Globally, 25 percent of children under 5 are stunted. In South Asia, the burden increases to 38 percent of children under 5, which is about 40 percent of the global burden of stunting. A team of global experts in maternal and child nutrition, including A4NH researchers from IFPRI and beyond, have contributed to a special issue of the international journal Maternal and Child Nutrition, Stop Stunting in South Asia, launched on May 18. The issue includes 15 research articles and 5 perspective papers on the cost of stunting to children, adults, and nations of South Asia, as well as the benefits of reducing child stunting in the region.
The consensus is that large declines in stunting can be achieved in the region. While this requires political will and investment, studies estimate that every US$ 1 invested in nutrition generates US$18 in economic returns.
According to Dr. Purnima Menon, Senior Research Fellow with IFPRI and co-editor of the special issue, “Countries in South Asia need to seize the opportunity of economic growth to invest in addressing child stunting at scale. These are investments that, if supported, can ‘lock in the potential’ for children and nations, with benefits that far exceed the cost.”
Dr. Victor Aguayo, co-editor of the special issue and UNICEF's Regional Nutrition Advisor for South Asia, agrees that investing in stunting is not only a smart move, but a necessity. He states, “The challenge ahead is to accelerate progress so that South Asia delivers its share of the global target to reduce child stunting. South Asian countries can afford to stop stunting and cannot afford the cost of inaction. The benefits of action will far exceed the cost.”
One of the papers in this issue estimates the cost of delivering direct nutrition interventions across India. The study estimates and compares the cost of delivering 10 Scaling Up Nutrition (SUN) interventions and 14 recommended nutrition (India Plus) interventions, throughout India. The interventions promoted by SUN and India Plus differ slightly but are broadly focused on direct, nutrition-speciﬁc interventions, including: community nutrition programmes, providing supplementary food rations, counselling for pregnant mothers and caregivers, cash transfers to support breastfeeding, micronutrient and deworming interventions, complimentary food rations, and acute malnutrition management. The interventions are predominantly focused on children under 5 years of age and pregnant women, some of the interventions such as iron fortification also target young adolescents and people of all ages.
The paper highlights that there is a wide variety in the unit costs for each intervention. For example, under India First, the paper estimates that providing vitamin A supplements is $0.07 per child per year whereas counselling for complementary feeding is $7.47 per child per year. Similarly for the SUN interventions, the paper estimates that iron fortification of staple foods costs $0.20 per person per year while providing complementary food for prevention or treatment of moderate malnutrition costs $51.10 per child per year.
The study estimates the total annual cost of implementing the 10 SUN interventions at US$4.22 billion and the total annual cost of implementing the complete set of India Plus interventions at full coverage throughout India at US$5.93bn. Estimates for SUN interventions were lower than estimates for India Plus because of differences in choice of intervention, target groups and unit costs. The largest proportion of the total India Plus cost, approximately US$2.9 billion and US$2.3 billion, is for the cash transfers to women to support breastfeeding and supplementary food rations respectively. The largest proportion of the total SUN costs, US$1.3 billion, is for food supplements to prevent and treat malnutrition. The lowest cost interventions for both sets of interventions include counselling for promoting breastfeeding, iron-folic acid supplements, vitamin A supplementation and deworming. The study also estimates that implementation costs vary considerably within India, for instance: states in the Indo-Gangetic area require the greatest amount of financing because of larger target population sizes. As a general rule the study advises planners to allocate US$140 per child between 0 and 24 months of age per year to cover for interventions.
The study notes that there is an urgent need for further costing studies on the costs of delivering of nutrition-speciﬁc interventions in different local contexts. In terms of benefits that could be realized, a recent paper by Hoddinott et al estimates the cost-benefits of nutrition intervention and finds a benefit of US$38.6 for each US$1 dollar invested in nutrition interventions in India. However, a recent review by Batura et al highlights that there is limited availability of cost-effectiveness studies especially on a country level. The paper highlights that there is a need to further investigate the cost-effectiveness of the different components of each set of interventions in India.