Nutrition Month: ‘Iwas stunting, sana all’

July is Nutrition month in the Philippines, and this year’s theme—“Batang Pinoy, Sana Tall; Iwas Stunting, Sana All”—embodies our people’s long-standing aspirations and struggle with height. More than a sign of good health and nutrition, tallness is associated with attractiveness, employment opportunities, and social standing in a country where the average height is 163.6 cm (about 5 feet 4 inches) for males and 152 cm (a little less than 5 feet) for females. With these numbers, Filipinos are among the world’s shortest people.

Contrary to popular belief, Filipinos are not naturally short. Genetics may contribute, but World Health Organization cohort studies have established that children from different continents and ethnicities share similar growth patterns provided they are well-nourished, given the proper care, and grow in clean, safe, nurturing environments. What has held back the height of many Filipino children is the stunting caused by the absence of these conditions. Alarmingly, only 23 percent and 13.4 percent of Filipino infants and young children 6-23 months old meet the minimum diet diversity and minimum acceptable diet recommendations of WHO.

Stunting is deceptively insidious, but it has profound and lasting consequences. Stunted children are less active, their motor and mental development are not at par with better-nourished peers, they do less well in school, and because their immune systems are compromised, they are more likely to get sick and die prematurely.

When stunted children survive into adolescence and adulthood, the consequences continue to affect work performance, incurring 6 to 8.6 percent declines in productivity for moderate and severe stunting, respectively. More compellingly, studies have found that every 1 cm increase in height translates to a 4 percent increase in wages for men, and an even larger (6 percent!) increase in wages for women.

At an individual level, the losses might seem small, but when we consider that 1 in 3 of our children are stunted, the aggregate loss to our country, from stunting alone, is calculated by Unicef to be a staggering $2.4 billion a year. That amount could be a make-or-break factor for our economy, particularly during this time of COVID-19.

The pandemic is bound to exacerbate stunting, given the redirection of financial and human resources to COVID-19 at the expense of, as well as the economic and logistical barriers to, the delivery of health and nutrition programs. Preventive and promotive services such as immunization, Vitamin A and iron supplementation, early care of childhood illnesses, and feeding programs for pregnant mothers and young children are effectively in limbo, with dire consequences for the millions who need them.

Beyond the interventions focused on food security and health care, we must also recognize that stunting is a syndrome, and preventing it entails addressing a wide range of factors beyond food alone. These extend from the microscopic, such as the child’s gut microbes, to sanitation and hygiene, access to safe water, as well as stressful living conditions. Critical to this continuum are the mother’s needs—her own health and nutrition, her safety and well-being. For the increasing number of teen moms, their own growth and maturation affect their ability to nurture and care for their children. In the context of COVID-19, we need to reflect on how various restrictions and systems breakdowns impact the health and nutrition of children.

National and local governments must act to protect our children NOW—especially those in the crucial period of the first 1,000 days of life—from stunting. Actions that cannot wait include: breastfeeding exclusively for six months and, together with complementary feeding, at least up to two years thereafter; access to safe, sufficient, and appropriate food for both the child and her mother; and enabling primary care capacity to implement crucial maternal and child care programs. While COVID-19 is an urgent concern, we cannot succumb to a “covidization” of health care at the expense of essential health and nutrition services.

Growing children cannot wait. The pandemic’s imprint on our children’s physical growth—and our futures—will remain long after it is over.

* * *

Cecilia Santos-Acuin, a physician and nutritional anthropologist, is the current president of the Philippine Association of Nutrition. Gideon Lasco is a physician, medical anthropologist, research fellow at the Ateneo de Manila’s Development Studies Program, and an Inquirer columnist.