Following up on the previous post about stunting, I wanted to mention two case studies I’ve come across in Brazil and India that are fascinating. I will need to investigate each one in more detail to really break out the shape and scope of the intervention plans, but I think these two case studies begin offering an optimistic insight into how other communities, countries, and regions can tackle stunting. Let’s begin in Brazil.
I hope to return to Brazil as a case study in a lot of contexts as this blog continues since it is a BRIC country that has made significant progress on several socioeconomic development factors (with room still for improvement). When we look at stunting rates in Brazil among children under 5 years, the results are dramatic. Over 40 years ago, that rate was a catastrophic 37.1%. Today, it is xxx% and declining still. Make no mistake – this is a dramatic and incredible accomplishment. Imagine the millions of lives that have inch by inch been improved over the last four decades.
A few of the factors that contributed to this tremendous human achievement include:
- Improving the purchasing power of households through minimum wage increases and expanded cash-transfer programs;
- Rising rates of female education and literacy;
- Improvements and expansion of maternal and child health services;
- Expansion of water and sanitation systems;
- Improvements in the quality and quantity of food produced by small family farms.
Crossing our way over to South Asia, let’s take a look at India for a moment. Due to the sheer enormity of its population, India has the most stunted children under 5 years in the world at an estimated 62 million. Progress in the country to fight stunting and malnutrition is varied across state, regional, and social lines. However, there is hope in Maharashtra where a broad-based government technical, advisory, and training body has seen significant improvements due to its efforts.
The Rajmata Jijau Mother-Child Health and Nutrition Mission has a three part mission:
- Advocate for the importance of the first 1000 days (see my previous blog post here for more information on what this is),
- Provide policy advice to the government on evidence-based interventions, and
- Act as a platform to foster convergence among different departments with a common objective of reducing malnutrition.
Launched in 2005, this body has contributed to a magnificent reduction in child stunting rates in Maharashtra. At the time of its launch, the state was looking at an overwhelming 44% rate of stunting; by 2012, in just seven short years, that number had been cut in half (22.8%).
Three things strike me about these two case studies that I am sure will be relevant to the implementation and adoption of broad-based interventions to combat stunting and malnutrition:
- Strong, proactive, and persistent political leadership combined with active, engaged, and adaptive civic society organs created and facilitated the processes to understand and tackle stunting,
- Emphasis was placed on building sustainability of these interventions by empowering community leadership and community management of these programs,
- Multisectoral approaches were used to address stunting, understanding that policies in education, labor, and agriculture all impact nutrition
These seem like the bedrock of some fairly exemplary best practices in generating and rolling out interventions across broad geographic areas.