A Window of Opportunity: Australian Aid and Child Undernutrition

Undernutrition in young children is a key development challenge. In low- and middle-income countries, undernutrition is associated with between one third and half of child deaths. The Australian Government’s 2014 development policy identifies early childhood nutrition as ‘a critical driver of better development outcomes’. International evidence shows that investments to reduce child undernutrition are cost-effective and protect other investments in health, education and private sector development. Providing the right nutritional support to children aged less than 5 years, and particularly those aged less than 2 years, is pivotal for a healthy life. This includes ensuring adequate protein and energy for growth, and micronutrients to prevent conditions such as anaemia. Children can suffer acute and/or chronic undernutrition. Wasting (thinness), often seen during famines, reflects acute undernutrition and significantly increases a child’s risk of death. Stunting (shortness) reflects chronic undernutrition and is associated with reduced capacity to resist disease, suboptimal cognitive development and poor school performance. Childhood stunting is associated with lower earnings and poor health in adulthood. The first 1000 days of a child’s life between conception and the age of 2 years is considered to be a ‘window of opportunity’, as stunting prior to the age of 2 years is largely irreversible. Maternal undernutrition, leading to poor growth in utero, may initiate stunting. In 2013, a quarter of children aged less than 5 years worldwide were stunted. Half of these children were in Asia and over one third in Africa. Undernutrition is also a significant development problem in priority regions for Australian aid. In Pacific countries with small populations, the number of stunted children is low compared to other regions, but the proportion of stunted children is amongst the highest in the world and there has been little improvement since the 1990s. In Southeast Asia, the proportion of children stunted is also high, especially in Cambodia, Laos and Timor-Leste. Undernutrition is caused by factors operating at the level of the individual (immediate causes), household (underlying causes) and society (basic causes). Nutrition-specific interventions, such as micronutrient supplementation and emergency food assistance, address the immediate causes of undernutrition, such as inadequate food intake and disease. Nutrition-sensitive interventions, such as crop breeding, health professional training, girls’ education and sanitation behaviour change, address the underlying causes of undernutrition, such as food insecurity, inadequate care, low status of women and intestinal worms. Nutrition-governance interventions, such as laws, policies and the promotion of economic growth, operate at the societal level to address the basic causes of undernutrition, such as weak governance and poverty. The evaluation aimed to answer three questions: 1. How does Australian aid policy and programming address child undernutrition? 2. To what extent does this approach align with the principles of good practice? 3. What opportunities exist to improve how Australian aid addresses child undernutrition? Four analyses were used for the evaluation: (1) a review of the international literature on undernutrition prevalence, the effectiveness of interventions and donor policies; (2) a financial analysis of Australia’s nutrition expenditure; (3) a document review to assess a sample of initiatives against the principles of best practice; and (4) a series of case studies to examine four initiatives in Pakistan and Timor-Leste in greater depth.