This analysis also suggests that nutrition drivers across sectors are complementary in their impact on child nutrition. In other words, children’s nutrition stands to benefit more if public and private efforts work to create favorable environments for children across multiple domains, not just a single one. But as decision makers move towards defining how limited resources should be used to improve child nutrition, what initiatives should be prioritized?

Empirically, the results explored in this paper suggest that the greatest reduction in stunting prevalence would occur if significant progress was made on two fronts: improving prenatal conditions and improving food security and diversity. Combined, sub-optimal conditions in these two domains account for nearly 50 percent of the cases of stunting in children under the age of 2 years and 42 percent of the cases of stunting in children between the ages of 2 and 5 years. In the former case, this means greater focus on supporting the nutrition and health of expecting mothers and adolescents to improve birth outcomes, including access to contraception to give women greater ability to exercise their fertility preferences. In the latter case, this means supporting efforts to ensure that children are regularly consuming a range of foods that deliver key micronutrients, including protein-dense perishable foods such as meat or eggs and the adoption of technologies that facilitate their consumption (such as refrigeration). This is especially important when children reach the age of 6 months and their dietary intake needs to be significantly supplemented with energy and nutrients from solid or semi-solid foods. In areas where birth outcomes and food security are already generally favorable (e.g. areas with low prevalence of preterm or LBW newborns and diets that incorporate diverse food sources), stakeholders might examine ways to improve the safety and reliability of the drinking water supply and sanitation and wastewater systems. One aspect of the home care environment that is not associated with stunting per this analysis, but nevertheless is important for the cognitive development of children is stimulation through reading and play. Nationally, only 39 percent of children under the age of 2 are both read to and get play time with their caretaker, so more direct interventions to improve learning and schooling outcomes might include encouraging cognitive stimulation for children through outreach, education and investment in early childhood development.

# **References and Notes**

> 1 The Philippines Plan of Action for Nutrition, 2017-2022, National Nutrition Council: http://www.nnc.gov.ph/index.php/downloads/file/998-ppan2017-2022-executive-summary.html

> 2 Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R, Maternal and Child Nutrition Study Group. Lancet. 2013 Aug 3; 382(9890):427-451.

> 3 Michelle A. Mendez, Linda S. Adair; Severity and Timing of Stunting in the First Two Years of Life Affect Performance on Cognitive Tests in Late Childhood, The Journal of Nutrition, Volume 129, Issue 8, 1 August 1999, Pages 1555–1562, https://doi.org/10.1093/jn/129.8.1555

> 4 Save the Children (2016). Cost of Hunger: - - Philippines. https://resourcecentre.savethechildren.net/library/cost <u>hunger philippines</u>

> 5 UNICEF (2017)

> 6 Harvard Univeristy Center on the Developing Child. The Science of Early Childhood Development. https://developingchild.harvard.edu/resources/inbrief-science-of-ecd/

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