Published on The Water Blog

How water impacts early childhood nutrition: An integrated water and nutrition framework

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Water is at the core of healthy growth and development. It is a driver of better nutrition, but when poorly managed can lead to negative impacts. The role of water for early child nutrition has centered on ensuring a hygienic living environment through clean water, adequate sanitation and good hygiene. However, the importance of water for nutrition is much broader.

A reliable water supply is needed to grow food to feed families, secure livelihoods, and provide income for other nutrition inputs. Yet water has become more variable as climate change accelerates, leading to more frequent and more damaging droughts and floods. Mismanagement of water resources results in shortages, pollution, and in some cases conflict, each of which impact a child’s ability to thrive. These relationships call for a more nuanced recognition of the role that water plays in early child nutrition, as well as the need for guidance on ways to mitigate the risks and boost the benefits of water investments for nutrition.

In collaboration with the teams focusing on Agriculture and Health issues at the Bank, the Water team developed an integrated water and nutrition framework to aid in understanding the various ways that water impacts early child nutrition.

This framework draws on the three dimensions of water security:

  1. Water quantity, adequate supply of water resources;
  2. Water quality, water that is free of contamination; and
  3. Water accessibility, reliable availability to all people, economies and ecosystems.

Each of these in turn affects the underlying drivers of poor nutrition outcomes in children: water determines disease environments and therefore the ability to physically utilize nutrients for healthy growth; water impacts the supply of food and nutrients that people have access to in their homes; and water influences livelihoods, which indirectly affects nutrition through income, time use, and education of caregivers. Challenges associated with water related conflict and water resources in the context of fragility cuts across each of the drivers of undernutrition.

Alongside the Water and Nutrition Framework for Action, the team developed operational guidance notes that summarize research evidence on ways to design water sector investments across irrigation, water management and water supply and sanitation for greater impact on early child nutrition.

It is often necessary to enhance current approaches to service delivery and water management since these have mainly been designed with more upstream outcomes in mind, such as improvements in access and use for water and sanitation services and improvements in availability of food and income for irrigation investments. It is also necessary to identify ways to coordinate with other sectors to help ensure that children receive all the necessary nutrition inputs that lead to better outcomes, not only water related inputs.

The Water and Nutrition Framework for Action has been influential in the design of the Ethiopia One WASH—Consolidated Water Supply, Sanitation, and Hygiene Account Project, which incorporates clear investments for sustainable WASH services, nutrition-sensitive behavior change, targeting to districts with high levels of child stunting and low levels of WASH access, and geographic convergence with other nutrition-specific and nutrition-sensitive projects.


Ede Ijjasz-Vasquez

Former Regional Director, Africa, Sustainable Development Practice Group

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