Average living standards in the Philippines have improved markedly since 2000. GDP per person (adjusted for inflation) rose at greater than 4 percent per year in nine of the 18 years between 2000 and 2017, contributing to an overall increase in real income per capita of close to USD 1,300 over this period. Overall, the distribution of income growth since 2006 has been inclusive and pro-poor, but especially so between 2012 and 2015 when income per capita among the poorest 20% of households increased by 16 percent.<sup>35</sup> As a result, between 2006 and 2015, poverty rates estimated on the basis of the national poverty line fell from 26.6 to 21.6 percent (and from 14.5 to 6.6 using the USD 1.90 international or “extreme” poverty line).

Other risk factors or interventions closely associated with stunting that clearly improved between 2000 and 2017 and that now affect less than 25% (or cover at least 75%) of the population, include anemia prevalence among women (pregnant or lactating), anemia prevalence among children between the ages of 1 and 5 years, diarrhea prevalence among children under the age of 3, breastfeeding prevalence, the share of births assisted by a skilled health practitioner and the share of the population with access to an improved, non-shared sanitation facility.

Risk factors or interventions that improved but still affect more than 25% (or cover less than 75%) of the population include anemia prevalence in children between 6 months and 1 year of age, exclusive breastfeeding prevalence among infants between 0 and 5 months of age, and children between 6 and 23 months of age receiving a diverse or acceptable diet.<sup>36</sup> Amid these positive trends are a few key areas of concern, some of which were pointed out previously. Adolescent fertility and childbearing prevalence are on the rise. Preterm births are estimated to have more than doubled since 2000<sup>37</sup> and DHS surveys conducted between 1993 and 2015 found that LBW prevalence (among all live births in the 5 years preceding the survey) increased from 14.7 to 21.4 percent. However, the most recent DHS estimate from 2017 found LBW prevalence to have fallen significantly to 14.5 percent. Estimates from the NNS of the share of children under the age of 4 whose mother reported (with or without a written record) a low birth weight was 15.9 percent in 2011, 11.1 percent in 2013, and 14.5 percent in 2015.<sup>38</sup> While not deteriorating, a measure of maternal nutrition used by the Department of Science & Technology’s Food and Nutrition Research Institute (DOSTFNRI) in its last three NNS reports - the percentage of pregnant women who are ‘nutritionally-at-risk’ - has not improved. In 2011, 2013 and 2015, around 1 in 4 pregnant women were estimated to be nutritionally-at-risk. Further, in 2015, pregnant women under the age of 20 were twice as likely to be nutritionally-at-risk than women above the age of 20 (39.6 vs. 21.9 percent). The relative risk of having deficient nutrition during pregnancy associated with adolescent age is greater than the risk associated with wealth.

Coverage of all 8 basic vaccinations according to the government’s vaccination schedule slipped from 79 to 71 percent between 2000 and 2003 and has remained around that level since.

The overall child nutrition picture in the Philippines presents a puzzle. Why did the country’s stunting rates stagnate between 2000 and 2015 amid improving living standards, improved child survival, expanding coverage of key health interventions, the implementation of a targeted cash transfer scheme and sustained progress against stunting elsewhere in the region?

Examination of the trends in key risk factors provides some clues. For example, combined with the fact that adolescent fertility is increasing, lower nutritional status among pregnant adolescents is a major headwind for child nutrition even as economic conditions improve. Closely associated is the rise of preterm birth and low birth weight prevalence, which signals a broader challenge with maternal health and nutrition. In addition, given that preterm births also face a significantly higher risk of neonatal mortality,<sup>39</sup> one implication of rising preterm birth rates in a context of improving care for 24