Image for representation. Photo: Tanjila Ahmed/Flickr. File
Stunting irreversibly affects not just the height, but also the cognitive development of a child. While the long-term impact of early childhood stunting on educational levels is recognised, the processes by which it results in lower educational achievements, particularly in low- and middle-income countries, are not well understood. A deeper insight into the underlying mechanisms is crucial for formulating effective policies to enhance educational outcomes in these contexts.
Challenge in research
A significant challenge in research on the effects of early human capital investments, such as nutrition, on cognitive development is their focus on specific cognitive-achievement test scores in areas such as math, reading, and vocabulary. Moreover, achievement tests, which assess knowledge acquired through schooling, may not fully reflect inherent cognitive skills. This is because they depend on both cognitive abilities and access to education. For instance, stunting might influence learning outcomes due to behavioural factors, such as delayed school enrolment, rather than purely cognitive deficits. Consequently, while cognitive skills are malleable and less dependent on educational investments, their assessment through traditional achievement tests remains complex and potentially misleading. In the case of India, NCERT’s National Achievement Test and Pratham’s Annual Status of Education Report also look at the status of children’s enrolment and learning outcomes only.
However, a recent study by Sánchez et al. (2024) in ‘World Development’ examines the link between early under-nutrition and four key cognitive skills developed later in childhood: working memory, inhibitory control, long-term memory, and implicit learning. The first two measure executive functioning.
The study done in Ethiopia and Peru provides an understanding of how stunting really affects cognitive ability. It found that stunting at approximately age 5 is negatively related to executive functions measured years later. This relationship remains strong even when accounting for household fixed effects. These are a statistical technique used to control for unobserved factors that are constant within a household but differ between households. This method allows researchers to focus on the effects of variables like stunting on outcomes such as cognitive development by comparing individuals within the same family.
The findings also suggest that the impact of stunting on working memory might occur as early as age 5, influenced by vocabulary development. These results add to the body of literature that connects early nutrition with educational achievement.
Empirical studies have shown that women’s height and educational attainment are strong predictors of child stunting in India. Interventions that improve these can indirectly contribute to better nutritional outcomes in their children.
These findings have implications for India as they underscore the critical importance of early childhood nutrition as a determinant of cognitive development and later educational outcome. India is addressing stunting in two ways. First, Poshan Abhiyaan and Integrated Child Development Services have played a significant role in addressing the issue of stunting. With the objective of reducing malnutrition in districts with the highest burden, Poshan Abhiyaan focuses on enhancing the utilisation and quality of Anganwadi services to ensure holistic development and adequate nutrition for pregnant women, mothers, and children.
Second, studies, including those by Spears (2013), found that improved sanitation reduces the incidence of diarrhoea and stunting. Investments in clean water and sanitation infrastructure are crucial. India has been addressing these with the Jal Jeevan Mission and the Swachh Bharat Mission.
Three key strategies
To markedly improve child nutrition and combat under-nutrition in India, three key strategies can be the largest needle movers. First, promoting early breastfeeding, along with continued breastfeeding for two years, coupled with appropriate complementary feeding starting at six months, is essential. This not only prevents stunting but also fosters optimal child development. Government initiatives, such as the Mother’s Absolute Affection Programme, need expansion to provide comprehensive lactation support and create breastfeeding-friendly environments. Leveraging mobile technology to educate mothers about the criticality of exclusive breastfeeding in the first six months is also vital. At the same time, improving maternal nutrition is crucial, as healthier mothers have healthier babies.
Second as children grow, diversifying their diet becomes crucial. India should implement and scale up community-based complementary feeding programmes. These can educate parents about the importance of adding a variety of foods to their child’s diet after six months of age, focusing on locally available, nutrient-rich food options.
Finally, adding an extra Anganwadi worker to each Anganwadi centre could help. Studies, including a randomised trial in Tamil Nadu, have shown that extra staff can double preschool instructional time and improve math and language scores and reduce child stunting and severe malnutrition. This approach promises better developmental outcomes for children and creates substantial employment opportunities.
Aditya Sinha is Officer on Special Duty, Research, Economic Advisory Council to the Prime Minister.
