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T H E STAT E O F T H E WO R L D ' S C H I L D R E N 2 019Children, foodand nutritionGrowing well in a changingWest andworldCentral AfricaEAST ASIA AND PACIFIC

3 T H E S TAT E O F T H E WO R L D ’ S C H I L D R E N 2 019A CHANGING WORLDIt is twenty years since The State of theWorld’s Children last examined children’snutrition, and, in that time, much has changed.These are the children whoare not growing well.Their numbers are worryingly high. Globally,one in three children under the age of 5is stunted, wasted or overweight and, inWe have changed where we live:some cases suffers from a combination ofmore families have left behind thetwo of these forms of malnutrition. In Eastcountryside and moved to cities.Asia and Pacific it is almost one in five.We have changed our roles: womenThe triple burden of malnutritionare increasingly joining the formalworkforce, balancing work responsibilitiesUndernutrition continues to affect tenswith their role as primary caregivers,of millions of children. Its presence isand often with little support fromvisible in the stunted bodies of childrenfamilies, employers and societies.deprived of adequate nutrition in the first1,000 days and beyond. These childrenLife on our planet has changed: climatemay carry the burden of early stunting forchange, the loss of biodiversity, andthe rest of their lives and may never meetenvironmental damage now raisetheir full physical and intellectual potential.concerns over whether we can feedUndernutrition is also evident in the wastedthis generation of children sustainably,bodies of children when circumstances likenever mind the generations to shortages, poor feeding practices andinfection, often compounded by poverty,And we have changed what we eat: we arehumanitarian crises and conflict, depriveleaving behind traditional diets and embracingthem of adequate nutrition and, in far toomodern diets that are frequently high inmany cases, result in death. In 2018, 149sugars and fats, low in essential nutrients.million children under 5 were stunted andThis is the backdrop to children’s malnutritiontoday. Like so much else, it, too, is changing.A word once inextricably linked in theIn 2018, 13 millionchildren under 5were stunted and4.5 million werewasted in East Asiaand the Pacificalmost 50 million were wasted. In East Asiaand Pacific, 13 million children under 5 werestunted and 4.5 million were wasted.public’s mind to images of hunger andDeficiencies of essential vitamins and mineralsfamine, malnutrition must now be used– hidden hunger – rob children of theirto describe children with stunting andvitality at every stage of life and underminewasting, but also those suffering from thethe health and well-being of children, young‘hidden hunger’ of deficiencies in essentialpeople and mothers. The numbers of childrenvitamins and minerals as well as the growingand women affected by various forms ofnumbers of children and young people whohidden hunger are striking. Recent globalare affected by overweight or obesity.estimates by UNICEF and partners indicate

U N I C E F E A S T A S I A A N D T H E PAC I F I Cthat at least 340 million children under 5groups that can support their rapidly growing(one in two) suffer from hidden hunger.bodies and brains. For the poorest children,the proportion falls to only one in five.The number girls and boys with obesitybetween the ages of 5 and 19 have soaredsince the mid-1970s, rising by between 10and 12-fold globally. Overweight and obesity,long thought of as conditions of the wealthy,are now increasingly a condition of the poor,reflecting the greater availability of ‘cheapcalories’ from fatty and sugary foods aroundthe world. They bring with them a heightenedrisk of non-communicable diseases, like typeMaking food systems work for childrenAt current levels, the impact of foodproduction on the environment will onlygrow, with food demand set to increaseby at least half by mid-century. Thisdemand will have to be satisfied againstthe backdrop of a world that, after decadesof decline, is seeing a slow rise in hunger,2 diabetes. Analysis carried out as part ofwith 820 million people worldwide sufferingthe Global Burden of Disease study suggestfrom undernourishment in 2018.that diets lacking adequate nutrition are nowthe leading cause of death worldwide.Surviving, but not thrivingUnderstanding how food systems workis essential to improving our diets. But fartoo often, the interests of a very importantgroup of people are left out of food systemsMore children and young people areanalysis – children. This is a dangeroussurviving, but far too few are thriving.omission. Poor diets have lifelong impactsTo understand malnutrition today requiresa focus on food and diet at every stage ofa child’s life. The picture that emerges is atroubling one: Far too many children andyoung people are eating too little healthyfood and too much unhealthy food.on children’s physical growth and braindevelopment. That is why they must beat the heart of our thinking about foodsystems. If food systems deliver forchildren, they are delivering for us all.Good nutrition can break theThese problems start early on: In their firstintergenerational cycles through whichsix months, only two out of five childrenmalnutrition perpetuates poverty, andare being exclusively breastfed, deprivingpoverty perpetuates malnutrition.them of the best food a baby can get. WhenChildren who are well nourished haveit comes to the ‘first foods’ that infantsa firm foundation from which theyshould start consuming at around thecan develop to their full potential. Andage of 6 months, these too are, in far toowhen children do that, societies andmany cases, not meeting children’s needs:economies develop better, too.Less than one in three children worldwidebetween 6 and 23 months are eating eatingfoods from the minimum number of foodOur goal must be to give children diets that arenutritious, safe, affordable and sustainable.»More children andyoung peopleare surviving,but far too feware thriving4

