4 new ways to cut the poverty-stunting cycle in 138 countries
If you want to know a real and tractable way to end the poverty cycle in places you care about, evidence-based, also using bonds and not aid budgets and corruption risks, this page is for you*. You can help right now, simply with feedback or questions here (not a fundraiser)
Stunting syndrome (described in black text below) affects 20% of babies worldwide, adult IQ and whole economies. There are hotspots from Duisburg to Lublin, from Mumbai to Nairobi to Blackburn, from Addis to Jo'burg, from Mississippi to NY, Istanbul to Rio to Jakarta.
Ending it will be world changing, and vital for 21st century economies.
Stunting at birth is invisible, and doesn't sound too serious, but it has more and longer lasting consequences than acute starvation.
It leads to huge, lifetime problems for whole families, even in Germany, France and USA. It affects 1%-10% of babies across Europe and up to 60% in large parts of Asia and Africa. This chronically increases health costs, and harms present and future economies.
Ending it will help end the "poverty-stunting cycle" (which is illustrated below).
The good news: recent research shows how to end it, and, delightfully, the same steps also reduce miscarriage, premature births and maternal mortality.
These are the 4 new ways:
women's bonds (to massively increase funding, as investment, not aid)
aflatoxin removal (fast, cheap, surprisingly important, and already done successfully in much of EU)
media/community interventions (aimed for and with adolescents, newlyweds or couples-who-may-conceive)
smoke, anaemia and parasite removal before conception (cats, kitchens and malaria all matter)
Cities, states, NGOs, community groups, a campaigning doctor-grandmother and even private sector can take a lead to make this happen in a given city or region (maybe someone you know?)
Please scroll down for an intro, FAQ and research summary, or click here to contact.
* There are other causes of poverty, which will require other solutions (watch this space) but (a) removing stunting is necessary for some of them (b) even if those other causes and all wars were ended, ending stunting syndrome and maternal deaths would still be urgent and vital.
Alternative text [is it better?]
To end it, prioritise:
a. women's health and nutrition before pregnancy
b. smoke and aflatoxin removal
c. adolescent health
d. cash transfers, education, media, and community-level work
Even more exciting:
This and maternity care and more can be funded via women's bonds .... which ends dependency on aid budgets ... and blended finance.
This is a draft presentation, for a general and student audience, aiming to be easy to read on mobile or laptop. Constructive feedback via Messenger / Google form is very welcome, and so are early volunteers (call me! Whatsapp +447765477305)
The problem:
Stunting-at-birth affects whole family well being; baby's brain, gut, immune system; adult IQ, adult earnings. It is preventable. The term "stunting" is actually from forestry (impaired growth of trees) but in human babies it's much more than just the visible impact on height/length: it's a whole syndrome of direct and epigenetic consequences, set in motion near the start of pregnancy.
One very useful focus is from Tufts/USAID's Dr Richard Webb on "group 1 stunting" because this is very serious, affects lifetime IQ, gut, nutrient absorption, and appears to be irreversible, so it must be prevented.
Triple win:
Many of the interventions which end group 1 stunting-at-birth also reduce prematurity and maternal mortality.
Why neglected?
The people who see stunting and its near term consequences are parents, nurses, midwives, paediatricians, UN agencies and later teachers, but research now shows that the people who can prevent it, alongside parents, are working in adolescent health, nutrition, agriculture, ventilation, women's empowerment, education, media. The research and impact studies connecting the two is only now coming through.
It seemed hard to solve. Until recent research by Webb and LHSTM, and some great work by NGOs listed below, it wasn't clear why anti-stunting interventions weren't working through age five: we now know that nutrition before conception is vital, and that aflatoxin and smoke play a role. So, suddenly, stunting-at-birth is solvable!
In the last 2 decades, stunting has been neglected relative to wasting, which is a more visible problem, popular with donors and paediatricians.
Most senior doctors alive today were taught in the 1970s-90s that the placenta ensures the foetus has all it needs, even if mother is malnourished, but research since then has overturned this ... so the worst case is that adolescent girls and women are being neglected, because some powerful doctors/funders haven't updated, and governments and large NGOs are fixated on infant feeding, PlumpyNuts, etc. There are exceptions, including Dr Andrew Prentice, a remarkable team at the World Bank, and many brilliant women's and community CSOs.
Solutions summary:
# Eliminate aflatoxins, smoke, anaemia before pregnancy
Aflatoxin can be done fast: the mould glows with a <$9 UV light
# Eradicate parasites before pregnancy
Cheap, relatively easy; very important for countries with malaria etc; ante-natal care and maternity also important, reduce maternal mortality.
# Empowerment including conditional cash transfers
Community interventions which reach mothers before conception are vital, and have other benefits - many studies prove this.
# Enable good NUTRITION BEFORE CONCEPTION
Varied diet is crucial, but it can take 6 months to get a healthy level of iron; in clinics or UNHCR camps, IV infusion is possible.
