Chapter One

13

Preventing Stunting: Why
it Matters, What it Takes

Martin Bloem
Senior Nutritionist and WFP’s Global Coordinator UNAIDS – United Nations World Food
Program; Adjunct Associate Professor, – Johns Hopkins Bloomberg School of Public
Health, Baltimore, USA; Adjunct Associate Professor, – Friedman School of Nutrition
Science and Policy, Tufts University, Boston, USA

“Hunger is not only a physical condition. It is a drain on economic
development, a threat to global security, a barrier to health andeducation reform, and a trap for the millions of people worldwide
who work from sun-up to sun-down every day to produce a harvestthat often doesn’t meet their needs... We have the resources to giveevery person in the world the tools they need to feed themselves and theirchildren. So the question is not whether we can end hunger. It’s whether we will.”
Hillary Clinton, 2009

Key messages•	Stunting is the result of inadequate nutritionin early life and has severe consequencesthat last a lifetime.
•	Stunting prevents individuals fromachieving their potential, physically,
intellectually and economically.
•	Stunting affects not only individuals but
also the entire societies to which they belong.
•	The right to adequate nutrition should berecognized as a Human Right.

Recent improvements in nutrition
The world has seen significant developments in the field of
nutrition since the development of the Millennium
Development Goals (MDGs), which were to be reached by
2015, and included ending hunger and reducing
underweight as part of MDG number 1.
In 2008, the Lancet published the first landmark series onnutrition, which summarized the magnitude andconsequences of the nutrition problem, as well as a numberof proven and low-cost solutions. In 2013, the follow-up
series on the subject was published. Four critical points
made by these two Lancet series are:i)chronic undernutrition, or stunting, is considered the main
nutrition problem because it is a key obstacle fordevelopment;ii)

the window to prevent stunting is very small: fromconception to two years of age;iii) stunting at two years of age is associated with ill health,poorer school performance, and an increased risk ofobesity, diabetes, and other chronic diseases later in life;andiv) economic analyses indicate the negative effects of poor
nutrition in early life on the overall economic developmentof nations.

A stunted child at the age of two is deprived from achieving its
full potential for the rest of his/her life, which is an enormous
drain on the world’s human resources. Sufficient knowledge
exists about effective strategies for prevention, and thesestrategies should be implemented by all parties concerned.
Prevention of stunting is central to the Scaling Up Nutrition(SUN) movement, and there is wide recognition that theprevention of stunting should also feature prominently inthe post-2015 development agenda.
According to the latest report of UNICEF/WHO/WorldBank (2012), 165 million children under 5 are stunted, andmany school-age children, adolescents and adults today
suffer the consequences of the stunting that theyexperienced during their early years of life.

14

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

15

What ‘stunting’ indicates
Stunting is defined as inadequate linear growth, and this isdue to the fact that nutrient intake does not meet nutrient
needs. Furthermore, nutrient needs may be increased byillness, and illness also reduces appetite and interferes withnutrient utilization, thus increasing the difficulty of meeting
nutrient needs with existing nutrient intakes. Stunting is arelatively easy indicator to measure, and reflects
undernutrition during a critical period of development, inparticular from conception until two years of age (i.e., thefirst 1,000 days of life). Inadequate nutrition during thisperiod has severe consequences for life, because many
developmental processes occur only during certain stages oflife, and cannot (re)occur later in life.
Stunting develops during life in utero and the first two
years after birth. It is a process of suboptimal growth anddevelopment that gradually accumulates to such an extent
that body length is below that of 97.7 percent of children in
the reference population. Children born with a low birthweight (<2500 g) due to restricted intrauterine growth are
at great risk of remaining stunted. Beyond 24 months ofage, stunting prevalence may still increase, but at a muchslower pace.

