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  • 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 poor, women, and children. In 2019, 149 million children were stunted (low height-for-age), which indicates not only a failure to achieve one’s own genetic potential for height but is also a predictor of many other developmental constraints, including cognitive deficits and future economic opportunities, including impeding a country’s ability to accumulate human capital.

    Since the 1990s, the worldwide prevalence of stunting declined from 40 percent in 1990 to 22 percent in 2017. However, stark regional differences persist, with South Asia and Sub-Saharan Africa remaining above the global average both in terms of prevalence and numbers of stunted children. Approximately 35 percent of all children under five were stunted in South Asia in 2017, decreasing from 61 percent in 1990. Even though the prevalence of child stunting in Sub-Saharan Africa fell from 49 percent in 1990 to 34 percent in 2017, the total number of stunted children in Africa increased by 13.9 million during the same period as a result of high fertility rates and lower rates of decline in stunting.

    Stunting early in a child’s life can cause irreversible damage to cognitive development and has educational, income, and productivity consequences that reach far into adulthood. 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.

    Fortunately, these losses are largely preventable if adequate investments in proven interventions are made, particularly those that focus on ensuring optimal nutrition in the critical 1000-day window between the start of a woman’s pregnancy and her child’s second birthday. 

    Globally, undernutrition is more common in poor households, but is also prevalent among wealthier households. 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, and poor sanitation and hygiene 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 the 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, and every region has seen some increase in the prevalence in overweight children under five years. Overweight is now pervasive even in countries where children experience undernutrition.

    Countries are now starting to experience the double burden of overweight among both adults and children 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 decline. 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: Oct 04, 2019

  • The World Bank Group is committed to supporting client countries by building the knowledge base, providing technical assistance for policy/program design and prioritization, and financing the scale up evidence-based nutrition interventions.

    Over the last decade, the World Bank has been a major contributor to dialogue and action on scaling up actions to prevent stunting. The seminal report Repositioning Nutrition as Central to Development brought attention to the issue among key partners and governments. The follow-on 2010 World Bank publication Scaling Up Nutrition: What Will It Cost? provided the world with the first estimates of global nutrition costs, and the SUN movement launched in 2010 rallied partners around the cause.

    Guided by the twin goals of ending extreme poverty and boosting shared prosperity, the World Bank’s commitment to investing in the early years of life (early  nutrition, early learning and stimulation, and nurturing care and protection from stress) is necessary to build human capital . To date, World Bank’s IDA and IBRD investments in nutrition have grown dramatically since FY10, from about 10m$ to about 1.2billion$ in FY18. In addition , new resources have been made  available to support this agenda at both global and national levels—from partners such as the Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation, the Japan Trust Fund for Scaling Up Nutrition – which is focused on high-malnutrition burden country programs, the Dangote Foundation, Tata Trusts, the Power of Nutrition, and the Global Financing Facility. These and many other partners, including civil society organizations and Parliamentarians, have been  working to catalyze further commitment in support of the Sustainable Development Goals. .

    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 World Bank, in partnership with R4D, 1000 Days, the Bill and Melinda Gates Foundation, and the Children’s Investment Fund Foundation published An Investment Framework for Nutrition which provides a roadmap, including estimates of resources required and possible financing scenarios to achieve the global nutrition targets set out by the World Health Assembly and enshrined in the Sustainable Development Goals.

    At the country level, the Bank has conducted a number of studies to support governments in Sub-Saharan Africa and South Asia to plan for and scale up investments in nutrition. The studies provide estimates of the financing needs, impacts 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 – starting from pregnancy to a child’s second birthday. The studies consider the current coverage of interventions, available delivery platforms, and unit costs for commodities, monitoring and evaluation, and capacity building. As of January 2017, scale-up studies have been completed for Cote d’Ivoire, Democratic Republic of Congo, Guinea-Bissau, Kenya, Madagascar, Mali, Nigeria, Togo, Uganda and Zambia. Analytic work is underway for Afghanistan and Bangladesh.

    In 2020, the Government of Japan will host the next “Nutrition for Growth” (N4G), global summit to mobilize and generate commitments from bilateral donors, philanthropies, domestic governments and Civil Society Organizations. The key focus of the N4G summit will be more effective and sustainable financing for nutrition, including synergistic efforts on domestic financing and more catalytic/innovative financing solutions to scale up high-impact interventions, supported by data systems to track nutrition financing and results.

    Last Updated: Oct 04, 2019

  • ·       Malnutrition was highly prevalent in Senegal at the start of the millennium when stunting affected as many as 30% of children under five. In response, the Government of Senegal, with support from IDA and other partners, shifted its approach on nutrition to a community-based holistic strategy. The effort was overseen by the Nutrition Policy Coordination Unit in the Prime Minister’s office, which worked with local governments, public service providers and NGOs to deliver to communities and households nutrition services, such as health education, breastfeeding promotion, infant and young child feeding counseling, monthly weighing sessions, essential micronutrient supplementation, conditional cash transfers, targeted food security support and more. The stunting prevalence in Senegal is now 19%, making it one of the lowest of Sub-Saharan Africa. 

    ·       In Ethiopia, the Bank contributed to the development and scale-up of the National Nutrition Program (NNP) through a stand-alone nutrition project (2008-2014) that supported service delivery, institutional strengthening, and capacity building in nutrition. A key achievement of the NNP was expanding the nutrition focus beyond humanitarian/emergency response and scaling up delivery of community-based nutrition services focused on the first 1000 days, including nutrition education and provision of micronutrients. This attention to nutrition has coincided with exceptional progress in improving nutrition in Ethiopia over the past several years (a 6 percentage point reduction in national stunting rates from 2011-2016 [44% to 38%]), and despite fluctuating economic growth.

    ·       In Peru, strong government commitment and multisectoral approaches, results-based financing, in addition to Bank and partner efforts in advocacy, operations and non-lending technical assistance, led to a reduction in stunting from 28.0% in 2005 to 14.6% in 2014. This is among the fastest rates of reduction seen for stunting globally.

    Last Updated: Oct 04, 2019

  • At the country level, strong partnerships have been forged with the Global Financing Facility  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, has multiplied 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 is also financing additional nutrition-sensitive activities that will further improve the nutritional status of children and mothers, including iron and folic acid supplementation in pregnancy; bi-annual Vitamin A supplementation for children, and promotion of improved breastfeeding and complementary feeding practices.

    The World Bank, in partnership with the Bill & Melinda Gates Foundation and the Burnet Institute, launched a new allocative efficiency modeling tool called Optima Nutrition in 2018. This quantitative tool helps facilitate country-level dialogue and decision-making toward allocating nutrition investments more efficiently. The model aligns with the World Health Assembly global targets on nutrition and, as such, optimizes funding allocations that minimize stunting, wasting, anemia and/or under-five mortality at both the national and regional levels. Country applications and case studies are being supported in Democratic Republic of Congo, India, Pakistan, Tajikistan, Burundi, and others.  

    Last Updated: Oct 04, 2019


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