5 T H E S TAT E O F T H E WO R L D ’ S C H I L D R E N 2 019Where are children not growing well?FIGURE 1 Prevalence of children under 5 who are not not growing well (stunted, wasted or overweight), East Asia and Pacific, (EAP) 2018%Greater than 6050.0 – 59.9Children under 5GLOBAL40.0 – 49.930.0 – 39.964.820.0 – 29.91 in 3 is not growing well10.0 –19.9cratic Republic 48.5EAPLess than 10.0No recent dataAlmost 1 in 5 is not growing wellNo data%Papua New Guinea 65Children under 5Timor-Leste 57Lao People's Democratic Republic 49Philippines 42Cambodia 40GLOBALIndonesia 59Vanuatu 37Malaysia 36Myanmar MWasted9.7MOverweightViet Nam 30Thailand 23China 18REGION 17Samoa 13EAPMongolia 19Note: Country data are the most recent available estimate between 2006 and 2018; where only data prior to 2000 are available, the dark grey color denoting no recent data is used. The designationsemployed in this publication and the presentation of the material do not imply on the part of the United Nations Children’s Fund (UNICEF) the expression of any opinion whatsoever concerning the legalstatus of any country or territory, or of its authorities or the delimitations of its frontiers.’Growing well‘ is defined as free from stunting, wasting and overweight. See Note on Figures on p. 179 for more information.Source: UNICEF analysis of UNICEF/World Health Organization/World Bank Group Joint Malnutrition Estimates, 2019 edition. Levels and trends in child malnutrition: Key findings of the 2019 edition ofthe Joint Child Malnutrition Estimates.

U N I C E F E A S T A S I A A N D T H E PAC I F I C»6What are young children eating?The importance of first foodsFIGURE 2 Percentage of children aged 6–23 months fed food groups, by type, East Asia and Pacific, 2018%GrainsVitamin A richfruits & vegetables90BreastmilkFlesh foods66Dairy54Eggs46When children start eating soft,semi-solid or solid foods at 6months old, they need nutritiousand safe diets with a range ofnutrients to grow well.7364Other fruits& vegetablesLegumes292325% of children in East Asiaand Pacific are not being fedmuch-needed nutrients fromanimal source foods.Without enough diversity in children'sdiets, they may not get enoughnutrients to grow well, which cantake a devastating toll on children’sbodies and brains. UNICEF andWHO recommend that childrenat this age eat a minimum offive of eight food groups.23% of children in East Asiaand Pacific are not fed any fruitsor vegetables.FIGURE 3 Percentage of children aged 6–23 months eating at least 5 of 8 food groups (Minimum Dietary Diversity), by country 20182128MyanmarTimor-Leste34353640Marshall IslandsChinaLao People'sDemocratic RepublicCambodia%455459634029MongoliaIndonesiaViet NamThailandEAP REGIONGLOBAL3 in 5 children do not eat foodsfrom the minimum number offood groups in East Asia andPacific.FIGURE 4 Percentage of children aged 6–23 months fed food groups, by type and age, East Asia and Pacific, 201885938180606–11 months12–23 months745944%58435529GrainsBreastmilkVitamin Arich fruits &vegetablesFleshfoodsDairyEggs3221Otherfruits &vegetables1831Children 6-11 months are eating lessdiverse diets compared to children12–23 months.LegumesNote: The regional and global estimates were generated using the most recent data available for each country between 2013 and 2018. UNICEF regional andglobal estimates are population weighted averages using the 2018 estimates from the World Population Prospects, 2019 revision as weights.Source for all figures: UNICEF global databases, 2019.

