JULY 26 — In a written parliamentary reply last week, Health Minister Datuk Seri Dzulkefly Ahmad said the country’s prevalence of stunting among children under five has increased from 17.7 per cent in 2015 to 21.2 per cent in 2022.
In fact, Malaysia’s current stunting prevalence is higher than its 1999 level. This in contrast to the steadily improving global rate which is now at 22.3 per cent, having previously stood at 33.5 per cent in 1999.
Despite being an upper middle-income country, Malaysia’s stunting rate is higher than some lower middle-income and low-income countries such as Ghana and Senegal. The prevalence of stunting in upper middle-income countries stands at 8.3 per cent, a striking distance from Malaysia’s 21.8 per cent.
Malaysia’s stunting prevalence is far worse than West Bank & Gaza (7.4 per cent) and comparable to Iraq’s stunting rate (22.6 per cent) at the end of the American invasion in 2011. Malaysia’s current rate far exceeds the target of 11.0 per cent to be achieved by the year 2025 under the National Plan of Action for Nutrition of Malaysia 2016-2025.
Stunting is still poorly understood, which may explain why efforts to reduce stunting in the country bear little fruit. Here are a number of myths about stunting:
1. Stunting only affects height
It is true that stunting means that a child is short for their age. Beyond just the child’s height however, numerous studies show that stunting actually wields devastating and practically permanent effects on a person’s cognitive development, reduced educational achievements, future health outcomes, and lower earning potential in adulthood.
2. Stunting is due to genetics
Contrary to popular belief, environmental differences rather than genetic endowments are the main determinants of differences in physical growth.
The Multicentre Growth Reference Study collected data on the growth of 8500 children aged 0-5 years from six sites (Brazil, Ghana, India, Norway, Oman, and the USA) and found that average growth is strikingly similar around the world when conditions for growth are optimal. The study found only about 3 per cent variability in foetal growth, whereby this variability is caused by factors unrelated to genetics or ethnicity, and were more influenced by nutrition, environment, and healthcare differences.
3. Stunting is caused by a lack of food
Nutrition is crucial for a child’s growth, especially during the critical first 1,000-day period covering pregnancy and the first two years of the child’s life. In actuality, stunting reflects the deficiencies in a child’s entire growth environment, of which nutrition is one of many other factors. Stunting is a complex issue with multiple causes which are linked to a combination of factors including inadequate healthcare, poor sanitation, and underlying infections. It is therefore problematic to label stunting as a “malnutrition” condition rather than what it is: growth failure due to environmental constraints. This explains why decades of research on real-life nutrition interventions show not just minimal but mostly null improvements on height, although the same interventions have highly positive results in other nutritional indicators. For instance, vitamin A supplementation and exclusive breastfeeding significantly lower morbidity and mortality, but do not impact stunting. Instead, policy interventions need to have multi-factorial solutions that encompass the child’s entire growth environment.
4. Stunting can be remedied during later years of a child’s development
Some parties have called for the revival of free breakfast programmes in schools or the provision of milk and other food aid to address stunting. While these food programmes can positively impact both health and educational outcomes and should be implemented for these benefits, the effects of stunting itself are largely irreversible after the first 1,000 days. This means that such interventions at the school-level may not have an impact on stunting. Instead, anti-stunting policies and interventions should focus on the critical 1,000-day window.
Tackling child stunting in Malaysia requries both policymakers and the public to understand and dispel these myths, in order that resources and efforts can be channelled correctly and effectively towards tackling the root causes of stunting in Malaysia. Policies cannot be made on the basis of myths and misunderstandings. Otherwise, we risk the wellbeing of our children — not only their futures, but their present too.
* Derek Kok is Senior Research Analyst at the Jeffrey Cheah Institute on South-east Asia, Sunway University. He is an expert on child stunting and social protection policies for children.
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
