The Decline of Child Stunting in 122 Countries: A Systematic Review of Child Growth Studies Since the Nineteenth Century (with Eric Schneider and other 41 coauthors)

Child stunting, a measure of malnutrition, is a major global health challenge affecting 148.1 million children in 2022. Global stunting rates have fallen from 47.2% in 1985 to 22.3% in 2022, but trends before the mid-1980s are unclear including whether child stunting was previously prevalent in current high-income countries (HICs). We conducted a systematic review of child growth studies before 1990 to reconstruct historical child stunting rates. We included reports of mean height by age and sex for children up to age 10.99. We excluded studies that were not representative of the targeted population and data for children under age two. Stunting rates were computed by converting the means and SDs of height to heightfor-age Z-scores (HAZ) using the WHO standard/reference, combining the HAZ distributions for all ages, and measuring the share of the combined distribution below the stunting threshold. We found 923 child growth studies covering 122 countries. We supplemented these historical studies with stunting estimates from the 1990s onward from the Joint Malnutrition Estimates database. Many current HICs had high levels of child stunting in the early twentieth century similar to low- and middle-income countries (LMICs) today. However, there was heterogeneity: stunting rates were low in Scandinavia, the European settler colonies and in the Caribbean, higher in Western Europe and exceptionally high in Japan and South Korea. Child stunting declined across the twentieth century. Working paper Web Appendix

The History of Child Stunting in India (with Eric Schneider and Maanik Nath

India has one of the highest child stunting rates in the world. Existing literature has offered explanations for these high rates at the country-level or through the use of granular data in the modern-day. There has been little work to show regional variation in stunting rates over time. Using new data at the state-level between 1950 and 2020, this paper fills this gap. It shows that while stunting rates were similar across regions in 1950, rates declined substantially for some states after 1970 while seeing only incremental change in other states till the 1990s. The paper situates these results against institutional changes in health and sanitation over time. More to follow.