7 T H E S TAT E O F T H E WO R L D ’ S C H I L D R E N 2 019“Double Duty” to Combat the Double Burden of Malnutrition in the PhilippinesThe Philippines is a middle-income country withpersistent severe inequalities despite high economicgrowth. Many children in the Philippines are being leftbehind, and economic gains do not reach the poorestof the poor. At the same time, the economic growth isbringing rapidly changing diets and food environments,with sugary beverages, processed foods, snacks and fastfood increasingly available and affordable, even in theremote rural areas. This means that while many Filipinochildren are still suffering from undernutrition - stuntingand wasting – increasing numbers of children and theirfamilies are also affected by overweight and obesity.The 2018 Expanded National Nutrition Survey showsthat undernutrition rates remain alarming. Stuntingis declining too slowly, from 34 per cent in 2003 to30 per cent in 2018, with 3.5 million children under5 affected. Just over 5 per cent of children werewasted, but this means 650,000 children are affected,300,000 of them with the severest form that requirestreatment. The Philippines has the highest rate oflow birthweight - 1 in 5 children - in the region. Datafrom this survey also shows the increasing doubleburden of malnutrition among children under fiveyears, around 460,000 or 4 per cent were overweight.Overweight among adolescents was found to be 12 percent with a steadily increasing trend since 2003. Amongadult women, over 40 per cent were overweight.Joemar Bacaltos is the face of the 300,000 Filipinochildren with severe wasting. The youngest child ofCaption. UNICEF Philippines/2016poor and sickly parents, living deep in rural Palawan,he is the perfect example of a child deprived of many ofthe rights and opportunities he is entitled to. Because ofthose deprivations, he became a severely malnourishedchild — all skin and bones. Joemar was lucky; he receivedappropriate treatment at the health centre and he fullyrecovered. With support from UNICEF, the PhilippinesDepartment of Health has been scaling up services totreat severely wasted children, enabling frontline workersto have the knowledge and skills they need to detect, treator refer children like Joemar. The Filipino public healthinsurance scheme is covering the costs of treatment,to ensure that poor children can receive treatment.The Department of Health and the National NutritionCouncil of the Philippines recognize the strong needto address both undernutrition and overweightand obesity. In fact, overweight and obesity is apriority program of the Philippine Plan of Action onNutrition 2017-2022. The Filipino Government hasalready passed a law to tax sugary beverages, andthe plan also includes other legislative measureslike restricting marketing of unhealthy foods andbeverages to children and putting in place clearfront of pack labels, as well as ensuring healthyschool food environments. In schools, health centres,the social transfer scheme and communicationmessages, ‘double duty’ is the focus of all nutritionefforts: supporting children and their families toeat more healthy foods and less unhealthy ones, sothat they have healthy growth and healthy lives.