Malawi president Joyce Banda at the Nutrition for Growth conferencein London, June 8, 2013
Soucre: Marisol Grandon/Department for International Development

Consequences of stunting
Lack of adequate nutrients in the first 1,000 days will, forexample, lead to irreversible gaps in brain development.
The outcome of brain development by the age of two years
determines to a large extent a person’s mental capacity forthe rest of his/her life, including success in schooling andincome earning.
Not only stunted children are affected by undernutrition:
non-stunted children in populations with a considerable
prevalence of stunting are also likely to be affected, i.e., they
have not reached their full potential either, although theirlength is not below the cut-off which classifies them as ‘stunted’.
Girls who grow up stunted are more likely to suffer
complications during childbirth as adolescents or adults,
because they have a smaller pelvis. Breaking theintergenerational cycle of undernutrition thus also requires
good obstetric care, to facilitate the birth of a larger baby, bornto a mother who may have been stunted herself but then had
good nutrition pre-pregnancy and during pregnancy, resulting
in the development of a larger infant in the womb.
United Kingdom Secretary of State for International Development Justine
Greening concludes the successful Nutrition for Growth conference,
where world leaders gathered with businesses, scientific and civil society
groups, committing to a historic reduction in undernutrition.
Soucre: Marisol Grandon/DfID

Stunting typically co-occurs with micronutrient deficiencies,
because foods that are rich in nutrients that are essential for
linear growth are also good sources of other micronutrients.
This also explains why stunting is such an importantChapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

indicator, reflecting a shortage of essential nutrients during
the most critical developmental phase in life.

16

As such, stunting has been linked to increased morbidity
and mortality, delayed mental development, poor school
performance, and reduced intellectual capacity. This in turnaffects income in adult life, as well as economic productivity
at national level. Furthermore, stunting is also related toincreased risk of overweight and non-communicable diseasesuch as diabetes and cardiovascular disease later in life.
The fact that much of this damage cannot be undone laterin life means that it is essential to prevent stunting.

Prevention of stunting requires anutritious diet
The prevention of undernutrition, or stunting, should start earlyin life, with interventions among at-risk populations that ensurethat pregnant and lactating mothers are adequately nourished,that children receive exclusive breastfeeding during the first 6
months of life, and provision of adequate complementary feedingin addition to breastfeeding for children aged 6–23 months.
Ensuring that pregnant women are adequately nourished may
require intervening before pregnancy, i.e., during adolescence andbefore a next pregnancy, also because the impact ofundernutrition already starts at conception.
The ultimate aim of interventions to prevent stunting
should be that nutrient requirements of the individual child,also during life in utero, are met and that illness is prevented.
An individual needs approximately 40 different nutrients, indifferent amounts, in order to grow, develop and remain
healthy. Meeting these requirements requires consumptionof an adequately diverse diet, including breast milk, and avariety of plant-source foods (vegetables, fruits, staples),animal-source foods (dairy, eggs, fish, meat) as well as
fortified foods. Where such a variety of foods is notavailable, or for those who (usually for economic reasons)cannot access such a variety, specially formulated foods may
be required that fill the so-called ‘nutrient gap’. These mayneed to be made available at lower than normal or no cost.
A home-fortification approach, where a small amount of apowder or lipid-based spread (<20 g, <100 kcal/d) is added tohome-prepared foods, which adds vitamins, minerals andsome other essential nutrients that are unlikely to be available
in adequate amounts in the prevailing diet, is a promisingstrategy for preventing stunting, because it hardly changes the
local diet and food practices. Another good option, which may
be more familiar to families, is the introduction of speciallyformulated complementary foods, such as infant porridges thathave a good content of essential nutrients.

