In Indonesia, chronic malnutrition is widespread with more than one-third of young children being stunted. Despite the reduction of the poverty rate from 16.6% to 11.4% from 2007 to 2013, the rate of stunting amongst children under the age of five has remained alarmingly high, exceeding 37% in 2013, although that figure has declined in the last two years. Stunting has important lifelong consequences for health, as well as for cognitive development, education, human capital accumulation, and ultimately for economic productivity.
However, to reduce stunting it’s not only important to focus on the health sector. It also requires improvements in other sectors such as agriculture, education, social protection, and water, sanitation, and hygiene (WASH). As originally emphasized by the UNICEF conceptual framework, to ensure that a child receives adequate nutrition depends on four critical factors: care, health, environment, and food security, areas that straddle multiple sectors.
Cash transfers are great – lots of people are telling you that on a continuous basis. However, it is an open question as to whether such programs can improve the wellbeing of their beneficiaries well after the cessation of support. As cash transfer programs continue to grow as major vehicles for social protection, it is increasingly important to understand if these programs break the cycle of intergenerational poverty, or whether the benefits simply evaporate when the money runs out…
While child mortality rates have plummeted worldwide, . Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
Just last week estimates were released suggesting that (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:
On September 30, the Guardian ran several articles (see here, here, and an editorial here) linking the halving of Peru’s stunting rate (from 28 to 14% between mid-2000s and 2015) to its CCT program Juntos. Of course, it is great to hear that the share of stunted children in Peru declined dramatically over a short period. However, as I know that while CCT programs (conditional or not) have been successful in improving various outcomes including child health, the effect sizes are never this dramatic, I was curious to see whether the decline was part of a secular trend in Peru or actually could be attributed primarily to Juntos…
Take these two numbers: 165 and 1. The former is the number of children in millions who are chronically malnourished or ‘stunted’; the latter is the number of robust impact evaluations comparing cash and in-kind transfers on malnutrition.
I emphasize ‘comparing’ since there is plenty of evidence on individual cash and in-kind (and voucher) programs, but very few studies deliberately assessing them under the same context, design parameters, and evaluation framework.
For the first time in history, the number of people living in extreme poverty has fallen below 10%. The world has never been as ambitious about development as it is today. After adopting the Sustainable Development Goals and signing the Paris climate deal at the end of 2015, the global community is now looking into the best and most effective ways of reaching these milestones. In this five-part series I will discuss what the World Bank Group is doing and what we are planning to do in key areas that are critical for ending poverty by 2030: good governance, gender equality, conflict and fragility, preventing and adapting to climate change, and, finally, creating jobs.
Seawater is rising in coastal Bangladesh. The soil contains more and more salt as the sea encroaches on the land. As a result, farmers see their crops declining. Communities are hollowing out, as working-age adults move to cities. Freshwater fish are disappearing, reducing the amount of protein in local diets. And in the dry season, mothers have to ration drinking water for their children – in some areas, to as little as two glasses a day.
Climate change is finally being taken seriously in the developed world, but it is generally seen as a future threat, to be managed over the coming years. For poor people in poor countries, particularly those living along coastlines, in river deltas, or on islands, it is a clear and present danger – and increasingly, a dominant fact of life.
Alassane Sow, World Bank Country Manager for Cambodia, and Rana Flowers, UNICEF Representative to Cambodia, wrote an op-ed for The Phnom Penh Post. Read the op-ed below, courtesy of The Phnom Penh Post.Did you know that in communities where a high proportion of people defecate outdoors, children are on average shorter than children living in communities where most people use toilets?
Open defecation – going outside without using a toilet or latrine – is one of the most important threats to child health and human capital, period; ending it must be a policy priority.
- India Rural Sanitation
- Open Defecation
- Public Sector and Governance
- Private Sector Development
- The World Region
- South Asia
- Middle East and North Africa
- Latin America & Caribbean
- Europe and Central Asia
- East Asia and Pacific