar could deliver a remarkable 33 dollars of social benefits. Investing more in pregnant mothers' nutritional support is one of the most efficient ways to make progress on sustainable development.

We owe it to the world to invest in such effective policies first.

PUBLISHED ON Apr 01,2023 [ VOL 23 , NO 1196]

Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at Stanford University's Hoover Institution. His new book is "Best Things First", which The Economist named one of the best books of 2023.

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