Nearly half of the children in Papua New Guinea (PNG) have stunted growth from chronic malnutrition, the consequences of which can last a lifetime. 

The Pacific nation has the fourth-highest child stunting rate in the world — a rate that is more than double the global average. 

And, according to national data in PNG, about 33% of all hospital deaths of children under 5 years old can be linked, either directly or indirectly, to malnutrition. 

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Other analysis, by Frontier Economics, believes the percentage to be much higher. The analysis identified malnutrition as the likely cause of up to 76% of total deaths of children under 5 across the country — significantly higher than the global 45%.

But, unlike many countries where childhood malnutrition is an issue, lack of food isn’t the main problem in PNG. That prompts the question — what is? 

For a child to be stunted, according to a report in the Guardian, they either aren’t getting the right nutrients in the first place, or the nutrients aren’t getting into their system effectively because of illnesses like diarrhea, malaria, or intestinal worms. 

But for PNG, both of these factors are an issue. 

To prevent an issue like childhood stunting, good nutrition throughout the first 1,000 days from conception is absolutely vital.

In a country like PNG, where around 80% of the country’s estimated 8.5 million people are reportedly living from subsistence agriculture, a pregnant woman may not have access to a diet that’s nutritious for a healthy pregnancy. 

A mother also needs education about sanitation, access to clean water, and an understanding of how to feed her child to keep it healthy. For nutrition experts, that means a renewed focus on breastfeeding. 

For Majella Hurney, from Save the Children Australia, the lack of understanding and education about nutrition and sanitation is a serious issue in PNG. 

“Mothers in East Sepik [a province in PNG] said they introduced complementary food, such as sago [a starch extracted from the pith of various tropical palm stems that is a staple in PNG] and fish soup, as early as two days after birth because they believed it would make their baby strong,” Majella Hurney, from Save the Children Australia, told the Guardian. 

Short changed: the cost of child undernutrition in Papua New Guinea - @devpolicyhttps://t.co/mb1iCZQjbV#nutritionpic.twitter.com/5L2pJMYnqT

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In a report published by Save the Children Australia in 2017 and written by Hurney, she described how she had met a mother who fed her 3-month-old baby chocolate milk, believing it was better than breast milk.

Another mother she mentioned in the report had been feeding her newborn baby sago mixed with water from a swamp containing both animal and human faeces. 

“Evidence shows that if a child is malnourished during the first 1,000-day period from conception to their second birthday, they will suffer cognitive and physical impairments that are permanent and irreversible,” according to Hurney. “These impairments limit a child’s education and employment prospects.”

“This is how malnutrition can trap children in an intergenerational cycle of poverty,” she added.

According to the Save the Children Australia report, giving an infant food other than breast milk before six months of age can be “highly dangerous.” 

“Depending on the type of food given, there is a risk that the child will be deprived of the energy and nutrients required to support their growth and development,” it added.

“It also increases the risk of the child suffering more frequent and severe episodes of disease, which causes them to be further malnourished and vulnerable to other diseases,” the report said. “This is how malnutrition and disease form part of a potentially lethal cycle.” 

But as well as the risks malnutrition poses to a child’s health, it also impacts the nation’s economy. 

According to Frontier Economics’ analysis, child undernutrition costs PNG around $508 million annually. And that’s reportedly a conservative estimate — it could be as high as $1.5 billion annually. 

Malnutrition affects the economy through a number of factors, including:

• Losses in productivity from a reduction in labour force due to increased childhood mortality 
• Losses in potential income and productivity from poor physical status and reduced cognitive function 
• Losses from increased healthcare expenditure in treating diseases associated with childhood undernutrition

In 2017, the government revised its National Nutrition Policy, which is a positive step towards improving child nutrition. 

But the challenge is too big for the government to tackle alone and, according to Save the Children, international donors need to reallocate assistance to support interventions to target child nutrition.