Drivers of Stunting Reduction in Bangladesh: A Country Case Study
Purnima Menon, Derek Headey, Harold Alderman
The American Journal of Clinical Nutrition · 2018 · DOI: 10.1093/ajcn/nqy216
Countries: Bangladesh
What Was Studied
A comprehensive case study analysing the factors that drove Bangladesh's dramatic reduction in childhood stunting from 51% to 28% over 14 years, using decomposition analysis of nationally representative survey data combined with qualitative policy analysis.
What They Found
The stunting reduction was driven by multiple sectors, not nutrition programmes alone: (1) Economic growth and poverty reduction accounted for 25% of the decline; (2) Improvements in maternal education (19%); (3) Better sanitation and hygiene (WASH) — open defecation fell from 42% to 1% (16%); (4) Improvements in women's decision-making autonomy (12%); (5) Nutrition-specific interventions including micronutrient supplementation and complementary feeding (15%). No single sector accounted for more than a quarter of the progress.
What This Means for Nepal
Nepal's Multi-Sector Nutrition Plan is on the right track by targeting nutrition through multiple sectors. Bangladesh's experience confirms that nutrition-specific programmes alone are insufficient — Nepal must simultaneously invest in WASH, girls' education, women's empowerment, and poverty reduction. The striking impact of eliminating open defecation is particularly relevant for Nepal, where open defecation remains significant in some provinces. Local governments should integrate nutrition into all health and development planning.
Contextualisation
Nepal and Bangladesh share similar stunting challenges in South Asia. Bangladesh reduced stunting from 51% to 28% between 2004-2018. Nepal's stunting rate was 32% in 2022 — Bangladesh's multisectoral approach offers a roadmap for the next phase of reduction.