Senior Fellow Roger Thurow details the true costs of malnutrition today and tomorrow.
It wasn’t a Mother’s Day gathering, but it certainly was a special day for the moms and moms-to-be meeting in the shade of towering trees.
“What makes a strong and healthy child?,” asked a community health officer in Ethiopia’s central highlands. As she waited for an answer, she stirred a cauldron of vegetable porridge. It was a hint: The answer was in the pot. “Good nutrition!” she said. “That’s what makes a strong and healthy child.”
She held up a poster of nutritious eating. In the center was a picture of a young boy with a mortarboard cap, a smiling graduate. “After your child eats well, your child will be like this one,” she said. “Your child will have good performance in school. Your child will graduate. Won’t that make you happy?”
“Yes, yes,” the moms shouted.
Pre-pandemic, in 2019, this was a routine gathering, a scene that had become increasingly familiar across Ethiopia and much of Africa. Nutrition lessons and cooking demonstrations, using foods that grow naturally all around them and in their cultivated fields, proliferated in rural communities as a key to harvesting a better tomorrow. The message was spreading: Reducing childhood malnutrition increases the possibility that their children get off to the best start possible in life, so, like the boy in the poster, they can achieve a good education.
A Site of Suffering Turned Hopeful
It was also a most remarkable gathering. For when these moms were little girls themselves, they knew this location as a place of great suffering. Behind them were the newest additions to the district hospital: an emergency room, a lab, an administration center. But back in 2003, this was just a small clinic surrounded by a vast field covered with large tents. They were emergency feeding tents, each filled with dozens of starving children. The first great hunger crisis of the 21st Century had pushed 14 million Ethiopians to the doorstep of starvation. The United Nations World Food Program and a host of international relief organizations were scrambling to distribute food aid and set up therapeutic feeding routines, especially for the children, as fast as possible.
At the time, more than 50 percent of Ethiopia’s children under the age of five were stunted in some manner, physically or cognitively, or both. Stunting is the result of poor nutrition of both the mother and child, particularly during the crucial first 1,000 days period—the time through a mother’s pregnancy to her child’s second birthday. This is the time when good nutrition fuels the physical and cognitive growth of the child and fortifies the immune system. It is the most important period for healthy individual development, and, by extension, the healthy development of families, communities, nations, regions, and the entire world.
Malnourished, stunted children may never reach their full possible height and their brains may never develop their full cognitive potential, stunting their education and their productivity and earning capacity later in life. For stunting is often a life sentence of underachievement, as stunted children become stunted adults.
A community health officer gives a lesson on child nutrition in Ethiopia.
Malnutrition Today Means a Less Fruitful Tomorrow
The toll of early childhood malnutrition is profound. In the years following the 2003 famine, the Ethiopian government conducted a survey with the World Food Program and estimated that the cumulative impact of stunting–loss of education, diminished labor productivity, higher health-care expenses–cost the country’s economy the equivalent of 16 percent of its GDP annually. The World Bank estimated the cumulative cost of malnutrition to the global economy to be about $3.5 trillion annually.
Those are staggering numbers. But as I found while reporting my book, The First 1,000 Days: A Crucial Time for Mothers and Children – And the World, perhaps the greatest cost of childhood malnutrition and stunting are immeasurable: A poem not written. A horizon not explored. An innovation not nurtured. A cure not discovered.
We must ask ourselves: What might a child have contributed to the world if they hadn’t been stunted? For a lost chance at greatness for one child is a lost chance for us all.
This incalculable loss compels us to act. In the past decade, as improving nutrition has gained momentum as an international development priority, overall stunting rates have declined. A new report from UNICEF, the World Health Organization, and the World Bank, notes that the global rate of stunting has fallen from 33.1 percent of all children under five in 2012 to 22 percent in 2020. In absolute numbers, that’s about 54 million fewer stunted children in the past two decades, falling from 203 million to 149 million. In Ethiopia, the stunting rate, once over 50 percent, had steadily declined to about 43 percent in 2012 and to about 35 percent in 2020.
But in the most recent years, the rate of decline has leveled off in Ethiopia and globally. The report concluded that only one quarter of all countries are ‘on track’ to achieve the goal set by the World Health Assembly to cut in half the number of children affected by stunting by 2030. In sub-Saharan Africa, the numbers were actually on the rise. “More intensive efforts will be required,” the report noted, “if the world is to achieve global targets of reducing the number of children with stunting to 104 million by 2025 and to 87 million by 2030.”
Even more troubling, the report warns that the COVID-19 pandemic threatens to significantly reverse the global progress of the past decade: “These numbers may increase substantially due to constraints in accessing nutritious diets and essential nutrition services during the COVID-19 pandemic, with the full impact on stunting possibly taking years to manifest.
“The impact of the pandemic on stunting will likely unfold gradually and may persist for years after COVID-19 is eradicated and economies recover. Given that stunting is the result of chronic or recurrent malnutrition, it will be influenced by how long these pandemic-related shocks to the economy, food systems and health systems persist.”
One of the shocks has been the interruption of the communal gatherings of moms and moms-to-be that were spreading far and wide the knowledge of good nutrition.
Many global assemblies to revive the momentum for improving the nutrition of the world’s population are on the schedule for later this year, most notably the United Nations Global Food Systems Summit and a Nutrition for Growth conference. Lofty rhetoric will echo, commitments to action will be made, investments will be pledged.
But it will be the revival of the gatherings of moms and moms-to-be under the tall shade trees of communities burdened by the impact of stunting that will be the most important of all.
What makes a strong and healthy child, and world? The answer is in the cooking pot.