Tanzanian campaigner Frank shares his experience of hunger with British
Prime Minister David Cameron at the Nutrition for Growth Summit
Source: Simon Davis/Department for International Development

Sun by the numbers

41
countries
commitedto Scaling Up
Nutrition

Bangladesh
Benin
Burkina Faso
BurundiCameroon
Chad
Cote d’Ivoire
Democratic
Republic of Congo
El Salvador
Ethiopia
GambiaGhana
GuatemalaWhich means thepotential to reach80

millionchildren
There are100+

committed partners
accountable forsupporting national
plans

GuineaHaiti
Indonesia
Kenya
Kyrgyz Republic
Lao PDR
Madagascar
MalawiMali
Mauritania
Mozambique
MyanmarNamibia
Nepal

Niger
Nigeria
Pakistan
Peru
RwandaSenegalSierra Leone
South Sudan
Sri Lanka
Tanzania
UgandaYemen
ZambiaZimbabwe

By focusing
on the critical

1,000

day window ofopportunity to
improve nutrition
All working
together to drive1

globalmovement

and unleash the potential ofmilllionsof healthier, smarter andstronger children

Status: June 2013. Please see the SUN website for more recent updates.

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

17

Starting at stunting’s basic cause,poverty and inequity
Both dietary diversity, which determines nutrient intake, anddisease, which affects nutrient utilization and nutrient needs,
and also food intake, are strongly linked to poverty. Stunting
at the age of two years is therefore a reflection of inequity andalso perpetuates this, due to its long-term negative health,economic, and social consequences for the individual, theiroffspring and the population they live in. Extreme poverty is
the most critical problem the world has to cope with.
The first millennium development goal (MDG), which wasformulated in 2000, set two indicators for reducing hunger:
the number of undernourished people (energy intake notmeeting requirements – based on food availability atnational level and estimates of the population’s energy
needs) and the percentage of underweight children underfive. Underweight, or too low weight-for-age, reflects bothstunting as well as wasting, which are two different forms
of undernutrition, in terms of immediate causes and possible
solutions, and are therefore better recognized separately.
Since the 2008 and 2013 Lancet series identified stunting as
the most critical indicator for malnutrition and the 65th

Paul Polman makes a heartfelt address to the assembled guests at the
Nutrition for Growth conference, held in the Unilever building in central
London, June 8, 2013
Soucre: Marisol Grandon/Department for International Development

World Health Assembly in 2012 set 6 global targets fornutrition, including as its first goal a 40 percent reductionof the global number of children under five who arestunted, there is a strong push among many stakeholders toinclude stunting as a target in the post-2015 development
agenda (successor of the MDGs).

Former UN Secretary-General Kofi Annan and chairman of the Alliance for a Green Revolution in Africa talks to USAID administrator Dr Raj Shahat the conclusion of the Nutrition for Growth conference in London, 8 June, 2013
Soucre: Marisol Grandon/Department for International Development

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

Prevention of stunting should be a human right
Although child undernutriton has long been used as anindicator or proxy for poverty, the world has never united
behind making prevention of undernutrition a goal in itself.
As stunting is now recognized as so detrimental todevelopment, depriving individuals of the possibility of
having equal chances for the rest of their life, the preventionof undernutrition, or stunting, should be recognized as ahuman right. In view of the fact that it has such widespreadconsequences, impacting on so many aspects of life, it
should not be regarded as merely a ‘nutrition problem’ thatnutritionists should solve.
While nutrition has been mentioned as a component of the“right to food”, “right to health” and “Convention on the
Rights of the Child”, the prevention of chronic
undernutrition has not yet been recognized as a right. In
fact, nutrition is mentioned sparsely in the various ‘humanrights’ documents, which is apparently due to the fact thatnutrition is not regarded as a right in itself but as anelement of health or an outcome of lack of access to food.
The Universal Declaration of Human Rights, article 25,
mentions both health and access to food as rights:“Everyone has the right to a standard of living adequate forthe health and well-being of himself and of his family,
including food, clothing, housing and medical care andnecessary social services, and the right to security in theevent of unemployment, sickness, disability, widowhood,
old age or other lack of livelihood in circumstances beyond
his control.”
The International Covenant on Economic, Social andCultural Rights, meanwhile, provides the mostcomprehensive article on the right to health in international
human rights law. Nutrition is mentioned as one of thedeterminants of health:
Article 12 of the Covenant recognizes the right of everyone to“the enjoyment of the highest attainable standard of physicaland mental health.” “Health” is understood not just as a rightto be healthy, but as a right to control one’s own health andbody (including reproduction), and be free from interferencesuch as torture or medical experimentation. States must
protect this right by ensuring that everyone within theirjurisdiction has access to the underlying determinants ofhealth, such as clean water, sanitation, food, nutrition andhousing, and through a comprehensive system of healthcare,which is available to everyone without discrimination, andeconomically accessible to all.

