Why is Nepal an Exemplar?

A 50 percent reduction

In 1995, Nepal recorded a stunting rate of 68 percent, the highest in the world. This amounted to more than 2 million stunted children. By 2016, the rate had been cut almost in half, to 36 percent.

Because the size of the under-five population had shrunk, the absolute number of stunted children had dropped by more than half, to fewer than 1 million. Moreover, Nepal had made this progress in the midst of a violent Maoist insurgency (1996–2006) and political instability (2006–2015).

Child growth is determined by multiple factors, and in 1995, several of these interacted in Nepal, leading to extraordinarily high rates of stunting. Extreme poverty was rampant, with 62 percent of Nepalese living on less than $1.90 per day.

Government systems, especially the health, education, and sanitation systems, were weak. Improvements related to even one of these factors would have had a big impact on the stunting rate.

In the two decades that followed, however, Nepal made improvements across the board. The Government of Nepal, with a new pro-poor outlook and ample support from donors and international NGOs, invested heavily in health, education, and sanitation. Furthermore, by decentralizing authority, they enabled these systems to function properly in a country with such cultural diversity and forbidding terrain. At the same time, Nepalese started to migrate in large numbers to the Gulf region and India for work, sending remittances home and relieving the burden of poverty. Between 1995 and 2010, thanks primarily to these remittances, the extreme poverty rate dropped by three quarters, to 15 percent .

With a stunting rate of 36 percent, Nepalese children are still among the most likely in the world to be stunted. However, the necessary infrastructure to address health and nutrition is now in place, setting the country up to build on the progress of the past generation.

What can we learn from Nepal

Stunting is multifactorial, and one of the lessons of Nepal’s experience is that improvements across these factors can drive significant improvement. Nepal, whose government shifted considerably toward pro-poor policymaking after 1990, invested heavily in its health and education systems and scaled up sanitation-related behavior change campaigns across the country. In concert with a steadily improving economic situation, these broad-based government efforts to reach more people with basic services cut the number of stunted children in Nepal in half in 20 years.