Child stunting: lessons from global history

Child stunting, being too short for one’s age, is widely seen as a problem of today’s poorer countries. A systematic review of data from 122 countries since the 19th century reveals that stunting was once common in wealthy nations. Pathways to decline varied, Eric B. Schneider observes, depending on more than income or infrastructure.

Child stunting, the condition of being too short for one’s age, affects an estimated 152 million children worldwide today, concentrated in sub-Saharan Africa and South and Southeast Asia (UNICEF-WHO-The World Bank 2025). This framing, familiar from global health statistics, can give the misleading impression that stunting is a persistent feature of poorer societies. In a recent open-access study published in BMJ Global Health, we assembled the most comprehensive historical record of child growth yet produced, covering 122 countries from the late 19th century to the present (Schneider et al. 2026). The findings reveal a world in which the geography of child malnutrition has changed enormously and offer important lessons for reducing stunting today.

Rich countries were once highly stunted

Before the 1980s, systematic global data on child stunting simply did not exist. To fill this gap, our team of 43 researchers from 34 countries conducted a systematic review of child growth studies, many of them never previously digitised. We located more than 1,000 studies covering over 129 million children. Stunting rates were computed in a standardised way using the World Health Organization’s 2006/2007 growth reference, allowing meaningful comparisons across countries and time.

The historical evidence overturns a common assumption. In the early 20th century, child stunting rates in many Western European countries were comparable to levels observed in lower-income countries today. Rates were highest of all in Japan and South Korea, where they exceeded 70% in 1900, well above the worst levels seen today. At the same time, Scandinavia, North America and the Caribbean had relatively low rates, indicating that the historical geography of child malnutrition looked very different from modern global maps. Figure 1 presents trends for 25 countries with reliable data.

Rapid decline is possible — but the pathway varies

Japan’s experience is among the most striking. Stunting declined at roughly 0.8 percentage points per year before the Second World War, then accelerated sharply to 2.2 percentage points per year afterwards, driven by rapid economic growth, dietary diversification and major improvements in public health. By the 1980s, stunting had been virtually eliminated. South Korea followed a similar trajectory. These rates of decline are among the fastest observed anywhere in the historical record, faster than celebrated recent successes such as Nepal, Ethiopia or Peru.

Yet the historical record also shows that there is no single formula. In Western Europe, the main stunting decline occurred during the interwar period, following improvements in urban sanitation and diet, but before the widespread introduction of antibiotics or formal child health services. In some countries, including Nigeria and the Philippines, progress has been much slower despite decades of economic growth, reminding us that rising incomes do not automatically translate into improvements in child nutrition.

One especially instructive comparison is between England and Jamaica in the early 20th century. England had made enormous investments in clean water and sewerage during the 19th century, successfully eliminating cholera and driving down typhoid mortality. Yet child stunting remained above 40% in the 1890s, and diarrhoeal disease remained a leading cause of infant deaths. Infrastructure alone was not sufficient.

Jamaica, by contrast, achieved a stunting rate of only 21% by the 1940s despite being far poorer. A key factor appears to have been a multifaceted Rockefeller Foundation hookworm eradication programme launched in 1919. The campaign combined medical treatment with latrine construction, education campaigns and community engagement, addressing both infrastructure and health behaviour simultaneously. The result was a dramatic fall in infant mortality and improvements in child growth. This suggests that behaviour change, not just physical infrastructure, is often decisive.

Policy implications: context matters

This historical perspective has several implications for policy today. First, it challenges fatalism. Countries now wrestling with high stunting rates are not trapped in a fixed condition. The experience of today’s high-income countries demonstrates that dramatic and sustained reductions are achievable.

Second, the historical record suggests we should not expect a single intervention to suffice. Broad-based development, including improvements in diet, sanitation, disease control and maternal health, has generally been necessary, even if specific contextual factors accelerated or slowed the process in particular settings. Targeted interventions that address only one determinant of stunting, whether malnutrition, sanitation infrastructure or economic growth alone, have shown mixed results both historically and in contemporary trials.

Third, our findings underscore the importance of health behaviour change alongside infrastructure investment. Historical cases in which sanitation improvements led to limited gains in child growth point to a consistent challenge: reducing the repeated infections that impair children’s ability to absorb nutrients requires not only providing toilets and clean water but also changing everyday practices. Failure to convince people to change their daily habits may help explain  the persistence of open defecation in countries like India despite major investment in sanitation infrastructure.

Finally, our results have implications beyond child health. Because the elderly in today’s high-income countries experienced high levels of childhood malnutrition, and because stunting is associated with metabolic and cardiovascular risk later in life, historical stunting patterns may help explain contemporary patterns of population ageing and chronic disease.

At the beginning of the  early twentieth century, the global child stunting rate was almost certainly far above the 47% estimated in 1985. The reductions achieved since then represent one of the great, if underappreciated, improvements in human welfare. History shows that further progress is possible and that understanding how it was achieved matters for the path ahead.

Notes

*Figure 1 – Note: Three-letter codes are standard country codes (https://www.iban.com/country-codes).*

References

Schneider EB et al. (2026) “The decline of child stunting in 122 countries: a systematic review of child growth studies since the 19th century”. BMJ Global Health 11:e018607. https://doi.org/10.1136/bmjgh-2024-018607

UNICEF-WHO-The World Bank (2025) Joint Child Malnutrition Estimates (JME) — Levels and Trends – 2025 edition.