PANEL 2.3 HOW DID MAHARASHTRA CUT CHILD STUNTING? LAWRENCE HADDAD
M
aharashtra, one of the wealthiest states in India, managed to reduce the share of children under age five affected by stunting from 36.5 percent to 24.0 percent between 2005–2006 and 2012, or a rate of more than 2.0 percentage points a year (equivalent to an average annual rate of reduction of 5.8 per- cent). What drove this rapid improvement in children’s nutrition? A recent mixed-methods study1
people, suffered from slightly less leakage than the all-India average; and female education rates were high and rising. There were vulnerabilities, however, with weak agricultural growth, still-high levels of PDS leakage, and high levels of open defecation.
addressed this question and found the following (Haddad et al. 2014): • The enabling environment for stunting reduction was favorable. Maharashtra, already a wealthy state, posted higher rates of economic growth and poverty reduction than the all-India average. Its governance, in terms of transparency, anti- corruption efforts, and service delivery, was not the best but not the worst in India.
• Underlying determinants were reason- ably supportive: women’s decisionmaking status inside and outside the home was high; the Public Distribution System (PDS), which distributes subsidized food to poor
• Spending on nutrition doubled from a low level, and vacancies among frontline workers in the Integrated Child Devel- opment Services (ICDS) scheme dropped dramatically.
• The decline in stunting was broad based and was greater—absolutely and propor- tionately—for the least wealthy, the least literate, and those with the worst access to improved water sources.
• The determinants that improved the most between the two surveys were the age of mother at first birth, maternal under- weight, maternal literacy, coverage of antenatal visits, delivery in the presence of birth attendants, child feeding practices, and access to ICDS.
• The state’s Nutrition Mission was seen as a signal of high-level political commitment to nutrition improvements and helped coordinate different sectors at village and policy levels.
Overall the three research approaches used in the study dovetailed to lead to three main conclusions: • The large decline in stunting rates was due to improvements across a wide range of determinants, and some improvements were quite modest.
• The declines in determinants were not so strong or comprehensive that Maharash- tra should be perceived as exceptional— similar declines could be achieved by other Indian states and other countries.
• The declines in stunting in Maharashtra are impressive, but they were 10 years in the making and required sustained commit- ment from government and civil society.
rising tax revenues—although these conditions do present chal- lenges for keeping overweight and obesity in check (Ruel and Alderman 2013; Headey 2013).
Finally, the increased momentum for action generated by
recent and upcoming events should make us more optimistic about accelerating improvements in nutritional status. Contribu- tors to this momentum include the growth of the SUN Move- ment, the 2013 Nutrition for Growth conference in London, the
2014 Second International Conference on Nutrition in Rome, and the follow-up high-level nutrition event planned for the 2016 Rio de Janeiro Summer Olympics.
Taken together, these considerations suggest that the 2030 goals should therefore not simply be five-year business-as-usual extrapolations of the 2025 WHA targets. They should be more ambitious than that.3
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION
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