title: Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy.
abstract: Stunting and chronic undernutrition among children in South Asia remain a major unresolved global health issue. There are compelling intrinsic and moral reasons to ensure that children attain their optimal growth potential facilitated via promotion of healthy living conditions. Investments in efforts to ensure that children's growth is not faltered also have substantial instrumental benefits in terms of cognitive and economic development. Using the case of India, we critique three prevailing approaches to reducing undernutrition among children: an over-reliance on macroeconomic growth as a potent policy instrument, a disproportionate focus on interpreting undernutrition as a demand-side problem and an over-reliance on unintegrated single-factorial (one at a time) approaches to policy and research. Using existing evidence, we develop a case for support-led policy approach with a focus on integrated and structural factors to addressing the problem of undernutrition among children in India. Key messages Eliminating child undernutrition is important from an intrinsic perspective and offers considerable instrumental benefits to individual and society. Evidence suggests that an exclusive reliance on a growth-mediated strategy to eliminate stunting needs to be reconsidered, suggesting the need for a substantial support-led strategy. Interpreting and addressing undernutrition as a demand-side problem with proximal single-factorial interventions is futile. There is an urgent need to develop interventions that address the broader structural and upstream causes of child undernutrition.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Child Health Evaluative Sciences and the Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Child Health Evaluative Sciences and the Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Iván
authors.initials: I
authors.lastname: Mejía-Guevara
authors.affiliation: Child Health Evaluative Sciences and the Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Aditi
authors.initials: A
authors.lastname: Krishna
mesh_terms: D001208:Asia / Q000453:epidemiology; D001827:Body Height; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology; D003672:Defecation; D057217:Economic Development; D006130:Growth Disorders / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007859:Learning Disabilities / Q000209:etiology; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control; D018673:Nutrition Policy / Q000639:trends*; D012499:Sanitation
keywords: India; childhood; cognition; economic growth; multifactorial; social determinants; stunting; support-led strategy; undernutrition; upstream interventions