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Malnutrition is the number one killer of children under age 5.


Malnutrition is an underlying factor in about 45% of deaths in children under age 5. [1] Malnourished children, particularly those affected by more severe forms of malnutrition, have a higher risk of death from common childhood illnesses, such as diarrhea, pneumonia, and malaria.  Globally, 15% of newborns have a low birth weight, 22% of under-5 children are affected by stunting, and 7.3% of under-5 children are affected by wasting. [2] Those who do survive severe malnutrition in early childhood are much more likely to suffer from lifelong illness and impaired cognitive development. 


This child death and disability is preventable. After years of study, scientists have identified a suite of clear, proven and affordable nutrition interventions that are ready to scale today. [3] These include supplying children with two high doses of vitamin A every year and ensuring pregnant women have prenatal vitamins and the support they need to breastfeed their babies. Models show that even if only 65% of those in need received these interventions, it could save millions of children over the next five years.[4] 


Nutrition interventions are some of the best buys in global development. Leading economists consistently rank nutrition interventions among the most cost-effective ways to save and improve lives around the world. [5]

Malnutrition is severely underfunded. Even though malnutrition is the underlying cause of 45% of all child deaths, and even though nutrition interventions are excellent investments, less than 1% of U.S. global health funding goes to nutrition. [6] This lack of funding has devastating consequences. From 2012 to 2020, an additional 9.5 million children’s lives across 25 U.S. Agency for International Development priority countries could have been saved if those children had been properly nourished.[7]


Make nutrition a key U.S. global development priority. The world is ready to end malnutrition-related child deaths, but progress needs bold leadership. The United States is well-placed to provide this leadership by leveraging investments from other donors and governments, and reaching globally agreed-upon health targets.

Increase funding to scale up proven nutrition interventions, especially by investing in the nutrition sub-account within the Global Health account at USAID. Congress has modestly but steadily increased nutrition funding [8] over the past several years, in large part due to the compelling new evidence supporting these cost-effective, high-impact interventions. Congress has also recently supported the development of several key strategies [9] prioritizing improved nutrition. Congress must provide sufficient resources to fully operationalize these strategies. Continuing the current level of funding will not allow these efforts to fully deliver on their promise.

Ensure global nutrition is a key pillar of any U.S. COVID-19 response plan. COVID-19 has overwhelmingly increased the number of children suffering and dying from severe malnutrition. Fortunately, these deaths and long-term disabilities are preventable. The heads of four key U.N. agencies recently called for a minimum of U.S.$2.4 billion for an Essential Package of four lifesaving interventions [10] to protect children and avoid preventable human loss.[11] If sustainably scaled, these high-impact interventions will not only save children today, but continue to reduce cases of malnutrition for years to come. We call on Congress to support an immediate rollout of the Essential Package and ensure addressing nutritional programming remains central to any global COVID-19 response strategies.

Photo Credit: World Vision

Smiles because today we are going to eat! Furaha and her daughters Jane and Shona full of joy after receiving their food ration at Sweswe Food Distribution Point in Kyaka II refugee settlement


Malnutrition in all its forms has become the leading cause of ill health and death globally, yet most people cannot access or afford quality nutrition care for prevention or treatment. Only about one-quarter of the 16.6 million under-5 children with severe acute malnutrition received treatment in 2017.[12] any of those children who survive are afflicted with lifelong illness, impaired cognitive development and lower IQs. Leading scientists and economists have consistently demonstrated that global nutrition interventions are some of the most successful, cost-effective, and scalable development investments. Compared to a list of possible development investments, studies show that nutrition interventions consistently generate some of the highest returns, [13] yielding up to $35 in economic returns for every $1 the U.S. spends. If the U.S. aims to maximize the return on its investments across development and humanitarian assistance, nutrition is a smart choice. 

The benefits of improved nutrition extend far beyond global health. For example, nutrition interventions are a cost-effective and under-leveraged resource in the fight for women’s rights.[14] Well-nourished women and girls are healthier, more productive and more likely to finish school, be economically independent and have healthy babies. Similarly, investments in child nutrition are the cornerstone of productive adulthoods, robust communities and well-functioning societies. One sees the same outsized effects across a host of other development sectors: prioritizing nutrition programming and increasing related resources can have a multiplier effect.

