Why does exclusion matter for malnutrition?

Many countries have shown it is possible to address malnutrition. Yet for millions of children who still suffer because of malnutrition, progress has not been fast enough or equal enough. Why is this?

A recent report (Shaheen et al. 2016) shows how certain groups are being left behind at the startof an era in which the commitment from world leaders is to “leave no one behind.” Our research (including data from Save the Children’s GRID1 database) shows that children’s life chances and health outcomes are lower than average if they are girls, refugees, displaced or disabled, or from a regionally disadvantaged area within a country or an excluded ethnic group. Not only are such children poor, but they are discriminated against and have little or no say in the decisions that affect their lives. Findings include the following:

  • Inequalities in stunting between regions within countries are increasing in 52 percent of countries for which we have data (Shaheen et al. 2016).
  • In Ghana, Gurma people are morethan three-and-a-half times more likely to be stunted than the Ga and Dangme people. The gap has increased from two times more likely in 2008 (Shaheen et al. 2016).
  • In Viet Nam, malnutrition rates are nearly four times higher among children from minority ethnic groups than those from the majority Kinh (GSO 2011).
  • A child in the remote North Westregion of Nigeria—where stunting rates are around 55 percent—is nearly four times more likely to experience malnutrition than a child in the South East region (Shaheen et al. 2016).
  • Children with a disability are consistently reported to have a high incidence of malnutrition, stunting, and wasting (AbdAllah et al. 2007). For example, children with cerebral palsy can be up to three times more likely to be underweight than nondisabled children (Tuzun et al. 2013).

What is underlying these statistics?

Ethnicity: Poor indicators of health and nutrition among disadvantaged ethnic groups are common, especially among indigenous peoples. Commonly reported barriers include lack of sanitation coverage; inequitable income distribution; and poor access to education, as seen in the cases of Brazil (Ferreira et al. 2012) and South Africa (Gradin 2015).

Disability: Many types of disability can be caused by malnutrition through lack of micronutrients or macronutrients or through exposure to high concentrations of antinutrients—toxins found in food, such as those in poorly processed cassava, that can lead to permanent neurological damage (Groce et al. 2013; Kuper et al. 2014). Disability can also lead to malnutrition through decreased nutrient intake, increased nutrient loss, and need for increased nutrients, which can put children at risk of further complications (Gradin 2015).

Children on the move: Worldwide displacement of people is now at the highest level ever recorded, with an estimated 59.5 million people (as of 2014) forcibly displaced as a result of persecution, conflict, generalized violence, or human rights violations (UNHCR 2014b). Refugees have a high burden of malnutrition and anemia; treatable noncommunicable diseases, exacerbated by lack of access to regular medication; and infectious diseases, including hepatitis A and B and parasitic diseases (Langlois et al. 2016).

Gender: Preferential treatment based on gender can result in differing feeding practices and food intake. In Kenya, a strong gender bias in intrahousehold food distribution was found to lead to more girls with malnutrition, stunting, wasting, and infectious diseases (Ndiku et al. 2011). Globally, while there are no major gender disparities in rates of stunting in children under 5 (Shaheen et al. 2016), as boys and girls get older, the disparities become more apparent (Bhutta and Zlotkin 2014)—up to half of all adolescent girls are stunted in some countries (Black et al. 2013).

Women are particularly vulnerable to malnutrition because of their high nutrient requirements during pregnancy and lactation and because of gender inequalities in poverty (Delisle 2008). In some settings, high rates of adolescent pregnancy and early marriage can further compound these disparities.