Under-nutrition and Stunting

Fact Sheet — 2010-09-14

“Malnutrition remains the world’s most serious health problem and the single biggest contributor to child mortality.”  

—The World Bank, 2006

“In poor countries maternal and child undernutrition is the underlying cause of more than one-third (3.5 million) of all child deaths under the age of 5 years, many of which are preventable through effective nutrition interventions operating at scale.” 

—The Lancet 2008

Under-nutrition and stunting: An overview

The World Bank warns that malnutrition continues to be the world’s most serious health problem and the single biggest contributor to child mortality.[i]

The term “malnutrition” refers to under-nutrition, which includes stunting, wasting, and deficiencies of essential vitamins and minerals (micronutrients); and over-nutrition, which includes obesity or over-consumption of specific nutrients.[ii]

Under-nutrition is the underlying cause of 3.5 million preventable maternal and child deaths each year. It is also responsible for 35 per cent of the disease burden in children under the age of five.[iii]

Globally, an estimated 200 million children under the age of five are chronically under normal height for their age (stunting) and another 26 million suffer from being severely underweight (wasting).[iv]

Ninety per cent of all stunted children live in only 36 countries; most of these are located in South-central Asia and sub-Saharan Africa.

Short and long-term effects

Under-nutrition contributes as both a direct as well as underlying cause of child mortality by rendering immune systems less resistant to infection, which in turn undermines the efficacy of immunization, worsens the disease condition and slows recovery.

Under-nutrition and stunting are difficult to detect, yet fully 80 per cent of malnutrition-related deaths can be attributed to mild or moderate malnutrition.

The effects of malnutrition are intergenerational. Maternal under-nutrition often leads to low birth weight, which contributes to 60 per cent of neonatal deaths,[v] and irreparable mental and physical impairments among newborns that do survive. It can also result in the deaths of both mother and child.

Malnutrition in children under the age of two can cause irreversible brain damage, retard normal growth and increase the risk of developing chronic disease later in life. All these factors combined lead to less productive adults and higher health care costs.[vi]

Early childhood under-nutrition also takes its toll on health later in life. Individuals are more likely to suffer from non-communicable diseases such as heart and kidney disease, obesity and diabetes. Estimates suggest that 11 per cent of the total global disease burden relates back to under-nutrition.[vii]

Economic impact

As well as undermining health and well-being, malnutrition limits intellectual potential and undermines economic development. Undernourished children are generally enrolled in school at a later age and suffer from intellectual impairments caused by nutritional deficiencies.[viii]

The economic losses due to mental impairment are also pervasive—under-nutrition in early life is associated with a 15-point decrease in IQ, which in turn is associated with a 10 per cent drop in earnings. In India, productivity losses owing to lower wages are an estimated US$2.3 billion.[ix]

Adults affected by under-nutrition earn almost 20 per cent less than their non-affected counterparts.[x] Widespread under-nutrition in early childhood can lead to an annual GDP loss of two to three per cent.[xi] Iron deficiency anaemia has been associated with a 17 per cent loss of productivity among those who engage in heavy manual labour.[xii]

Conversely, children that are well nourished in the first two years of life are more likely to survive, more likely to go to school and more likely to earn up to 46 per cent more than their more deprived counterparts as adults.[xiii]

Reducing the prevalence of under-nutrition and stunting

Effective interventions to reduce stunting, micronutrient deficiencies and child deaths are readily available and, for the most part, inexpensive. Only a few interventions, however, hold the greatest potential for reducing child deaths and the short- and long-term effects of acute and chronic under-nutrition.

These include:

  • encouraging mothers to breastfeed and offering breastfeeding counselling
  • appropriate complementary feeding
  • vitamin A, zinc, iron and iodine supplementation

Under-nutrition and the Millennium Development Goals

Ensuring adequate nutrition is not only important for the growth, development and survival of children, it is central to community development. Malnutrition stands in the way of the Millennium Development Goals (MDGs)—specifically those relating to extreme poverty and hunger, HIV and AIDS, malaria, education, and maternal and child mortality. None of these can be effectively addressed without tackling malnutrition.[xiv]

Improved nutrition contributes to sustainable and equitable growth, which in turn leads to poverty reduction. For example: One study reveals that Guatemalan men who received highly nutritious food supplements from birth to two years of age earned US$0.67 per hour more than those who did not receive such supplements. This is comparable to a 46 per cent increase in average wages. Eliminating anaemia likewise results in significant economic benefits: According to one study, reductions in anaemia led to a five to seven per cent increase in adult productivity or two per cent increase of GDP in high-burden countries.[xv]

Good nutrition also significantly decreases maternal and child deaths, improves maternal health, enhances gender equality and improves the efficacy of treatment for HIV and AIDS. Investing in nutrition, therefore, is central to achieving the MDGs and reaching overall development goals.

