The number of malnourished children in the developing world has remained fairly constant. However, while experience varies by region, the prevalence of malnutrition has been progressively declining: in 1970 the percent of underweight children under age five in developing countries was 46.5 percent; by 1995 this share had dropped to 31 percent (Figure 1). Explaining Child Malnutrition in Developing Countries: A Cross-Country Analysis, Research Report 111, by Lisa C. Smith and Lawrence Haddad, draws on the experience of 63 developing countries over this 25-year period to clarify the relative importance of the various determinants of child malnutrition for each developing region. Six factors are explored; the first four have a more direct influence on malnutrition. The four, ranked by their strength of impact, are women’s education, national food availability, women’s status relative to men’s, and health environment quality. These are termed “underlying determi-nants.” The other two, termed “basic deter-minants,” are national income and democracy, which influence malnutrition indirectly by facilitating investment in the direct de-terminants. The report concludes by iden-tifying policy priorities for reducing child malnutrition at the fastest pace now and over the coming years to 2020 for each developing region. The method employed is country fixed-effects regression analysis.

It is not surprising, then, that this report finds women’s education and status relative to men’s to be strongly associated with child malnutrition in developing countries. Improvements in female secondary school enrollment rates are estimated to be responsible for 43 percent of the total 15.5 percent reduction in the child underweight rate of developing countries during the period 1970–95. The estimated contribution of improvements in women’s status relative to men’s is only 12 percent, mainly because there has been little progress in this area during the period in spite of its strong influence (Figure 2). Women’s relative status in the report is measured by the ratio of female life expectancy to male life expectancy.

The quality of the health environment, such as water cleanliness, sanitation, and access to health services, is also known to be a prime determinant of children’s nutrition. The report, which uses the proportion of each country’s population with access to safe water as a proxy measure, confirms this assumption. Improvements in safe water access during 1970–95 have led to major reductions in child malnutrition (Figure 2). However, while it is an important part of the picture, from a relative standpoint, this factor does not have as strong an impact as do women’s education and status and national food availability.

Growth in national income per person is an extremely potent force for reducing child malnutrition, and income growth was substantial in the developing world during 1970–95. The report estimates that about half of the total reduction in child malnutrition over the period came from income growth. Like national food availability, however, national income’s impact declines as it rises. As countries’ incomes increase, further income growth will contribute less to the reduction of child malnutrition. More effort will need to be placed on allocating income to the appropriate investments, such as increasing women’s education and food supplies, or on increasing the efficiency with which they reduce malnutrition.

While democracy is a potent force for reducing child malnutrition, it is not as strong as national income growth. Because the developing countries on average saw no increase in democracy during the period, this factor made no contribution to reducing child malnutrition.

Under all three scenarios, the absolute numbers of malnourished children in Sub-Saharan Africa are expected to be higher in 2020 than they were in 1995. A sharp regional shift in the location of child malnutrition is projected: South Asia’s share of the total numbers of children will fall from 51 percent to 47 percent, but Sub-Saharan Africa’s share will rise from 19 percent to near 35 percent (Figure 4).

But the future does not have to be a reflection of past trends. Geographical areas where child malnutrition is most severe should receive high priority as well as the types of interventions that will reduce it at a faster pace. The report concludes by identifying priorities for reducing child malnutrition in each developing region based on (1) the relative strengths of impact of the four underlying determinants considered (national food availability, women’s education, women’s status relative to men’s, and the health environment) and (2) the degree to which each is below its desirable level in that region. In Sub-Saharan Africa and South Asia, improvements in per capita food availability and women’s education offer the best hope for future reductions in child malnutrition. In South Asia, promotion of improved status for women should also be prioritized. In East Asia, the Near East and North Africa, and Latin America and the Caribbean, women’s education should be given top priority, followed by women’s status relative to men’s. Additional secondary priorities are food availability for East Asia and health environment improvements for Latin America and the Caribbean. However, if national incomes and democracy are not improved, the resources and political will necessary for investing in health environments, women’s education and status, and food availability will not be forthcoming. These areas must also be prioritized in order for child malnutrition to be reduced and eventually eliminated in the 21st century. Finally, the report emphasizes that investments in all the areas considered will support the crucial role of direct nutrition programs, such as community-based programs to improve home-based caring practices, micronutrient supplementation, and food fortification.