Published on The Water Blog

When nutrition meets WASH: reflections from Ethiopia and Madagascar on fighting stunting

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Co-author: Sophie Durrans, Research Uptake Officer at London School of Hygiene & Tropical Medicine

A child who is stunted early in life – who fails to grow as tall as expected for their age – often has reduced physical and mental development. Water supply, sanitation, and hygiene (WASH) influences a child's growth in multiple ways. Evidence across low and middle-income countries demonstrates that higher open defecation rates are associated with stunting and higher overall incidence of poverty.

In recent years, better understanding of the links between poor water, sanitation, and hygiene and undernutrition has led to improvements in multi-sectoral policies and programs. A new World Bank report called Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals – which is part of the World Bank’s ongoing initiative in 18 countries to look at WASH Poverty Diagnostics – shows that 2 + 2 can equal 5: water, health, and nutrition interventions need to be coordinated  in the fight against childhood stunting and mortality. While improving water and sanitation alone does improve a child’s well-being, the impacts on a child’s future are even greater when WASH is combined with health and nutrition interventions.

However, substantial knowledge gaps remain. Until now, research and development practitioners have largely focused their efforts to fight stunting in rural settings; less attention has gone to how poverty, overcrowding, and poor-quality water and sanitation services interact to magnify these risks in densely populated peri-urban areas.
In a bid to fill the knowledge gaps, at Stockholm World Water Week, stakeholders from the water and nutrition sectors came together to discuss the evidence, policy, and practice examples of how we can effectively address stunting in slums and informal settlements.
After the session, we spoke with Ambinintsoa Raveloharison, National Coordinator of the National Nutrition Office in Madagascar and the Scaling Up Nutrition (SUN) government focal point, and Bethlehem Mengistu, Country Director of WaterAid Ethiopia. Here are the reflections they shared on the session and, more broadly, on how #NutritionMeetsWASH:   
Q: What are your key takeaways from the session?
The WASH sector needs to take much stronger action to integrate nutrition ; too few WASH plans consider the impact of water, sanitation, and hygiene on nutrition. WASH Ministries must be involved in the decision-making of the nutrition sector. There are clear, practical actions all governments and donors can take to integrate WASH and nutrition: things like co-location, hygiene promotion, BabyWASH interventions, and ensuring WASH in health centers and schools.
This session piqued my interest on the difference between the levels of stunting and wasting, particularly around why stunting is decreasing, but not wasting. I'd like to find out more about this, as it's the same in my country. The Recipe for Success presentation highlighted how national plans offer a multisectoral approach. In Madagascar, we need to improve how to harmonize and create impacts and effects.
Q: What is one thing you want people who couldn’t attend the session to know?
You can't end hunger and chronic malnutrition with food alone!  You've got to look at the underlying causes and the environment. Investing in WASH is key!
The integration of WASH and nutrition is key. I'd like people to consider how it impacts their work. 
Q: What was the most surprising or unexpected thing you heard in the session?
I really like the facilitator’s point that ‘the session reflects the whole narrative: research on evidence, what the policies say, and the action on the ground. We will no doubt have a different and improved picture of the issues in the coming years.’ I think this is a positive statement that is quite encouraging and conducive to getting actors out of silos and investing in comprehensive interventions that are win-win for all and in line with the SDGs.
I was surprised and encouraged to see the combination of researchers, policymakers and development practitioners who are all collaborating with and supporting governments and countries to improve nutrition outcomes.
The collaboration between WASH and nutrition stakeholders at Stockholm World Water Week continues through the Scaling Up Nutrition (SUN) and Sanitation and Water for All (SWA) Partnership, and supports integrations well as sharing good practices. At the SUN Global Gathering in November this year, stakeholders will meet again to explore these issues – helping to strengthen a network of researchers and development practitioners that can ultimately make a difference in children’s lives.


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