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Stunting

Introduction


Stunting reflects chronic undernutrition during the most critical periods of growth and development in early life.

It is defined as the percentage of children, aged 0 to 59 months, whose height for age is below minus two standard deviations (moderate and severe stunting) and minus three standard deviations (severe stunting) from the median of the WHO Child Growth Standards. 

In India, almost half (48 per cent) of children younger than five years of age are stunted, a manifestation of chronic undernutrition.  Stunting and other forms of under-nutrition are thought to be responsible for nearly half of all child deaths globally.

Stunting is associated with an under developed brain, with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood, reduced earnings and increased risks of nutrition related chronic diseases, such as diabetes, hypertension, and obesity in future.

While India’s economy has been growing at impressive rate, the country still has the highest number of stunted children in the world, (61 million children) representing one third of the global total of stunted children under the age of five.
 
Stunting starts from pre-conception when an adolescent girl and who later becomes mother is undernourished and anaemic; it worsens when infants’ diets are poor, and when sanitation and hygiene is inadequate. It is irreversible by the age of two. Child survival and health is inseparably connected to reproductive and, maternal health.

As high as 70 per cent of adolescent girls in India are anaemic and half of adolescents are below the normal body mass index, which has an impact on the health of their future pregnancies and children. Preventing stunting is critical to survival in the immediate term, and in the longer-term, to ensure healthy, well-educated and productive adults. Tackling this insidious disease and vicious cycle is a critical aim for UNICEF India
 
The implications for low stature mothers giving birth to stunted children are very real.

Child Survival is linked to Water, Sanitation and Hygiene 

A lack of adequate food is a primary cause of death, under-nutrition and stunting; but the story of child mortality and malnutrition in India is not just one of poor diets. The lack of water, sanitation and hygiene practices - which leads to illnesses and life threatening diseases like diarrhoea - is thought to cause of up to 50 per cent of all child malnourishment. 2.5 billion cases of diarrhoea in children under-five are recorded worldwide every year.

With every episode of diarrhoea vital nutrients are lost from the body. 
Repeat episodes of diarrhoea are increasingly also thought to be connected to chronic malnutrition, stunting and death.

With 595 million people in India defecating in the open, without toilets and without adequate facilities, there is elevated risk of bacterial infection. With mothers, birth attendants and extended family member’s all potentially handling children with infected hands, the chances of child sickness and death are high.

Big Picture

48 per cent or 54 million children under-five years in India are stunted . India accounts for 33 per cent of stunted children in the world.
Stunting (inadequate length/height for age) reflects cumulative effects of intergenerational poverty, poor maternal and early childhood nutrition, and repeated episodes of illness in childhood.
Stunting is the most prevalent form of under-nutrition, yet it goes largely unrecognized. 
Stunting prevalence varies across states. The levels of stunting in children is above the national average in Uttar Pradesh (56.8%), Bihar (55.6%), Chhattisgarh (52.9%), Gujarat (51.7%), Meghalaya (55.1%), Madhya Pradesh (50%) and Jharkhand (49.8%). Prevalence of wasting is highest in Madhya Pradesh (35%) followed by Jharkhand (32.3%), Meghalaya (30.7%) and Bihar (27.1%) . 
The lifelong effects of stunting are said to result in at least 10 per cent decrease in future income over the lifetime of stunted adults.
 
Case Study 1

India’s bid to Becoming Poo-Free and to Reduce Stunting

UNICEF has worked to convince State Government of the need to generate demand from the communities themselves for better health and sanitation facilities. As communities became better aware of the link between sanitation and child mortality and morbidity, they demand and use these facilities and services.  Read More
 
Case study 2
 
Prevalence of stunting in children under-two years in Maharashtra decreased from 38.8% in 2006 to 22.8% in 2012. Importantly, the prevalence of severe stunting decreased from 14.6% in 2006 to 7.8% in 2012 . Read More 

UNICEF In Action

Better Sanitation and Hygiene 
 
As well as strengthening the nutritional intake of mothers, newborns and infants, UNICEF focuses on improving poor sanitation and hygiene to improve their health and chances of survival.

Millions of already vulnerable underweight newborns in India are born in such poor conditions. Their first mothers-embrace, the first time they are held by a birth attendant, and the first time they are fed are likely to be with hands covered in diarrhoea-causing bacteria from faeces - increasing their chances of infection, critical illness, stunting or death.

As much as 50 per cent of malnutrition is caused not by a lack of food or poor diets, but due to poor water, poor sanitation facilities and unhygienic practices – like not washing hands properly with soap – which leads to life-threatening disease and infections such as diarrhoea. 
 
There is little benefit for the child if a new mother washes her hands, while her nurse, midwife, mother-in-law and other family members who come into contact with the newborn do not use a toilet and do not wash their hands too. India is not reaching its sanitation targets fast enough - only constructing 20 million new toilets a year.

A key strategy in UNICEFs work is tackling open defecation and the lack of sanitation facilities for whole communities so everyone is aware of its importance in child survival, nutrition and growth.

Preventing children under two years old from dying, as well as preventing malnutrition and stunting in India can only be tackled fully with a focus on ensuring doctors, nurses, caregivers and mothers all have clean hands from the moment a child is born, breastfed or when food is prepared. This can only be done with adequate water and sanitation facilities in both health centres and in homes, and better knowledge and thorough hand washing with soap. 
 
UNICEFs water, sanitation and hygiene interventions therefore work with government to increase the motivation of people to use toilets – to change the beliefs, opinions and behaviour of whole communities. 
 
UNICEF works in partnership Government programmes such as the National Rural Drinking Water Programme (NRDWP), and the Nirmal Bharat Abhiyan (Total Sanitation Campaign) that encourages communities to demand and then construct and use their own latrines.

Using state level pilot initiatives, UNICEF offers the government high-level technical support to demonstrate policies, practices and strategies that work – based on field-based data and evidence of progress in child survival.