Last week, Jim Yong Kim, the president of the World Bank, promised to name and shame countries that failed to check stunting in children less than five years of age. Yong Kim’s move could be particularly embarrassing for India, which despite progress in the battle against malnutrition, continues to lag its peers.

A recent study by Chunling Lu, the director of the Program in Global Health Economics and Social Change at Harvard Medical School, and her co-authors, published in the prestigious medical journal, The Lancet showed that China and India have contributed the most to reducing the number of children at risk of poor development over the past decade. Yet, India continued to have the largest number of children at risk in 2010, the study estimated.

The study examined 141 low and middle-income countries in order to identify children who were at the risk of poor development. The study defined children at risk of poor development as those who were either stunted (height-for-age below two standard deviations from the median of the international reference population recommended by the World Health Organisation in 2006) or were living in extreme poverty (less than $1.25 a day at 2005 international prices). It used WHO data on prevalence of stunting in children less than five years of age combined with poverty ratio data from the World Bank, and looked at data from 2004 and 2010 in order to gauge the change that has occurred over this period. The authors point out that children under 12 years of age have the highest poverty levels among all age groups, especially in low income countries.

The study found that the numbers of children at risk of poor development fell from 279•1 million in 2004 to 249•4 million in 2010. India had the world’s highest numbers of children at risk of poor development in 2010: 52% of the country’s 121 million children less than 5 years of age were at risk. Nevertheless, as the chart below shows, in absolute numbers, India and China have accounted for the bulk of the reduction amidst all the 141 countries between 2004 and 2010.

In percentage terms, India lagged behind peers such as Vietnam and China, which were able to reduce the proportion of children at risk of poor development much faster. Vietnam saw a drop of 45% in the number of children at risk, while China witnessed a 40% dip between 2004 and 2010. India saw a 20% drop in the number of children at risk over the same period. The large absolute decline in numbers for India is because of the size of its population and its younger demographics. In all, 27 countries have seen a reduction of 20% or more in the numbers of children at risk, and the list includes emerging economies such as Brazil and South Africa.

Despite the advances, the study shows that the top ten countries that account for the largest numbers of children at risk remained unchanged since 2004. India tops this list, followed by China, Nigeria, Bangladesh, Indonesia, Pakistan, Ethiopia, DR Congo, Tanzania, and the Philippines. Together, these countries accounted for 64% of all children at risk in 2010. Out of the 34 countries that had a prevalence rate of 60% or higher for children at risk, 28 countries are from sub-Saharan Africa alone. Regionally, south Asia experienced the largest drop, though it continues to host the highest numbers of children under 5 who are at risk of poor development.

While the estimates of this study is based on projections from older data, new data on India’s nutritional and child development outcomes broadly conform to the study’s findings: India seems to have taken a few strides forward in the battle against malnutrition but still lags behind peers.

Data from both the Rapid Survey on Children (RSOC), conducted by the ministry of women and child development in 2013-14, and from the National Family Health Survey-4 data (for states for which the data has been released) indicate an improvement in stunting and under-weight rates among under-five children. Nonetheless, even the improved figures make India a nutritional laggard among developing countries globally. The proportion of stunted children in the country (38.7% according to RSOC, and 32% on average for states for which NFHS-4 data is available) is similar to rates of stunting in sub-Saharan Africa.

Such high rates of stunting not only deprive children of a normal and healthy childhood but also entail significant economic costs for the country. A recent Harvard School of Public Health study showed that poor growth in early childhood translates to weak academic performance, resulting in poorer earning power later on in life. The researchers quantified this loss at $177 billion in lost wages for children born in developing countries, and they argued that every dollar invested in early childhood development yields a return of $3.

Early childhood development should be a priority for India, with or without Yong Kim’s warning.

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