SHAPING THE FUTURE HOW CHANGING DEMOGRAPHICS CAN POWER HUMAN DEVELOPMENT

and under-five mortality rates also have high
fertility rates. When expected child survival is
low, families continue to have more children, and
face a lower probability of reaching their ideal
family size. Afghanistan, Kiribati, Lao People’s
Democratic Republic, Pakistan, Papua New
Guinea and Vanuatu are countries facing this
issue. Others have achieved low child mortality
while reducing fertility rates.
FIGURE 3.5:
Malnutrition rates are generally
higher in South Asian countries than
East Asian ones
HOME TO HALF THE WORLD’S
STUNTED CHILDREN
Nearly half of all deaths in children under five
are attributable to malnutrition—the situation
is even worse for children with disabilities (Box
3.7). Poor nutrition in the first 1,000 days of a
child’s life can lead to stunted growth that impairs
cognitive ability, and later school and work
performance. 46 A child stunted by malnutrition
also faces a higher risk of non-communicable
illnesses such as diabetes, obesity and cardiovascular
diseases. 47 If caught early enough, the
impacts of stunting can be reversed, but over
time, the consequences can be lifelong.
Between 1990 and 2013, stunting declined
globally, from 40 percent to 25 percent of children
under five. In Asia-Pacific, more than
100 million children under five are free from
stunting as a result—numbers have fallen from
183 million in 1990 to 82 million in 2013. The
region still accounts for half of the world’s
stunted children, however. 48 In Afghanistan,
Bangladesh, Cambodia, India, Lao People’s
Democratic Republic, Nepal, Pakistan, Papua
New Guinea and Timor-Leste, more than 40
percent of children under five are stunted (Figure
3.5). Nepal reduced stunting by more than
one-third over a little more than 15 years, albeit
from excessively high levels. Stunting levels
are on average twice as high in the poorest 20
percent of households compared to the richest
20 percent in Bangladesh, India, Indonesia and
Nepal. Both stunting and wasting rates are
higher for boys than girls. 49
Between 1990 and 2013, Asia-Pacific made
significant progress in lowering the share of
underweight children under five, which fell from
20 percent to just 5 percent in East Asia and
the Pacific, and from 52 percent to 32 percent
in South Asia. The region still accounts for
Note: data ranging from 2000 to 2013.
Source: WHO 2016b, OECD-WHO 2014.
two-thirds of the world’s underweight children,
however, and leads other world regions in the
share and number of low birth weight children. 50
Infants born at a low birth weight are at greater
risk of death during the neonatal period. Globally,
South Asia and East Asia and the Pacific in 2013
had the highest percentages of child mortality
attributable to neonatal deaths. 51
For the region as a whole, further progress
on child nutrition depends largely on South
Asia, which has the highest prevalence and
greatest numbers of children under five affected
by malnutrition. Reducing poverty, achieving
nutrition and food security, and improving
feeding practices are among the most critical
issues to accelerate progress.
A stunted child
faces a higher risk
of non-communicable
illnesses as an adult
97