The benefits of interventions which improve early nutrition are well recognised. These benefits, however, only accrue to the extent that later life circumstances allow. Consequently, in adverse contexts many of the benefits will never be realised, particularly for the most vulnerable, exacerbating inequality. Returns to investment in early nutrition could be improved if we identified contextual factors constraining their realisation and interventions to weaken these. We estimate cost and impact of scaling 10 nutrition interventions for a cohort of South African children born in 2021. We estimate associated declines in malnutrition and mortality, and improvements in years of schooling and future earnings. To examine the role of context over the life-course we estimate benefits with and without additional improvements in school quality and employment opportunities by socio-economic quintile. Scale up reduces national stunting (height for age < = -2SD) rates among children at 24 months by 3.18 percentage points, implying an increase in mean height for age z-score (HAZ) of 0.10, and 53,000 years of additional schooling. Quintile 1 (the poorest) displays the largest decline in stunting, and largest increase in mean HAZ. Estimated total cost of increasing coverage of the interventions for the cohort is US$90 million. The present value of the additional years of schooling is estimated at close to US$2 billion. Cost-benefit ratios suggest the highest return occurs in quintile 5 (1:23). Reducing inequality in school quality closes the gap between quintile 5 and the lower quintiles. If school quality and labour force participation were equal the highest returns are in quintile 1(1:31). An enabling environment is key to maximising human development returns from investing in early nutrition, and to avoid exacerbating existing inequality. Therefore, particularly for children in adverse conditions, it is essential to identify and implement complementary interventions over the life course.

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Maternal and early malnutrition have negative health and developmental impacts over the life-course. Consequently, early nutrition support can provide significant benefits into later life, provided the later life contexts allow. This study examines the limits of siloed investments in nutrition and illustrates how ignoring life-course contextual constraints limits human development benefits and exacerbates inequality, particularly in fragile contexts. This case study focuses on Burkina Faso, a country with high rates of early malnutrition and a fragile state. We modelled the impact of scaling up 10 nutrition interventions to 80% coverage for a single year cohort on stunting, nationally and sub-nationally, using the Lives Saved Tool (LiST), and the consequent impact on earnings, without and with a complementary cash-transfer in later life. The impact on earnings was modelled utilising the well-established pathway between early nutrition, years of completed schooling and, consequent adult earnings. Productivity returns were estimated as the present value of increased income over individuals’ working lives, then compared to estimates of the present value of providing the cost of nutrition interventions and cash-transfers. The cost benefit ratio at the national level for scaled nutrition alone is 1:1. Sub-nationally the worst-off region yields the lowest ratio < 0.2 for every dollar spent. The combination of nutrition and cash-transfers national cost benefit is 1:12, still with regional variation but with great improvement in the poorest region. This study shows that early nutrition support alone may not be enough to address inequality and may add to state fragility. Taking a life-course perspective when priority-setting in contexts with multiple constraints on development can help to identify interventions that maximizing returns, without worsening inequality.

MotivationInvesting in girls’ schooling in low‐ and middle‐income countries (LMICs) is seen as central to improving gender equity. It is argued that interventions to promote girls’ enrolment are appropriate as girls face gendered barriers to school enrolment and completion and investing in girls’ schooling has high economic and human‐development returns. But is this fair to boys and enough for girls?PurposeWe ask how appropriate it is to direct development assistance towards improving girls’ school enrolment, compared to prioritizing schooling for both girls and boys, and addressing barriers to gender equality throughout the life‐course.Methods and approachWe frame the enquiry through a human development framework with three distinct but interdependent domains: protection of human development potential; realization of human development potential; and use of human development potential.Using publicly available data, we identify indicators likely to be correlated with the degree to which human development potential is protected, realized, and utilized in LMICs. We compare male and female outcomes on each of these indicators to assess gender parity at different life stages.FindingsIn most regions, girls are ahead of boys in both school enrolment and completion. Girls have better outcomes than boys in several other indicators in early life and childhood.In adolescence and adulthood girls and women fall behind boys and men. This is especially apparent in workforce participation, in unemployment, in pay, and in share of unpaid care work and political participation where women have less favourable outcomes than men. The bias against women is most marked in South Asia and sub‐Saharan Africa.Policy implicationsA focus on girls’ schooling should be tempered by ensuring quality pre‐primary, primary, and secondary schooling for both boys and girls. Simultaneously we must address causes of gender inequality, including labour market discrimination and social norms which justify the exclusion and exploitation of women and girls.