Severe malnutrition stunts potential and wastes lives, but it does not have to. Scaling up proven nutrition interventions will allow children around the world to escape these preventable deaths. With current levels of nutrition financing far below what is needed to meet agreed-upon global nutrition targets,[15] ambitious U.S. government investment in global nutrition can uphold America’s legacy of leadership, vision and goodwill, unlock additional resources from other donors and country governments alike, and improve overall health and well-being on a global scale.


COVID-19-related disruptions are causing rates of severe malnutrition to rise substantially. Recent estimates predict that every year these disruptions continue, an additional 6.7 million children will suffer from wasting,[16] a severe form of malnutrition that increases a child’s chances of dying up to 11 times.[17] In many parts of the world, malnutrition related to the pandemic is projected to kill more people than the pandemic itself.[18]

Malnourished individuals are at a far greater risk of contracting and dying from infectious diseases, allowing these diseases to spread more easily.[19] Improving nutritional status around the world is a key way to build resilience to future pandemics.


Emma Feutl Kent, 1,000 Days,

Meaza Getachew, 1,000 Days,

HEADER PHOTO CREDIT: Humana People – Planet Aid




[3]  Bhutta, Zulfiqar et. al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Maternal and Child Nutrition. The Lancet. 

[4] Johns Hopkins School of Public Health. 2020. The Lives Saved Tool (LiST)

[5] Copenhagen Consensus 2012. Outcome: The Expert Panel Findings

[6] KFF. 2020. Breaking Down the U.S. Global Health Budget by Program Area

[7] USAID. 2019. Acting on the Call: A Focus on the Journey to Self-Reliance for Preventing Child and Maternal Deaths.

[8] While the Global Health Programs – USAID (GHP-USAID) account is not the only source of funding for U.S. global nutrition programs, it supports vital services such as providing nutrition education to improve maternal diets, enhancing nutrition during pregnancy, promoting exclusive breastfeeding and improving feeding practices for infants and young children. Resources from GHP-USAID, Global Health Programs – State, Food for Peace (FFP), Development Assistance (DA), and the Economic Support Fund (ESF) also support the promotion of diet quality and diversification (fortified staple foods, specialized food products, community gardens), along with the delivery of nutrition services such as micronutrient supplementation and community management of acute malnutrition.

[9]These strategies include the USAID Multi-Sectoral Nutrition Strategy, the U.S. Government Global Nutrition Coordination Plan, and the U.S. Government Global Food Security Strategy.

[10] The Essential Package calls for: prevention of wasting in children at risk; treatment for children who are wasted; biannual vitamin A supplementation for children ages 6 to 59 months; and mass communication for the protection, promotion and support of breastfeeding that focuses on caregivers or families of children ages 0 to 23 months.

[11]  Fore, Henrietta H et. al. 2020. Child malnutrition and COVID-19: the time to act is now. The Lancet. 


[13] The World Bank. 2006. “Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action.” 

[14] Feutl Kent, Emma. 2020. Nourishing Gender Equality: How Nutrition Interventions are an Underleveraged Tool in the Fight for Women’s Rights

[15] The Global Nutrition Report. 2020. FIGURE 5.1 The Global Solidarity financing scenario: additional financing needs to achieve WHA nutrition targets

[16] Fore, Henrietta H et. al. 2020. Child malnutrition and COVID-19: the time to act is now. The Lancet.

[17] Headey, Derek and Marie Ruel. 2020. Economic Shocks and Child Wasting. IFPRI Discussion Paper 01941.

[18] FAO, IFAD, UNICEF, WFP and WHO. 2020. The State of Food Security and Nutrition in the World 2020. Transforming food systems for affordable healthy diets. Rome, FAO.

[19] Bourke et. al. 2016. Immune Dysfunction as a Cause and Consequence of Malnutrition.