Children affected by the 2008 food crisis in Peru show stunting can be reversed. Is it time to focus beyond the first 1,000 days?
In 2008 there was a terrible food crisis in Peru. The price of rice doubled in three months and millions of families were struggling to put food on the table. Six years on, thousands of Peruvian children who were babies and toddlers during the food crisis are much smaller than they should be. And for many, their cognitive skills development has been negatively affected too.
Children's bodies and brains develop fastest when they're in the womb and during the first two years of their lives: the first thousand days. And it's during this crucial period that physical stunting and cognitive impairment can really set in if pregnant mothers and babies miss out on adequate nutrition.
Research has suggested that early stunting and its effects are irreversible. So will these Peruvian children's futures be permanently blighted because they weren't getting enough to eat when they were little?
At Young Lives we've been studying the progress of 12,000 children in Peru, Vietnam, Ethiopia, and India - measuring all aspects of their physical, cognitive, and social development since 2002. We've been following the development of children who were undernourished early in their lives and we've discovered that the effects of early undernutrition aren't always irreversible. Some children in our studies were able to recover from early stunting and develop normally.
In particular, our results show that around 50% of children in Peru who were stunted in 2002, when they were around a year old, were not stunted in 2009. The same figure was around 45% for India.
So while the first thousand days are very important, the rest of a child's life is too. It now seems clear that children can recover from stunting after their first thousand days.
Our findings indicate that factors like household income, maternal education and health, local water, sanitation and health infrastructure, which are key to stunting prevention, are also important for recovery from stunting.
Recovery from stunting after the first thousand days may also lead to the reversal of developmental setbacks such as cognitive impairment. Our findings suggest that children who recovered from early stunting performed better in vocabulary and mathematics tests than children who remained stunted.
School meals, cash transfer and health programmes can help
This and other evidence suggests that school feeding programmes may help undernourished children to recover from stunting. Young Lives findings show that India's national school feeding programme helped children to recover from a decline in growth due to a severe drought when they were one-year-old. In Peru, national feeding programmes, such as Qali Warma and Vaso de Leche may have helped children who became stunted as a result of the food crisis to recover.
Conditional cash transfer programmes that provide financial incentives to poor households to invest in children's health may also be a powerful instrument in the fight against child undernutrition. An example of such a programme in Peru is Juntos, which requires that children below the age of five in families that receive the support, must attend health facilities for comprehensive healthcare and nutrition.
To prevent stunting, there are potential benefits to extending the coverage of early child development programmes to older children. For example, Cuna Mas in Peru, which aims to improve development for children living in poverty, could be extended from children younger than three to children younger than six-years-old.
There's no doubt about the importance of the first thousand days for a child's growth and development, so nutrition intervention needs to start early. But intervention shouldn't always end when the child reaches two. It needs to be sustained throughout childhood and target the most stunted and undernourished children so they have a decent chance to recover.
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Will children who didn't get enough nutrition during the 2008 food crisis in Peru be stunted for life? Photograph: Esteban Felix/AP