The chart below shows trends in child under-nutrition among all developing country regions over the period 1990-2012. Under-nutrition is measured by the proportion of children under five who are underweight (low weight for age reflecting wasting, stunting or both) as reported by the International Food Policy Research Institute in the Global Hunger Report for 2014.
It is clear from this chart that, on average, child nutrition has been improving everywhere over the last two decades.
Now take a look at the following chart showing trends in caloric adequacy as measured by the proportion of the population whose food intake is insufficient to meet dietary energy requirements continuously (data also taken from Global Hunger Report). This shows improvement in all regions except the Middle East and North Africa (MENA) and, to some extent, in Europe and Central Asia (ECA) which has had a mixed trend. Why has child nutrition continued to improve in MENA despite an unfavorable trend in caloric intake?
To understand what may be going on it is helpful to have a conceptual model of the determinants of child nutrition. My preferred model stipulates first, that child nutrition is determined by both food quantity and food quality; and second, that the impact of food quantity is subject to a threshold effect. Once a certain minimum caloric intake is ensured, moderate variations in this level have a limited impact on child nutrition. Using this model, I would argue that the dominant determinants of child nutrition in MENA in recent years have been factors related to food quality as the region has been at or above the threshold level of caloric adequacy.
While this sort of model is best assessed through a multivariate regression, we can check its basics through simpler methods. For example, is the threshold assumption reasonable? Look again at the caloric sufficiency chart above. It is clear that undernourishment levels in the MENA and ECA regions have been the lowest among developing regions, averaging around 6% over the past two decades. Other regions, such as South Asia, Sub-Saharan Africa and East Asia, have much higher levels of caloric inadequacy despite improving trends.
We can also check the validity of the other element of the model, namely, the role of food quality. Lacking long-run data series on children’s food intake composition by country we must make do with proxies. One reasonable proxy for good child nutrition practices is mother’s education. Other proxies could be breastfeeding practices or access to clean drinking water and sanitation. The next chart shows trends in female education by region. It is clear that MENA has seen substantial improvements in female educational attainment over the past twenty years, indeed at the fastest rate among developing regions. So it is fair to assume that the MENA region must have benefited exceptionally from this in terms of child nutrition.
To recapitulate, given the relatively high average level of caloric intake in the MENA region, recent gains in child nutrition have likely come from improvements in food quality. Of course, for countries like Iraq and Yemen that continue to have high levels of caloric deficiency one must continue to be concerned about child nutrition problems arising from this source.