Smith and Haddad on Nutrition and Post-2015 Development

Child Undernutrition

I finally read Lisa Smith and Lawrence Haddad’s 2015 paper “Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era.” I’m glad I did. Building on their 2000 paper, the authors explore the determinants of child undernutrition and identify priorities for accelerating reductions in the post-MDG era.

As the authors note, in 2011 an estimated 45% of all deaths among children under five was due to undernutrition (Black et al. 2013). For undernourished children who do not die, they are at risk of underperforming in school. Poor school performance places students at risk of diminished lifetime economic capacity, which is itself a risk of staying or falling into poverty.

“A child with inadequate dietary intake is more susceptible to disease; disease in turn depresses appetite, inhibits the absorption of nutrients in food, and competes for a child’s energy.”

Conceptual framework guiding empirical analysis. Sources: Adapted from UNICEF (1990, 1998), Engle, Menon, and Haddad (1999)

Smith and Haddad’s 2015 conceptual framework guiding empirical analysis. Sources: Adapted from UNICEF (1990, 1998), Engle, Menon, and Haddad (1999)

Looking toward the future, the authors summarize what can be done to accelerate reductions in child undernutrition in those regions where its high prevalence has been “stubbornly persistent.”

Smith and Haddad reiterate the key importance of income growth, which influences undernutrition at the household level by increasing the ability to pay for nutrition inputs such as food, water, sanitation, and medical care. Higher national income achieved by “a pro-poor pattern of growth” is associated with greater provision of public services (e.g., health services, social protection, and education).

“National income has a broad reach. We find that it reduces child stunting by facilitating access to sanitation, increasing the percent of women who have a formal education, and increasing both the quantity and quality of food available in countries.”


Guided by the UNICEF 1990 conceptual framework on nutrition, shown above, Smith and Haddad draw 8 conclusions. They base these conclusions on a cross-country econometric analysis using data from 116 developing countries collected from 1970 to 2012.

  1. All three underlying determinants (food, care, and health environment) contributed to stunting reductions from 1970 to 2010.
  2. Increasing dietary energy from non-staples will have the greatest future impact on child stunting reductions, followed by access to sanitation and women’s education.
  3. Investments in women’s education, gender equality, and national food availabilities will impact national stunting rates in the short run (~ five years), while investments in health environments and dietary diversity impact national stunting rates only in the long run.
  4. Income growth reduces child stunting by supporting access to sanitation, women’s education, and the quality and quantity of food available in countries.
  5. The governance analysis is a particularly new contribution to the literature and one that opens up a new field for empirical exploration. Improvements in the quality of governance reduces child stunting by addressing its underlying determinants. “Water is particularly political, and perhaps the finding reflects this, but more research is needed to explore this pathway.”
  6. The two regions with the highest child stunting prevalences are South Asia and sub-Saharan Africa. These regions likewise have the lowest national incomes among. Two determinants require particular focus in both regions: access to sanitation and gender equality. “Improving the quality of governance should also be a priority in both regions, with a focus on political stability in South Asia and on bureaucratic effectiveness and restraint of corruption in Sub-Saharan Africa.”
  7. Changing the child undernutrition indicator from underweight (in the MDGs) to stunting (proposed in the SDGs) improves the ability to track levels and trends in undernutrition and to identify priority actions for future reductions.
  8. The authors did not find structural changes in the importance of the determinants pre- and post-2000, when the MDGs launched. “[I]t will be interesting in future work to explore the pre- and post-2008 relationship given the food, fuel, and financial disruptions of that year.”

About Amanda Pearson

Editing & writing @HarvardWCFIA on global politics, people, history, and health. Alumna @GWpublichealth @LSEGovernment
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