Reducing childhood stunting in India: Insights from four subnational success cases

Abstract

Global success case analyses have identified factors supporting reductions in stunting across countries; less is known about successes at the subnational levels. We studied four states in India, assessing contributors to reductions in stunting between 2006 and 2016. Using public datasets, literature review, policy analyses and stakeholder interviews, we interpreted changes in the context of policies, programs and enabling environment. Primary contributors to stunting reduction were improvements in coverage of health and nutrition interventions (ranged between 11 to 23% among different states), household conditions (22–47%), and maternal factors (15–30%). Political and bureaucratic leadership engaged civil society and development partners facilitated change. Policy and program actions to address the multidimensional determinants of stunting reduction occur in sectors addressing poverty, food security, education, health services and nutrition programs. Therefore, for stunting reduction, focus should be on implementing multisectoral actions with equity, quality, and intensity with assured convergence on the same geographies and households.

Implementation Outcomes of National Convergence Action Policy to Accelerate Stunting Prevention and Reduction at the Local Level in Indonesia: A Qualitative Study

“…The key success of convergence implementation in this study is focused on the responsible agents and their roles: a strong leadership of the first-line district authority; increased funds for a technical conductor role by the DDPB; better advocating and agility of the District Health Agency; a strong coordination at the sub-district level; the commitment and consistency of the village leader. This result is in line with Avula’s opinion that all central, district, and community stakeholders work closely together, ensuring sustainable leadership and adequate funding [ 41 ].…”

Stories of change in nutrition: lessons from a new generation of studies from Africa, Asia and Europe

“…Studies aiming to understand the determinants of stunting reduction (and anaemia in the case of Ghana) in different contexts (Adeyemi et al, 2022 ; Aryeetey et al, 2021 ; Avula et al, 2022 ; Becquey et al, 2022 ; Harris et al, 2021 ; Iruhiriye et al, 2022 ) built on previous work (Headey et al, 2016 , 2017 ) and applied regression-decomposition analysis on large national datasets over multiple years (Table 1 ). Many studies used and adapted the 1990 UNICEF framework on the causes of child and maternal malnutrition in the identification of underlying and basic determinants of change in these outcomes.…”

“…Studies aiming to assess the public policy environment (Adeyemi et al, Forthcoming ; Aryeetey et al, 2021 ; Avula et al, 2022 ; Drimie et al, Forthcoming ; Harris et al, 2022 ; Harris et al, 2021 ; Iruhiriye et al, 2022 ; Salm et al, Forthcoming ; Turowska et al, Forthcoming ) drew on multiple policy analysis frameworks and methods. Policy frameworks included the community readiness framework (Plested et al, 2007 ), the policy space (Grindle & Thomas, 1991 ), advocacy coalitions (Sabatier, 1988 ), and the nutrition-enabling environment (Gillespie et al, 2013 ).…”

“…Other sectoral improvements at household and community level included those driven by growing access to sanitation, or piped water (Becquey et al, 2022 ; Turowska et al, Forthcoming ). In some countries, improvements in this sector also reflected significant government initiatives, such as a National Sanitation Programme (Avula et al, 2022 ), and a range of national sanitation policies and action plans (Aryeetey et al, 2021 ). In Nigeria, increased construction of toilets and boreholes and availability of environmental health officers to promote/enforce environmental sanitation was also noted by stakeholders (Adeyemi et al, Forthcoming ).…”

“…In Africa, studies took place in Ghana (Aberman et al, 2022 ; Aryeetey et al, 2021 ), Nigeria (Adeyemi et al, 2022 ; Adeyemi et al, Forthcoming ), Burkina Faso (Becquey et al, 2022 ; Turowska et al, Forthcoming ), Rwanda (Iruhiriye et al, 2022 ), Zambia (Harris et al, 2019 ) and South Africa (Drimie et al, Forthcoming ). In South-East and South Asia, studies took place in Vietnam (Harris et al, 2020 , 2021 , 2022 ) and across four states of India (Odisha, Tamil Nadu, Gujarat & Chhattisgarh) (Avula et al, 2022 ; Avula et al, Forthcoming ). In Europe, a city-level study took place in Brighton and Hove in the United Kingdom (Salm et al, Forthcoming ).…”