Malnutrition is one of the world’s most serious but least-addressed development challenges. Its human and economic costs are enormous, falling hardest on the very poor, women and children. Malnutrition undermines progress towards achieving the World Bank Group twin goals of reducing poverty and promoting shared prosperity.

The prevalence of stunting (an indicator of chronic undernutrition) has declined globally. However, 159 million children are stunted in their growth (low height for age), and have limited potential to contribute to their country’s growth. In sub-Saharan Africa, stunting reduction has flat lined, and there are now 12.5 million more stunted children in the region than there were in 1990. Undernutrition increases the risk of children dying in the first few years of life and contributes to nearly one-half of all child deaths. Undernutrition causes increased frequency, severity, and duration of infectious disease, such as diarrhea, respiratory infections and malaria.

For children who survive, childhood stunting impairs long-term human capital formation. Stunting early in a child’s life has educational, income, and productivity consequences that reach far into adulthood. For example, children who are deficient in iodine and essential micronutrients have on average 13 fewer IQ points than those who are iodine-sufficient. Similarly, stunted children are more likely start school later, perform more poorly on cognitive functioning tests, and are more likely to drop out of school. Studies show that adults who are stunted as children earn 20% less than comparable adults who were not stunted and are 33% more likely to live in poverty and less likely to work in skilled labor.

The economic costs of undernutrition, in terms of lost national productivity and economic growth, are significant—ranging from 2 to 3% of GDP in some countries and up to 11% of GDP in Africa and Asia each year.

Globally, undernutrition is more common in poor households, but is also prevalent among the better-off households. For example in Bangladesh, Indonesia, and Ethiopia, more than 40% of children in the poorest households are stunted, yet one-fifth to one-quarter of children living in the wealthiest 20% of households are also stunted. Income is one—but not the only—determinant of stunting: food insecurity, diets lacking in diversity, high rates of infectious diseases and inappropriate infant feeding and care practices also contribute to persistent stunting. Food and financial crises, as well as conflict and natural disasters, have worsened undernutrition in many regions.

At the same time, a global nutrition transition is underway, leading to rapid changes in food systems, environments, and living conditions in many low- and middle-income countries (LMICs). These changes have stimulated a rapid increase in their burden of overweight/obesity, previously considered an ailment of wealthy countries. In fact, over the past 30 years rates of overweight have risen faster in LMICs than in high income countries. Overweight is now pervasive even in countries where children experience undernutrition.

Across all World Bank regions, countries are now starting to experience the double burden of overweight among women and stunting among children. Today, more of the world’s overweight individuals reside in low- and middle-income countries than in high income countries, and there is no evidence that the rise in obesity in LMICs will soon attenuate. As countries experience economic growth and achieve middle and upper-middle income status, their poor will experience a greater share of the burden of overweight and obesity, increasing their vulnerability to health and economic shocks. There is an urgent need to ensure that the world’s poor have access to the knowledge, resources, and services needed to achieve optimum nutrition.

Last Updated: Mar 31, 2016

The World Bank Group is committed to supporting client countries in their endeavors to reduce malnutrition by building the knowledge base, providing technical assistance for policy/program design and prioritization, and financing the scale up evidence-based nutrition interventions. The Nutrition Global Solutions Group within the World Bank is leveraging its global knowledge and expertise to take a multisectoral approach to reducing malnutrition across client countries, with a focus on countries with a high burden of stunting.

In April 2010, the World Bank, in partnership with the Bill and Melinda Gates Foundation, and the Governments of Canada and Japan, and United States Agency for International Development, convened high level partners in support of Scaling Up Nutrition. The Scaling Up Nutrition Framework for Action sets forth principles and priorities for action to address malnutrition, in line with the Millennium Development Goals and Sustainable Development Goals.

The main elements of the framework for action are:

  1. Start from the principle that what ultimately matters is what happens at the country level. Individual country nutrition strategies and programs, while drawing on international evidence of good practice, must be country-owned and built on the country’s specific needs and capacities.
  2. Sharply scale up evidence-based cost-effective interventions to prevent and treat undernutrition, with highest priority to the first 1,000 days “window of opportunity” (between conception and a child’s second birthday) where we get the highest returns from investments.
  3. Take a multisectoral approach that includes integrating nutrition in related sectors and using indicators of impact on undernutrition as one of the key measures of overall progress in these sectors. The closest actionable links are to food security (including agriculture), social protection (including emergency relief), early childhood development, and health (including maternal and child health care, immunization and family planning). There are also important links to education, water supply and sanitation as well as to cross-cutting issues like gender equality, governance (including accountability and corruption), and state fragility.