Investing in nutrition is cost-effective. Produced by a panel of leading economists—including a number of Nobel Laureates—The Copenhagen Consensus 2008 listed combatting under-nutrition as the best development investment considering its cost-benefit ratio—as high as 1 to 200. In other words, each dollar spent on micronutrient programmes targeting children under the age of two would realise gains of more than US$17 in terms of fewer deaths, better health and increased future earnings.

Increasing efforts to tackle under-nutrition and stunting

Apart from the fact that undernourished children are slightly shorter than well-nourished ones, there are few obvious physical signs. Perhaps because of this (particularly with respect to stunting and micronutrient deficiencies), political leaders and policy makers tend to ignore the issue—even though tackling the causes of under-nutrition is critical to economic and human development. However, global momentum is building to combat under-nutrition, with enormous potential to save and improve the lives of millions of children.

National leaders and finance ministers in developing countries can play a major role in the economic development of their countries by placing nutrition high up on the political and development agenda. This means acquiring additional resources and assigning top political leaders to develop coordinated cross-ministerial efforts under a credible national nutrition plan with strong accountability measures at the local district and national levels.

Governments and donors need to provide top-level political support to scale up nutrition interventions. This leadership must speak with a coordinated voice and seek to bolster country-level efforts by releasing adequate funds and supporting large-scale cross-sectional nutritional interventions, food security and health programmes. This also means placing nutrition front and centre of international partnerships for health.

New and existing resources to strengthen world food security and agriculture must be refocused, with the aim of reducing under-nutrition and not simply increasing the availability of food. These include funds such as those provided by G8 countries through the L’Aquila Initiative to be channelled partly through the World Bank Trust Fund.

To improve the nutrition of the world’s most impoverished children, international and national efforts need to reach them where they access services: at home and in the community. Thus, a greater emphasis on family and community care will go a long way toward improving the nutritional status of these most vulnerable children. By investing is grassroots nutritional programmes, education, and maternal, newborn and child programmes, stakeholders will realise the greatest returns on their investments and put an end to the scourge of under-nutrition and stunting.

For more information or to arrange an interview with a key spokesperson, please contact:


Geraldine Ryerson Cruz, media relations World Vision US

Tiffany Baggetta, public relations World Vision Canada

[i] World Bank. Repositioning nutrition as central to development. A strategy for large-scale action. Washington, 2006.

[ii] Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, 2Mathers C, Rivera J, Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371 (9608): 243-260.

[iii] Ibid.

[iv] UNICEF. Tracking progress on child and maternal nutrition. United 4Nation Children’s Fund: New York, 2009.

[v] J R Berrman et al (2004) Hunger and malnutrition. Copenhagen consensus challenge paper

[vi] Allen LH, Gillespie SR. What works? A review of the efficacy and 7effectiveness of nutrition interventions. ACC/SCN, in collaboration with the Asian Development Bank, Manila: Geneva, 2001.

[vii] R E Black, L H Allen et al (2008) ’Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet 371: pp 24-59.

[viii] Jukes M, McGuire J, Method F, Sternberg R., “Nutrition and 6Education.” In Nutrition: A Foundation for Development, ACC/SCN: Geneva, 2002.

[ix] J M Hunt (2005) ‘The potential impact of reducing global malnutrition on poverty reduction and economic development’, Asia Pacific Journal of Clinical Nutrition, 14(supplement): pp 10-38

[x] S G McGregor et al (2007) ‘Development potential in the first 5 years for children in developing countries’, The Lancet 369: pp 60-70

[xi] Ibid.

[xii] R Martorell et al (2010) ‘Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries’, Journal of Nutrition 140(2): pp 348-54.

[xiii] Shekar, Meera (2010) “Malnutrition:Is it an imperative for improving the health of women and young children?” World Bank http://www.cappd.ca/prototype/files/meera%20skekar-%20g8.pdf

[xiv] UNICEF. Strategy to reduce maternal and child undernutrition. East Asia and Pacific Regional Office, Health and Nutrition Working Paper. United Nations Children’s Fund: Bangkok, 2003.

[xv] J Strauss, and D Thomas (1998) ‘Health, nutrition and economic development’, Journal of Economic Literature 36(2): pp 766-817