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Stunting Cross Country Synthesis

Exemplars in Global Health has identified Ethiopia, Kyrgyz Republic, Nepal, Peru, and Senegal as Exemplars in reducing stunting.

This cross-country synthesis provides the highest-level insights from our stunting research across all Exemplar countries. For policy makers, funders, and NGO leaders seeking to understand what has worked to reduce stunting quickly and at scale, this is a central repository of knowledge on our website.

Here, we have highlighted the most critical take-aways, lessons learned, and recommendations that apply to all Exemplars countries across the topic of stunting. The hyperlinks on this page serve as a useful tool for locating corresponding background and illustrative examples that support our findings within each country narrative.

Linear growth is a complex biological phenomenon, influenced by a range of factors. Stunting is a marker for poor linear growth in populations . No single intervention can eliminate stunting in any country, and the combination of interventions required to make noteworthy progress differs in every country, depending on context. Each of the five Exemplar countries we studied took a different path to reducing its stunting burden.

Burden of stunting

Nevertheless, we identified key themes across all the study countries that are relevant to any country prioritizing the fight against stunting and helped assemble a robust framework for thinking about reducing stunting at scale.

  • Reproductive, maternal, and child health & nutrition interventions: Improvements in maternal and child health care, including administration of key supplements (e.g., IFA), access to health services (e.g., ANC), family planning (e.g., birth spacing), and nutrition counseling (e.g., breastfeeding), played an important role in progress in all five countries.
  • Poverty reduction: Although data in this category was not consistently available, an increase in wealth (e.g., remittances), and an improved distribution of resources available, especially to the poorest, were key contributors to progress in all five countries.
  • Food security: Improvements in agricultural yield and investments made in addressing food insecure populations despite climate / conflict headwinds also proved critical to addressing challenges around stunting.
  • Education: In four out of the five countries we studied, investments in education, for both boys and girls, emerged as pivotal.
  • WASH: While recent trials suggest caution around WASH  as a tool to address stunting, examination of its independent contribution to stunting declines over the ~10 year period studied shows meaningful contributions of WASH improvements to stunting reduction in three of the five countries studied.

It is also clear that what matters is not just what a country invests in, but also how it invests. The absence or presence of enabling factors helps determine whether investments fail or succeed. We identified three key factors in our Exemplar countries:

  • Political will with financial commitments: Leadership (government and external influencers) that prioritize nutrition-relevant investments and set clear, specific targets tend to secure the financial commitments and cross-sector buy-in to excel.
  • Scaling up evidence-based, data-driven interventions: Where robust data systems exist, the design and delivery of interventions are more likely to be based on evidence, with clear links between investment and impact to drive financing at scale.
  • Efficient service delivery mechanisms targeted towards the vulnerable: Governments that make an effort to identify the most vulnerable populations and meet their specific needs increase their odds not only of making equitable progress but also of making progress overall.

When drawing lessons from other countries’ experience with fighting stunting, it is important to distinguish between what we can learn from each Exemplar country’s unique path and what we can learn from commonalities among those paths.

Within this framework, it is possible to determine the sub-set of activities most likely to reduce stunting. We have compiled a 10-part list, enumerated below with specific examples, of highly effective approaches to fighting stunting. The list is based on a review of current knowledge in relevant fields cross-referenced with findings from our Exemplar case studies and selected studies of other countries that have reduced stunting (including Brazil, Cambodia, Mexico, Thailand, Vietnam, and Zambia).

In addition to understanding what countries did to make progress, it is equally important to understand how strategies were executed to drive sustainable progress. Alongside the list of 10 intervention areas above, we identify several promising practices that many Exemplar countries have adopted to maximize efficiency and scale with each intervention (“Proven delivery approaches”). We also highlight a set of practices that are high-impact and are priorities for sustainable health and development, but where more can be done both at the global and country-level (“Emerging priorities”).

Just as every country we studied took a unique path to reducing its stunting burden, every country faced a unique set of challenges. However, by comparing and contrasting countries’ experiences, we can draw some general conclusions about the kinds of barriers that have tended to get in the way of progress.

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Stunting Cross Country Synthesis Exemplars