No.3: Between 1990 and the year 2000, reduction of severe and moderate malnutrition among under-five children by half No. 9: Special attention to the health and nutrition of the female child and to pregnant and lactating women

The Challenge

Good nutrition is the cornerstone for survival, health and development for current and succeeding generations. Well-nourished children perform better in school, grow into healthy adults and in turn give their children a better start in life. Well-nourished women face fewer risks during pregnancy and childbirth, and their children set off on firmer developmental paths, both physically and mentally.

When the ambitious goal of halving child malnutrition was adopted in 1990, over a third of the world's under-fives - some 174 million children - were malnourished.

Malnutrition is implicated in more than half of all child deaths worldwide. Malnourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhoeal diseases and respiratory infections, and for those who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Their plight is largely invisible: three quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished, showing no outward sign of their vulnerability.

Poverty, low levels of education, and poor access to health services are major contributors to childhood malnutrition, a complex issue that requires tackling on a wide number of fronts. To name only a few:

• Ensuring food security for poor households, both enough food and the right kinds of food;

• Educating families to understand the special nutritional needs of young children, notably the value of breastfeeding and the importance of introducing suitable complementary foods at the right age;

• Protecting children from infections, by such measures as immunization against common childhood diseases and provision of safe water and sanitation;

• Ensuring that children receive quality care when they fall ill;

• Shielding them from the micronutrient deficiencies that can bring death and disability, especially iodine, iron and vitamin A deficiencies;

• Paying special attention to the nutritional needs of girls and women, since chronically undernourished women tend to bear low-birthweight babies and so perpetuate the vicious cycle of malnutrition into the next generation.

Progress to Date:

Overall, significant progress has been made in the reduction of child malnutrition, with underweight prevalence declining from 32 to 28 % in the developing world as a whole. The largest decline was achieved in East Asia and the Pacific where underweight levels decreased by a third (from 24% to 16%). This regional decline is driven primarily by improvements in China, which achieved the WSC goal. However, underweight prevalence for other countries in the region did not decline at the same level. Substantial improvements were also made in the Latin America and the Caribbean region where rates declined by more than a quarter (from 11% to 8%), although overall levels were already relatively low to begin with. South Asia also experienced declines over the decade (from 55% to 48%), however, the region continues to suffer from staggeringly high levels of child malnutrition with close to half of all under five children being underweight. The underweight prevalence rates for the Middle East and North Africa region as a whole showed an increase, but this is primarily due to the deterioration in nutritional status in Iraq. In Sub-Saharan Africa there has been little or no change over the decade and nearly a third of all under fives remain underweight.

The number of malnourished children in the developing world declined from around 174 million at the beginning of the decade to 150 million at the end of the decade. Half of all malnourished children live in South Asia and more than one fifth in Sub-Saharan Africa. The actual number of malnourished children in Sub-Saharan Africa has actually increased over the decade, partly due to the lack of progress and the increase in overall population size. It is worth noting that only three countries, India, China and Bangladesh, make up half of all malnourished children in the developing world. 

The WSC goal of reducing 1990 levels of child malnutrition by half, was technically achieved by only a small number of countries. However, as shown in the figure below, 18 countries achieved reductions of 25% or more over the decade - a remarkable achievement. The list includes some of the most populous countries such as China, Indonesia and Bangladesh. 

Despite these striking achievements, there are still many countries, particularly in South Asia and Sub-Saharan Africa, with shockingly high levels of chronic malnutrition. The underlying causes of malnutrition in many Asian countries include poverty, the low status of women, poor care during pregnancy, high rates of low birth weight, high population densities, unfavorable child caring practices, and poor access to health care. In sub-Saharan Africa, extreme poverty, inadequate caring practices, low levels of education and poor access to health services are among the major factors. Conflicts and natural disasters in many countries have further exacerbated the situation. The increase in the number of malnourished children in Africa also reflects a rapid rate of population growth. In many countries in Africa, the devastating effects of HIV/AIDS, particularly in the second half of the decade, have reversed some of the gains made in the decade's early years.

Disparities

The available data, particularly those from MICS and DHS, also allow for the analysis of disparities within the population.

Data from 102 countries show that there is very little difference between boys and girls with respect to underweight prevalence. In fact, except for South Asia, most regions show slightly higher rates among boys.

By contrast, the urban rural differentials do show significant differences. On average, the underweight prevalence rates are more than one and a half times higher in rural areas than in urban areas.

Underweight Prevalance (1995-2000)

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