The UN Committee on Economic, Social, and Cultural
Rights defines the “right to food” as follows:“The right to adequate food is realized
when every man, woman and child,alone or in community with others,
has physical and economic access at
all times to adequate food or means
for its procurement. The right toadequate food shall therefore not beinterpreted in a narrow or restrictive
sense, which equates it with aminimum package of calories,
proteins and other specific nutrients.
The right to adequate food will haveto be realized progressively. However,States have a core obligation to takethe necessary action to mitigate andalleviate hunger as provided for inparagraph 2 of article 11, even intimes of natural or other disasters.”
However, as argued above, the prevention of chronic
undernutrition, or stunting, should be a human rightbecause of its widespread and irreversible lifelong
consequences.

Bill Gates pledged $800 million to support the work of the Gates
Foundation on nutrition and agriculture at the Nutrition for Growth conference
Source: The Children’s Investment Fund Foundation

18

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

All stakeholders need to work together to prevent stunting
As thoroughly recognized by the Scaling Up Nutrition
movement, all stakeholders need to work together toprevent stunting, including governments, the United
Nations network, donor networks, civil society, and theprivate sector. These stakeholders must work together atnational, regional and global level, in order to ensure accessto adequate nutrition for all – in particular women andyoung children – and to prevent disease, which for example
requires action by the healthcare sector as well as
implementation of hygiene and sanitation measures. The
call for all stakeholders to work together is easily made, but
requires the laying out of a strong, localized roadmap thatclearly identifies areas and responsibilities for action for thedifferent stakeholder groups. Division of tasks withinstakeholder groups should be done transparently. Trackingof implementation and progress is key to ensuring that thecountry stays on track relative to its roadmap.

the average height of populations in the US, Europe, andparts of East Asia and Latin America in the second half ofthe 20th century coincided with dramatic economic
development, and because access to healthcare, water andsanitation, and primary education was already good anddid not change much during this period in these parts of theworld, the improvement of nutritional status was to a large
extent due to better access on the part of the lower
economic strata of these populations to a more diverse diet,including improved, processed, complementary foods aswell as animal-source foods such as dairy products. A good
example is the average height of the Dutch male population,
which increased from 165 cm in 1935 to 185 cm at the endof the 20th century. Increased height, which reflects better
nutrition, is associated with higher IQ, a lower risk ofcardiovascular diseases, but a slight increase of some kindof cancers, however, overall with a more healthy population.

It is increasingly recognized that the private sector,
particularly the food industry, plays a critical role inachieving adequate nutrition and preventing stunting, andhas to take that role even more seriously. The increase of

The increase since the 1960s of cardiovascular diseases,
obesity, type 2 diabetes, cancers, and other chronic diseases
related to overconsumption of foods with a high content offats and/or sugars but at the same time a low content of

Average annual
reduction rate

The ten countries with the fastest annual reduction of stunting between 1990 and 2010
% Children
Stunted

19

Saudi Arabia

9.3

7.3

Angola

29.2

6.6

China

13.7

6.0

Brazil7.1

5.7

Mexico15.5

4.7

Vietnam

30.5

4.1

Korea DPR

43.1

4.1

Turkey15.6

3.9

Cambodia

39.5

3.0

Bangladesh

43.2

3.0

Average annual reduction rate
7% and over6 - 6.99%

5 - 5.99%

4 - 4.99%

3 - 3.99%
Country

Source: http://scalingupnutrition.org, June 2013
http://scalingupnutrition.org, June 2013

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

20

vitamins, minerals and other essential nutrients, however,has further complicated the nutrition field. This requires
corrective action from the food and beverage manufacturers.
This is also where the collaboration of the private sector
with governments (who have legislative and norm-setting
responsibilities) and civil society, donors and UN (who, forexample, are important partners in healthcare, educationand promoting consumer awareness of health and nutrition)is important, and the only way to ensure adequate nutrition
for all.

