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DATA BRIEFS: Progress and Disparity

Rural/urban nutrition gaps identified

The prevalence of stunting or low height for age is consistently higher in rural areas than urban areas, according to data from 68 developing countries. Rates of stunting among rural children in these countries are, on average, more than 1.5 times higher than among urban children. In 36 countries, rural rates are from 1.5 to 4.3 times more than urban rates.

The rural/urban gap is greatest in China, followed by Viet Nam, Kazakhstan and Peru; 6 of the 12 countries with the highest rural/ urban stunting disparities are in Latin America and the Caribbean.

These findings spotlight the urgent need to address these disparities and to ensure that all children's and women's right to adequate nutrition is fulfilled.

Stunting is a critical indicator of child malnutrition, and malnutrition plays a major role in more than half of all child deaths in developing countries.

Stunting often begins in the womb as a result of maternal malnutrition, which also leads to low-weight births. Low-birthweight babies are much more likely to die in the first month of life than babies of normal weight, and those who survive are likely to be stunted for the rest of their lives.

Long-term reduction in dietary intake and repeated episodes of illness cause stunting, and these are most damaging during the first two years of life. Since the brain is the most rapidly growing organ at this time, children who are stunted may also suffer reduced cognitive development and learning ability. In the Philippines, for example, children stunted before six months of age scored significantly lower on intelligence tests at 8 and 11 years of age than children who were not stunted. Stunting is also associated with diminished work capacity and increased risk of degenerative diseases in adulthood.

Stunting's impact: Two 12-year-olds in Bangladesh. The line on the wall shows the normal height for that age.

Women who are stunted are more likely to experience obstructed labour and face a greater risk of dying in childbirth. If they live, they will more likely give birth to low-birthweight infants, continuing the impact of stunting over generations.

The rural/urban disparities are of particular concern because, overall, rates of stunting in the developing world have declined.

Nearly half of under-fives in developing countries were moderately or severely stunted during the 1980s; during the 1990s, the rate has declined to 38%, although seven countries have national rates of 50% or more: Afghanistan, Angola, Bangladesh, Cambodia, Guatemala, India and Pakistan.

While there is no single formula for improving nutrition, certain elements are essential. Eliminating discrimination against women and girls is vital, including ensuring access to education for girls. Sustained national economic growth is associated with improved nutrition, though not a necessary condition for it.

In countries such as Oman and Tanzania, the 'triple A' approach has helped rural communities assess nutritional problems, analyse their causes and initiate actions to improve nutrition. Targeted investment in basic social services can also help reduce disparities.