Panel 6.2 How Did Bangladesh Reduce Stunting So Rapidly?

from 59 percent to 40 percent, nearly 1.4 percent a year over a sustained time period. For the 0–6-month age group, the declines have been even more rapid: from 28 percent to 16 percent. This rate of performance is significantly better than India’s. Over similar time periods, the decline in stunting rates of children under age 5 was almost twice as fast in Bangladesh.1 This is all the more puzzling because the evaluations of Bangladesh’s Integrated Nutrition Program (BINP) in the early years of the new millennium concluded that the impacts on nutrition were modest at best (White and Masset, 2007). So what has driven this rapid decline? Using repeated rounds of the Bangladesh Demographic and Health Survey (DHS) (1997, 2000, 2004, 2007, and 2011), an analysis explains about 55 percent of the declines in height-for-age, the basis of stunting rates (Headey et al, 2014). Which drivers are responsible for the portion of the decline in stunting that can be explained? The analysis shows that the drivers are multidimensional: improvements in household assets, parental education, sanitation coverage, demographic outcomes and health utilization all make important contributions to improvements in child height-for-age scores. As shown in Figure 1, increases in household assets are responsible for nearly a quarter of the explained declines in height-for-age. Changes in primary and secondary education, both maternal and paternal, are responsible for another quarter. So changes in the basic and underlying determinants are important. But so too are the more proximal determinants such as declines in open defecation rates (contributing 12 percent) and nutrition-related interventions in the health sector such as prenatal care and birth in a medical facility (together accounting for 18 percent of the decline). Finally, declines in fertility, an often-overlooked contributor (lower birth interval and lower birth order), are important drivers