# Education/media work (integrated with the above)
In the "Solutions Gallery" below, I've included (on the left) real world studies showing routes to impact, and (on the right) ways to make this fundable.
For those who like a video intro, Dr Andrew Prentice below explains why programmes on ante-natal care, breastfeeding and infant feeding alone are important but not sufficient:
Dr Prentice highlights the importance of intervening before pregnancy, and maternal nutrition.
Women in many countries take folate when wanting to conceive, so as to prevent spina bifida. Likewise, malnutrition during early pregnancy leads to problems with a newborn baby's brain, gut and immune system. This causes problems with absorbing nutrients. It means that no amount of vitamins, Plumpy Nuts and so on in infancy will solve things if mothers and mothers-to-be are neglected, also because breast milk is affected.
Background and Mission
Importance: stunting and maternal mortality together affect >20% of families globally:
in South Asia >22% .... USA >3% .... Ethiopia >60%.
They must be ended to end the poverty cycle and protect global IQ. Projects which draw on the best research and innovative finance can do this, and scale. This could be the most crucial social inclusion step of this century, enabling universal literacy.
Mission: we will ensure that by 2040 almost every baby is born with their mother alive and well, and with an undamaged brain, gut and immune system. We will help to scale success, using bonds, impact bonds, impact research and ... whatever it takes.
Current focus:
identifying: (a) path-to-impact (b) gaps in provision & planning (c) priorities other than Nigeria, UK, USA
advocacy for proof-of-impact research on complete prevention of group 1 stunting-at-birth (for example: complete suite of cash transfers, aflatoxin/smoke reduction, education, diet variety, anaemia/parasite prevention, ante-natal care)
fundraising for London, Asia and Africa teams
setting up: a scalable finance enterprise
(to complement work by TPON, SUN and Welthungerhilfe, and structure bonds for middle income countries, enabling aid to focus on lowest income countries)catalyse production of missing online content (for example: importance of working pre-conception, community interventions, cash transfers, work with adolescents, husbands, etc)
Why group 1 stunting matters so much: 20% of the world's babies are stunted, and those in group 1 are still stunted at age five, have lasting brain damage. This is the world's single greatest and most pernicious social inequality. It feeds the poverty cycle, because group 1 babies are more ill throughout childhood, do less well in education, and have reduced IQ and income as adults. Research highlights are in the gallery below.
Solutions: infant feeding programmes and ante-natal care are popular and important, but alone they can not solve this. As explained by the research below, it's also essential to nourish mothers before conception. This can be achieved through education, work with adolescents, spacing pregnancies, cash transfers, media work, etc. Maternal mortality can be brought down by a range of established methods, also by treating anaemia or (better) preventing it from adolescence onward. Malaria in pregnancy is especially important in Nigeria and DRC, also parts of Asia.
Key locations: Louisiana, Lancashire, India, Nigeria, Ethiopia, Kenya, Uganda, London's Tower Hamlets, Rwanda, DRC, West Ukraine, East Slovakia, Romania, Turkey .... more detail to follow
SOLUTIONS GALLERY
Below is key research, impact routes and finance mechanisms we want to help apply. They are presented here to show why previous work hasn't fully succeeded, and how that can be turned around.
NB. Links are not to our source work: all credit belongs to linked authors. Left side is research, right side is implementation and funding.
His and others' work shows that shows:
the worst kind of stunting is present at birth and still present at age 5, despite intensive infant feeding
it's caused by maternal malnutrition, also aflatoxin and smoke affecting mother and foetus during pregnancy
it happens early in pregnancy*
it is preventable, with very specific measures with mothers-to-be, but not by infant feeding
*confirmed by MRI scans in this remakable study from London and Cape Town.
It can take months to correct anaemia, so doing things through ante-natal care is way too late: prevention needs pre-conception interventions.
This means (for example) interventions via media and at community level, and with adolescents.
It also explains some of the successes below, especially healthy diet education for adolescents, and conditional / open cash transfers to future mothers.
An international NGO based out of London, working on blended finance to support nutrition interventions in some of the poorest countries, and low income communities in Nigeria.
This is important because gov-to-gov aid and charity is unreliable, often inflexible, and will never be sufficient. Bonds and blended finance demand results, and also give countries or cities control and autonomy.
There are ways to ensure the money is spent well.
Call to action: right now, $10M from a philanthropists would release $50M from World Bank - please call us if you know someone!
Benefit-cost of interventions
Successes:
Cash transfers in Pakistan (AAH-NY and ENN)
Review of conditional cash transfers in Latin America (working provably via maternal nutrition)
Key research:
UCLA and Wageningen work showing importance of nutrition pre-conception and during pregnancy, and failure of infant feeding. (Indonesia, Mexico, Egypt, Kenya.)
Maternal mortality from bleeding at birth is preventable and treatable, proven in WOMAN-2 trial.
There's a visual WHO test for anaemia in adolescents which costs 2 cents from ICRC.
Questions?
Contact Ray Taylor on the numbers below to get more information about the embryonic project
(UK time zone)