Conclusion
There is an urgent need to give every child equal
opportunities at the age of two. To achieve this, theprevention of stunting should be recognized as a humanright. All stakeholders, including the private sector, need tocollaborate to prevent stunting.

Two girls, Juhora Akter (left) and Asma Akter, who are both 12 years
old, stand in front of a wall with a black tape line indicating thenormal projected height for a 12-year-old child, in a rural area near
the town of Shahrasti, Chandpur, Bangladesh
Source: UNICEF/NYHQ1997-0518/Gilles Vauclair

Because when...
Girls and women
are well-nourishedand have healthy
newborn babies

Communities
and nations
are productive
and stable

Children receive
proper nutrition anddevelop strong
bodies and minds

The world isa safer, more
resilient andstronger place

Families andcommunities emergeout of poverty

Adolescents
learn better andachieve higher
grades in school

Young adults are
better able to obtainwork and earn more

http://scalingupnutrition.org, June 2013

MixMe™ micronutrient powder being added to a meal to improve its
nutritional value
Source: Mike Bloem PhotographyChapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

21

A brief history of Human Rights

The General Assembly proclaims this Universal Declaration of Human Rights
as a common standard of achievement for all peoples and all nations, to theend that every individual and every organ of society, keeping this Declaration
constantly in mind, shall strive by teaching and education to promote respect
for these rights and freedoms and by progressive measures, national andinternational, to secure their universal and effective recognition and observance,
both among the peoples of Member States themselves and among the peoples ofterritories under their jurisdiction.
Declaration of Human Rights, 10 December 1948

The first known instance of a human rights agenda can betraced back to 539 BCE, when Cyrus the Great of Persia
conquered the city of Babylon. In the wake of his triumph,
he did something totally unexpected, freeing all the slaves in
the city to return home. Moreover, he declared that thepeople under his rule should choose their own religion. The
Cyrus Cylinder, a clay tablet containing these pronouncements,
is one of the first human rights declarations in history.1

The first draft of the Declaration was proposed in
September 1948 with over 50 Member States participatingin the final drafting. By its Resolution 217 A (III) of 10
December 1948, the General Assembly, meeting in Paris,
adopted the Universal Declaration of Human Rights witheight nations abstaining from the vote but none dissenting.
Hernán Santa Cruz of Chile, member of the drafting
sub-Committee, wrote:

The idea of human rights spread quickly in the ancientworld to India and Greece, and eventually Rome. The mostimportant advances since then have included the 1215
British Magna Carta, which not only gave people newrights but also made the king subject to the law; the British
1628 Petition of Right, which formalized the rights of thepeople; the 1776 United States Declaration of
Independence, which proclaimed the right to life, liberty
and the pursuit of happiness; and the 1789 French
Declaration of the Rights of Man and of the Citizen, adocument stating that all citizens are equal under the law.2“I perceived clearly that I was participating in a truly
significant historic event in which a consensus had beenreached as to the supreme value of the human person, a valuethat did not originate in the decision of a worldly power, butrather in the fact of existing – which gave rise to theinalienable right to live free from want and oppression and to
fully develop one’s personality. In the Great Hall…there wasan atmosphere of genuine solidarity and brotherhood among
men and women from all latitudes, the like of which I havenot seen again in any international setting.”