  4. Provide substantially scaled up domestic and external assistance for country-owned nutrition programs and capacity. Ensure that nutrition is explicitly supported in global as well as national initiatives for food security, social protection and health, and that external assistance follows the agreed principles of aid effectiveness of the Paris Declaration and the Accra Agenda for Action. Support major efforts at the national and global levels for strengthening the evidence base—through better data, monitoring and evaluation, and research—and, importantly, for advocacy.

Over the last several years, the SUN movement has grown, with 56 countries and over a 100 partners signing on to the partnership.






Last Updated: Mar 31, 2016

The World Bank has led the effort to estimate the cost and cost-effectiveness of nutrition interventions to support advocacy and increase investment in nutrition at the global and country levels. At the global level, the Bank, in partnership with R4D, 1000 Days, the Bill and Melinda Gates Foundation, and the Children’s Investment Fund Foundation, is estimating the cost and financing available and needed to reach nutrition targets set out by the World Health Assembly and in the Sustainable Development Goals.

At the country level, the Bank has conducted a number of studies to support governments in Africa and South Asia to plan for and scale up investments in nutrition. The studies provide estimates of the costs and benefits of scaling up a package of evidence-based nutrition interventions proven to improve nutrition outcomes during the first 1,000 days of a child’s life. The studies consider the current coverage of interventions, available delivery platforms, and local costs for commodities, monitoring and evaluation, and capacity building. They provide policymakers with several context-specific scale-up scenarios, designed to maximize allocative efficiency in situations where available resources for investments in nutrition are limited. As of March 2016, scale-up studies have been completed, for Nigeria, Togo, Mali, DRC, Zambia, Cote d’Ivoire, Cameroon, and Uganda. Analytic work is underway for Afghanistan, Bangladesh, Guinea-Bissau, and Madagascar.

Last Updated: Mar 31, 2016

International Development Association (IDA) commitments from 2003 to 2013 provided more than 117 million people with a basic package of health, nutrition, or reproductive health services.

Country-level results include the following:

  • In Senegal, the Bank supports an innovative nutrition health program that operates at the community level in collaboration with local governments, district health authorities, and civil society organizations. National underweight malnutrition rates dropped from 22% in 2005 to 17% in 2012, bringing Senegal--among very few countries globally--within reach of achieving the MDG to halve the rate of malnutrition.

  • In Ethiopia, funding from the Bank’s Rapid Social Response Program has helped the country expand nutrition data collection and analysis and build capacity to respond quickly to worsening nutrition situations and economic shocks. In addition, the Bank supports the July 2015 Seqota Declaration, which reaffirms Ethiopia’s commitment to invest further to improve nutrition for health and sustainable development.

  • In Peru, strong government commitment, in addition to Bank and partner efforts in advocacy, operations and non-lending technical assistance, led to a reduction in stunting of 8.3%, from 27.8% in 2007/8 to 19.5% in 2011 (using WHO 2006 growth reference standards). This is among the fastest rates of reduction seen for stunting globally.

The Bank has been instrumental in advocating for food fortification as a cost-effective approach to improve nutrition. In Tanzania, for example, Bank research showed that food fortification would have a benefit-cost ratio of 8.22:1, leading to a government decision to make Tanzania the first country in East Africa to institute mandatory fortification of wheat flour, maize flour and edible oil.







Last Updated: Sep 08, 2015

The World Bank’s work to address malnutrition is led by the Health, Nutrition, and Population Global Practice in partnership with other Global Practices, including Agriculture, Water, Social, Urban, Rural, and Resilience; Education; Social Protection and Labor, and Poverty. At the country-level, strong partnerships have been forged with the Global Financing Facility for Every Woman, Every Child to make the investment case and ensure that essential nutrition actions are included in efforts to improve the health of women, adolescents, and children everywhere.

The World Bank Group was a founding member of the Scaling Up Nutrition movement, and currently serves on the Executive Committee for Governance and in the SUN Lead Group. In April 2015, the World Bank Group joined the Power of Nutrition, partnership of investors and implementers committed to helping children grow to their full potential, ending the cycle of undernutrition, and enabling countries to build strong and prosperous communities. Backed by leading organizations from private philanthropy and international development, the partnership aims to unlock US $1 billion dollars to tackle child undernutrition in some of the world’s poorest countries.

The Power of Nutrition’s $20 million investment in Tanzania, made through its partnership with the Bank, will multiply investment in nutrition, enabling up to $44 million to be released for new nutrition-specific activities in Tanzania within a larger $306 million health and nutrition initiative in the country. This initiative will also finance additional nutrition-sensitive activities that will further improve the nutritional status of children, including the presumptive treatment for malaria among pregnant mothers and zinc treatment with oral rehydration salts for children with diarrhea.

Last Updated: Mar 31, 2016

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