U N I C E F E A S T A S I A A N D T H E PAC I F I C»8An agenda to put children’s nutrition firstThis agenda is driven by two imperatives. First, children have unique nutritional needs and can suffer unique harm from malnutrition. Putting children’s needs first is key to ensuring that every child and young person has the nutrition they need to get thebest start in life. Second, all children and young people will need nutritious, affordable and sustainable diets 1ifinsocieties3 childrenare tois not growing wellmeet the economic, social and environmental challenges of our changing world in the 21st century.1 Empower families, children and young people to demand nutritious foodDemand affects supply as food producers respond to consumers’ behaviours andaspirations. When healthy options are affordable, convenient, and desirable, parents andcaregivers make better food choices for children. As children grow older, knowledgeand1 in 3 childreninformation can make them powerful agents of change. Stimulating demandfor nutritiousis not growingwellfoods means not only educating consumers on the benefits of healthy diets, but 1alsoin 3 childrenis not growing wellleveraging cultural and social aspirations.For every childto grow wellFor every childto grow well12 Drive food suppliers to do the right thing for childrenDemand alone is not enough: Healthy food must also be available, affordable, safe, andconvenient. Food producers and suppliers have a key role to play, and so do governments,which must create a level playing field for all producers and suppliers, ensuring their actionsalign with children’s best interests. Food systems are diverse, and so are solutions. But allfood production and consumption must become sustainable if we are to protect children’snutrition today and tomorrow.Empower families, children and young1 1Empower families, children and youngpeople to demand nutritious foodSOCIALPROTECTIONFOODpeople to demand nutritious foodSOCIALSOCIALPROTECTION4WATER &WATER &SANITATIONEDUCATION4 4for every child4 Mobilize supportive systems to scale up nutrition results15Mobilize supportive systems to scale upnutrition resultsfortoallscalechildrenMobilize supportivesystemsupnutrition results for all childrenthe right thingfor childrenEDUCATIONHEALTHThe personal and external food environments are where children and theirPROTECTIONcaregivers inter-SANITATIONact with the food system. While the forces of supply and demand shape food environments,context-appropriate actions such as mandatory front-of-pack labelling and protectionFOODFOODagainst exploitative marketing and mandatory labelling can help create food environmentsconducive to nutritious diets for children.HEALTHEDUCATIONHEALTHMobilize supportive systems to scale upnutrition results for all children18%5 Collect, analyse and use good-quality data and evidence regularly toguide action and track progressLack of adequate data prevents governments from responding with effective policies,strategies and programmes. Accurate and timely data is needed to understandmalnutrition, take coordinated, evidence-based action, and hold all actors accountable.Data collection methods and frequency must be transformed to expand what weknow about the diets and nutrition of children, adolescents and women at every stageof life. Data systems must become responsive and develop a culture of data sharingand transparency.1%33for all childrenBuild healthy food environmentsfor allchildrenCollect, analyse and use qualitydataand evidenceregularly to guide action and track progress5regularly to guide action and track progress18% 1%Empower families, children and youngpeople to demandnutritiousfoodBuildhealthy foodenvironmentsSOCIALAs well as food systems, four other key systems must be mobilized to deliver nutritionPROTECTIONservices, improve nutrition practices and achieve nutrition outcomes at scale. Thehealth, water and sanitation, education and social protection systems must all deliverinterventions in a coordinated fashion. A systems approach to children's nutritionCollect, analyse and use quality data and evidencecan help ensure that children and families have access to healthy diets andthatregularlyto guide action and track progresschildren receive the nutrition services they need to develop to theirfullanalysepotential.Collect,and use quality data and evidence522Drive food suppliers to doDrivethingfood suppliersto dothe rightfor childrenEmpowerfamilies, foodchildren and youngpeople to demandnutritious3 Build healthy food environments for all childrenWATER &SANITATION1 in 3 childrenis not growing wellHEALTHWATER &SANITATIONFOODEDUCATION4Mobilize supportive systems to scale upnutrition results for all children5Collect, analyse and use quality data and evidenceregularly to guide action and track progress

What do adolescents andyoung mothers think aboutnutrition and eating habits?BACKGROUND12 workshopswere implementedin China, Indonesiaand the Philippineswith adolescentsand first-timemothers to discusseating habits, foodand nutrition,and barriers toeating well. UNICEF/China/2019/Ma YuyuanADOLESCENTS“Cheap food is not healthy, healthy food is not cheap.”–Female, 13, China“To stay healthy, it is important to avoid consuming fatty andoily foods” –Male, 14, IndonesiaFor more information,the full report is availble photo UNICEF/UN074041/PirozziMOTHERS“My mother-in-law wants to feed her congee every daybecause these are easy-to-digest foods. I want the child hasall kinds of food.” –Female, 27, China“[It is difficult] when I want to feed my child, but I have to goto work”” –Male, 25, Indonesia

3 in 5 children do not eat foods from the minimum number of food groups in East Asia and Pacific. FIGURE 2 Percentage of children aged 6–23 months fed food groups, by type, East Asia and Pacific, 2018 FIGURE 3 Percentage of children aged 6–23 months eating at least 5 of 8 food groups (Minimum Dietary Diversity), by country 2018 Children 6-11 months are eating less