In response to the crimes against humanity that werecommitted during the Second World War, the human rights
revolution grew rapidly, subsuming claims from minorities,
women, the politically oppressed, and marginalcommunities from around the globe.3
The human rights revolution began with a disarmingly
simple idea: that every individual, whatever his or her
nationality, political beliefs, or ethnic and religious heritage,
possesses an inviolable right to be treated with dignity.
From this basic claim grew many more, and ever since, thecascading effect of these initial rights claims has
dramatically shaped world history.4
The Universal Declaration of Human Rights, the first document
to list the 30 rights to which everyone is entitled, was adopted by
the UN General Assembly on 10 December, 1948.5

The entire text of the Universal Declaration of Human Rights
was composed in less than two years. At a time when theworld was divided into Eastern and Western blocs, finding acommon ground as to what should constitute the essence ofthe document proved a colossal task.6
1. Adapted from A Look at the Background of Human Rights, http://www.
youthforhumanrights.org/what-are-human-rights/background-of-humanrights.html, July 2013
2. Adapted from A Look at the Background of Human Rights, http://www.
youthforhumanrights.org/what-are-human-rights/background-of-humanrights.html, July 2013
3. Adapted from The Human Rights Revolution: Description http://global.
oup.com/academic/product/the-human-rights-revolution-9780195333145?cc=
gb&lang=en&tab=description, July 2013
4. Adapted from The Human Rights Revolution: Description http://global.
oup.com/academic/product/the-human-rights-revolution-9780195333145?cc=
gb&lang=en&tab=description, July 2013
5. Adapted from History of the Document http://www.un.org/en/documents/
udhr/history.shtml, July 2013
6. Adapted from History of the Document http://www.un.org/en/documents/
udhr/history.shtml, July 2013

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

Case study
Household Rice Expenditure and Maternal and Child
Nutritional Status in Bangladesh
Increases in global food prices have raised concerns thatthe prevalence of malnutrition may increase, especially indeveloping countries. Rising food prices may decrease theability of households to purchase food. Because poor
households use a relatively large proportion of income topurchase food, increases in the price of food can directly
affect the amount and type of food their income can buy,
which can be reflected by decreased amounts of fat andvegetables in meals, elimination of some meals, and an
overall reduction in dietary diversity. Because dietary
diversity and animal-source foods are recognized as key
components of high-quality diets, rising food prices canlead to a reduction in the quality of the diet. Reduced
quality of the diet may adversely affect both nutrition andhealth over time. Previous studies have shown that
increases in food prices lead to greater levels of stunting
among children, decreased maternal micronutrient status,
and impaired growth of infants.
In Bangladesh, poor rural families often deal with highfood costs by purchasing primarily rice. The objective of[the current] study was to characterize the relationshipbetween household expenditure on rice and non-rice foods
with maternal and child malnutrition.
A recent study of data collected in the Nutritional
Surveillance Project (NSP) in Bangladesh between 1992 and2000 evaluated how changes in rice price affected childunderweight. The percentage of underweight children

Further reading2013 Lancet Series on Maternal and Child Nutrition
Scaling Up Nutrition website: scalingupnutrition.org.
Copenhagen Consensus 2008/2012.

22

declined in the situation where rice expenditures fell andhouseholds were able to spend more on non-rice foods. We
sought to expand these investigations to evaluate therelationship between rice expenditure, non-rice expenditure,and household food expenditure and child stunting andmaternal underweight between 2000 and 2005.
The results of [our] study show that households withhigher expenditure on rice have increased odds of childstunting. Conversely, households with a higher
expenditure on non-rice foods have decreased odds ofchild stunting. A similar relationship was observed
between rice and non-rice food expenditures and maternal
underweight. Previous studies have shown that changes inweekly expenditure on rice reflect changes in rice prices …
Previous studies have shown that the percentage of childunderweight increases as rice expenditures rise. The
present study extends these findings and suggests thathigher expenditure on rice (reflecting higher food prices)increases the likelihood of developing child stunting.
Households with highest expenditures on rice and lower
expenditures on non-rice foods have greater childmalnutrition across all age categories up to 59 mo andgreater maternal underweight. In a situation of global foodprices, these findings suggest that there will be considerable
impact upon the prevalence of child malnutrition andmaternal underweight in developing countries.
Source: First published November 25, 2009, doi: 10.3945/jn.109.110718 J.
Nutr. January 2010 vol. 140 no. 1 189S-194S [adapted and abridged]

