Regarding Nyasha Tirivayi’s question, “Studies have shown that the first 1000 days of life are a crucial window for preventing irreversible undernutrition like stunting. Yet other research rebuts this position by showing that catch-up growth is still possible even after the first 1000 days of life. From your experiences, who should we target when implementing nutrition enhancing social protection measures? Under 3 years? Over 3 years?”:
While there has been a recent push back from the polar view that there is no catch up after the 1000 day period, the evidence marshaled is not programmatic; there still is little evidence that programs at scale are as effective after that period as they are during the 1000 days. This is particular true for food transfer programs which have shown that supplements during weaning have larger impact than those receive subsequently. See, Lutter CK, Mora JO, Habicht JP, Rasmussen KM, Robson DS, Herrera MG. Age-specific responsiveness of weight and length to nutritional supplementation. Am J Clin Nutr. 1990. 51(3):359-64 as well as Schroeder, Dirk, Reynaldo Martorell, Juan Rivera, Marie T. Ruel and Jean-Pierre Habicht. 1995. Age Differences in the Impact of Nutritional Supplementation on Growth. Journal of Nutrition 125: 1051S-1059S. There is also some evidence that attempting to address stunting after a child’s second birthday increases the chance of subsequent obesity or heightens the risk of chronic diseases in adulthood.
On the other hand, there is a wealth of information on the potential to close the gap in cognitive and socio-emotional skills attendant to stunting in the post 1000 day period as referenced in the 3rd Lancet article launched June 6 and linked with this discussion. While one will always desire more costing studies, investing in preventing stunting in the first 1000 days makes sound economic sense while the resources available for programs aimed at children somewhat older would be better spent on other aspects of child development, perhaps directing particular attention to those children who for a variety of reasons, did not avoid stunting during the critical early years. Such prioritization may be made on a criterion of efficiency of investments as well as an objective of equity in subsequent educational opportunities.
Regarding the question: “Recent research shows that stunting has far reaching consequences even affecting income earning capacities in adulthood and on a national scale leading to two –three percent losses in GDP (Bhutta, Sachdev et al. 2008). In that case, should we prioritize eliminating stunting over wasting or underweight? Or we should not prioritize one over the other?”
Wasting is a transitory measure; most children either succumb to the risks of severe acute malnutrition or gain enough so that they are no long classified as severely malnourished. Fortunately, there have been major strides in both identifying children in this critical situation and in implementing cost effective programs to reach these children. While these are excellent programs, they are not social protection activities (except, perhaps, when family emergency response is coupled with age specific emergency measures in, for example, drought or hurricane relief). Targeting other more predictable social protection endeavors to poor families with children in the most vulnerable age bracket will likely simultaneously address stunting and underweight; I cannot think of a social protection instrument that, once the age of the target population is considered, can distinguish its impact on stunting relative to that on underweight.
The more difficult choice is determining the share of available resources that address the consumption needs to other population groups be they slightly older children or even elderly. There are equity reasons to address the needs of such groups. However, with limited resources there are likely tradeoffs on these two dimensions. For example, programs targeted to the elderly have (at best) only indirect nutritional impact compared to allocating similar funds to children. Conversely, prioritizing funds towards programs linked to investment in health have a recognizable investment potential but may exclude those that cannot take up opportunities for child investments. Thus, while consideration of the potential for social protection to impact nutrition is important, it does not eliminate the need to balance between the twin priorities of equity and efficiency.
Dr. Harold Alderman