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The Millennium Development Goals (MDGs) have galvanized unprecedented global action to tackle thechallenge of poverty and have spurred progress on a number of development issues. Progress to date,however, has been uneven. While the goal of halving the incidence of extreme poverty by 2015as defined

by the World Bank as the proportion of people living on less than $1.25 per dayhas been met, it can beargued that unacceptably high levels of extreme poverty persist. Relying on an income poverty measure asthe barometer for broad-based development fails to adequately capture the realities faced by the worldspoor, marginalized, and vulnerable. This is particularly true when one looks at the non-income human faceof povertystunted children. This brief proposes using stuntingwhich is indicative of severe, irreversiblephysical and cognitive damage caused by chronic malnutritionas a headline indicator for the post-2015development agenda and global framework.

WHY STUNTING?Stunting indicates a failure to achieve ones own genetic potential for height.iIt iscaused by frequent infections early in life and inadequate nutrition required tosupport the rapid growth and development of infants and young children during

the critical 1,000 days between a womans pregnancy and her childs secondbirthday. The physical manifestation of stunting belies the true impact of chronicnutritional deprivation early in life: delayed neurological development, permanentcognitive impairment, weakened immune systems, and a susceptibility to chronicdiseases such as diabetes, heart disease, and certain types of cancers inadulthood.

Research shows that the developmental damage caused by stunting can result inlower IQ, poorer educational performance and school completion rates, and adiminished earning capacity. At a macroeconomic level, chronic malnutrition earlyin life can cost countries up to 11% of their GDP in terms of lower wages and lost

productivity.

ii

Chronic malnutrition also tightens the noose of intergenerationalpoverty. Children born to stunted women are themselves likely to be stunted. In this way, stunting reflectsthe persistent, cumulative effects of poor nutrition and other deficits that span across several generations.

Stunting is as pervasive as it is persistent. Globally, 1 in 4 children under the age of 5 is stunted.Interestingly however, the majority (70%) of the worlds 165 million stunted children live in middle-incomecountries. As such, stunting as a headline indicator can provide a strong measure of the level of inequalitypresent in a society by shining a light on the most vulnerable and marginalized in ways that income povertymetrics often fail to do.

The use of stunting as a way to measure poverty is particularly powerful because addressing stuntingrequires action in many different sectors, a focus on systems (e.g. food systems, health systems, water and

sanitation infrastructure, social protection) and the overall status of women in society. For this reason,stunting is gaining wider acceptance as a leading indicator for the post-2015 development agenda:

Stunting (height for age) is the result of many factors, some direct, such as poor nutrition, but many indirect,

such as poor health, mothers education (lack of which contributes to poor nutrition, low income, and poor

health), access to water and sanitation (which contributes to poor health), short birth spacing and high

parity, and overall poverty. In addition, stunting is concentrated among the poorest. Thus, to reduce stunting,

a multi-sectoral response . . . targeted at the poorest is needed. This would seem to be just what any post-

2015 targets might wish to achieve.iii

The child on the left is stunted; she is 4

ears old while the child on the right is

2 years old. Photo: Dr. Mercedes de

Onis, World Health Organization.

NUTRITION RECOMMENDATIONS FOR THE POST-2015FRAMEWORKTHE HUMAN FACE OF EXTREME POVERTYSTUNTED CHILDREN

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CURRENT GOALS PROGRESS ON STUNTINGRecognizing that accelerated global action is needed toaddress the pervasive yet solvable problem of malnutrition, theWorld Health Assembly (WHA) agreed in May 2012 on globaltargetsivto improve maternal, infant and young child nutrition.The current global target on stunting proposes to reduce from

170 million to approximately 100 million the number ofchildren under age 5 who are stunted by 2025a 40%reduction.UNICEF, WHO and the World Bank estimated that the globalprevalence of stunting will decrease to 23.8% by 2015,compared to 39.9% in 1990.v Although the prevalence ofstunting has decreased, overall progress is still insufficient andmillions of children remain at risk. It is crucial that the next setof goals establish a bold target to diminish stunting, whichbuilds upon and exceeds the current WHA global target toreduce the prevalence of stunting by 40% by 2025.vi

AN ULTIMATE GOAL OF ZERO STUNTINGAt the June 2012 UN Conference on Sustainable Development (Rio+20), UN Secretary-General Ban Ki-moon launched the Zero Hunger Challenge,vii which called for zero stunted children less than 2 years ofage by ensuring universal access to nutritious food in the 1,000-day window of opportunity between thestart of pregnancy and a childs second birthday, supported by nutrition-sensitive health care, water,sanitation, education and specific nutrition interventions, coupled with initiatives that enable empowermentof women

By supporting a focus on getting to zero, an important shift is underway from relative goals to absolutegoals, setting minimum standards for the right of all people to food and nutrition security, health, nutritioneducation, and water, sanitation and hygiene (WASH), and working toward universal access to these basicnecessities. It is therefore critical that future development goals are guided by a vision of sustainably endingpoverty, or getting to zero, that is broader than ensuring that no one lives on less than $1.25 per day.

iUNICEF: Stunting, or low height for age, is caused by long-term insufficient nutrient intake and frequent infections. Stunting generallyoccurs before age two, and effects are largely irreversible. These include delayed motor development, impaired cognitive function andpoor school performance. http://www.unicef.org/progressforchildren/2007n6/index_41505.htmiiEconomic Commission for Latin American and the Caribbean and World Food Programme: The Cost of Hunger: Social and EconomicImpact of Child Undernutrition in Central America and the Dominican Republic. February 2008.http://documents.wfp.org/stellent/groups/public/documents/liaison_offices/wfp175334.pdfiiiSchweitzer, Makinen, Wilson, Heymann. Results for Development Institute and Overseas Development Institute. Post-2015 HealthMDGs. July 2012. http://www.odi.org.uk/resources/docs/7736.pdfivWorld Health Organization. Global targets 2025 to improve maternal, infant and young child nutrition.http://www.who.int/nutrition/topics/nutrition_globaltargets2025/en/vWorld Health Organization, UNICEF and the World Bank. Estimated prevalence of stunted preschool children 1990-2015 with 95%confidence intervals by UN regions and sub-regions. July 2012. http://www.who.int/entity/nutgrowthdb/jme_stunting_prev.pdfviIn keeping with the World Health Assembly global targets to improve maternal, infant and young child nutrition, established May 2012and summarized at: http://thousanddays.org/wp-content/uploads/2012/05/WHO-Targets-Policy-Brief.pdfviiThe Zero Hunger Challenge: http://www.un.org/en/zerohunger/challenge.shtml

The use of stunting as aHEADLINEINDICATOR allows for an approach toending extreme poverty that:

is focused on the most vulnerable and

marginalized.helps ensure increased and equitable

access to food, health, water and

sanitation and other basic necessities.

promotes action and progress in a

range of sectors: food security and

agriculture, health, education, early

child development, WASH, gender

equality and economic growth.

helps measure a persons physical

and developmental well-being.