Baldi G, Martini E, Catharina M et al. Cost of the Diet
(CoD) tool: First results from Indonesia and applications
for policy discussion on food and nutrition security.
Food Nutr Bull 2013;34:35S–42S.
de Pee S. Food Security. In: Caballero B. (ed.)
Encyclopedia of Human Nutrition (3rd ed), vol. 2, pp.
353-360. Waltham, MA: Academic Press, 2013.

Chapter One | Preventing Stunting: Why it Matters, What it Takes | Martin Bloem

23

Case study
Malnutrition is treatable: access to nutrition services
saves the life of a child (Uganda)
When 7-month-old Frank arrived at the Rubaga Hospitalin Uganda in 2010, he was severely malnourished. He
weighed only 7.5 pounds. Frank’s aunt had less than $1
per week to feed and clothe him and his four othersiblings. One of NuLife’s 1,200 volunteers referred Frankto the hospital. (There are 54 NuLife-supported healthfacilities. NuLife is managed by University Research Co.,
LLC (URC) in partnership with the Uganda Ministry of
Health (MOH). They are tasked with engaging multiple
stakeholders to ensure nutrition care for people livingwith HIV/AIDS, pregnant and lactating women, andorphans and vulnerable children.
Frank was diagnosed with severe acute malnutrition. Staff
prescribed and provided Frank with ready-to-use
therapeutic food (RUTF) to treat his condition andenrolled him in an outpatient therapeutic care program.

My personal view
Martin Bloem

Senior Nutritionist and WFP’s Global Coordinator UNAIDS– United Nations World Food Program; Adjunct Associate
Professor, – Johns Hopkins Bloomberg School of Public
Health, Baltimore, USA; Adjunct Associate Professor, –Friedman School of Nutrition Science and Policy, Tufts
University, Boston, USA

While the prevention of chronic
undernutrition, or stunting, should beeveryone’s concern, because of thewidespread consequences forschooling, economic development,
long-term health etc, its prevention
should ultimately result from better
meeting children’s nutrient requirements, and preventing
an increase thereof, during the critical window of

His aunt also received nutrition counseling.
Frank’s recovery was remarkable. After two months of
RUTF he had exceeded his target weight by 20%.
“Everybody gave Frank just two days to live when I firstbrought him, but now everybody wants to hold him andplay with him,” his aunt said. Frank would need to betaken back to hospital for regular follow-ups and more
RUTF to ensure continued recovery.
Frank is just one of 16,000 individuals that have received
treatment via NuLife. Project-supported healthcare
facilities now assess close to 85% of HIV-positive
individuals for malnutrition at admission, and sustainable
processes are now in place allowing facilities to continue
to address malnutrition. These NuLife achievements allow
Ugandan health facilities to continue to treat children likeFrank even after the project’s completion in August 2011.
Source: Thousand Days Partnership, USA
http://www.thousanddays.org/success-story/malnutrition-is-treatable-accessto-nutrition-services-saves-the-life-of-a-ugandan-child/ Dec 2011 (abridged)

opportunity (conception to two years of age). Therefore,
nutrition-specific actions, complemented with nutritionsensitive approaches, are key. In the human rights
documents, nutrition is only considered as a determinant
to health, and the right to food only mentins access to“nutritious food” but none of the “human rights”
documents recognizes the importance of nutrients in thesense that all required nutrients should be provided inadequate amounts. The particular need of children 6-24
months for nutrient-dense foods is very specific and thefact that these needs are difficult to meet from local foods
for large segments of the world population urges for a
discussion on the right to nutrients to prevent chronic
undernutrition. Furthermore, meeting nutrient
requirements of adolescent girls and women, particularly
during pregnancy and lactation, should be prioritized aswell, in order to protect their health and give theirchildren the right start in life.