1. Nutrition in Ethiopia:
An emerging success story?
Derek D. Headey
Senior Research Fellow,
Poverty Health & Nutrition Division, IFPRI, Washington DC
June 15th, 2015
Addis Ababa, Ethiopia
d.headey@cigar.org

2. Introduction
• Undernutrition is a complex multidimensional problem
• Requires changes in diets, care practices, sanitation & health, and all
the underlying factors that affect these different pathways
• But from a policy point of view we would like to identify:
Which factors are driving nutrition improvements over time?
Which factors can be sources of future progress?
• As part of TRANSFORM and Stories of Change we are looking at
understanding nutritional successes in different countries
• Approach is 90% quantitative; dynamic focus on changes over time

3. T1. The 5 fastest reductions in pre-schooler stunting in
the 2000s at the global level
Rank Country Start &
end dates
Start &
end stunting ()
Speed of change
(points per year)
1st Nepal 2001 57.1
2011 40.5 -1.66 points per year
2nd Bangladesh 1997 56.7
2007 43.2 -1.42 points per year
3rd Lesotho 2000 53
2010 39 -1.40 points per year
4th Vietnam 2000 42.7
2010 29.3 -1.34 points per year
5th Ethiopia 2000 57.4
2011 44.2 -1.20 points per year

4. Table 2: Trends in prevalence of stunted children in
Ethiopia, 2000 to 2011,
2000 2011 Change change
All Ethiopia 55.7 43.4 -12.3 -22.1
Rural 56.8 45.3 -11.5 -20.2
Urban 46.6 30.2 -16.4 -35.2
Boys 57.2 45.5 -11.7 -20.5
Girls 54.3 41.3 -13.0 -23.9
Oromia 53.0 40.5 -12.5 -23.6
SNNP 56.5 42.9 -13.6 -24.1
Amhara 61.0 50.6 -10.4 -17.0
Tigray 60.0 50.9 -9.1 -15.2
Somali 46.6 32.0 -14.6 -31.3
Afar 50.8 48.8 -2.0 -3.9
Gambela 41.5 27.2 -14.3 -34.5
Addis Ababa 34.5 21.1 -13.4 -38.8
Dire Dawa & Harar 37.9 31.8 -6.1 -16.1

5. F1—Trends in child HAZ scores by children’s age … or
changes in nutrition in the first 1000 days
-2.5
-2
-1.5
-1-.5
0
PredictedHAZscores
0 20 40 60
Child's age (months)
95% CI 2000 2010
A large & significant
improvement in birth size!
Postnatal growth faltering
still very steep; little change

6. F2 … same graph – rural areas only
-2.5
-2
-1.5
-1-.5
0
PredictedHAZscores
0 20 40 60
Child's age (months)
2000 2011

7. F3….Urban areas only
-2
-1.5
-1-.5
0
.5
PredictedHAZscores
0 20 40 60
Child's age (months)
2000 2011
Substantial improvement in postnatal
growth faltering after 16 months

8. Investigating improvements in birth size…
• In rural areas almost all the
improvements stems from birth
size & hence maternal nutrition:
-macro & micronutrient intake?
-improved maternal health?
• In urban areas the improvement
happens much later:
-improved feeding practices?
-improved health/sanitation?
Table 3—Proportion of children reported by
their mothers to be below average size at birth
Rural Urban
2000 42.2 28.2
2011 33.8 29.4

9. T4: Explaining small birth sizes in rural areas
Variation Marginal effects
(%)
Average
2000
Average
2010
Predicted change
in small birth size
Asset index (1-10) -1.4** 1.0 1.5 -0.68%
Father’s education (years) -1.1*** 1.5 2.3 -0.81%
4+ ANC visits dummy (0/1) -3.3* 8.0% 15.1% -0.23%
Open defecation (0-1) 7.0** 91.5% 46.3% -3.16%
Maternal age>40 years (0/1) 5.7* 7.7% 6.5% -0.07%
Maternal height (cm) -0.1 0.00
Female dummy (0/1) 8.0*** 0.00
Year 2010 dummy (0/1) 1.5 0.00
Number of children 5,635 (children 0-24 months)

10. F4. Links between open defecation, maternal anemia
and small birth size
.25
.3
.35
.4
.45
0 .2 .4 .6 .8 1
Open defecation (0-1)
Maternal anemia Small birth size
Important threshold
gf about 60%

11. F5. Comparing experiences across
three major success stories
18.5% 12.7% 14.5%
20.7%
14.1%
6.2%
8.5%
24.5%
9.1%
4.9%
11.6%
7.5%
67.3%
5.1%
6.6%
18.7%
43.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Stunting in Nepal:
2000-2011
Stunting in Bangladesh:
1997-2011
Small birth size in
Ethiopia: 2000-2010
Totalchangeinnutrition(%)
Wealth accumulation Mother's human capital Father's human capital
Health services Sanitation & water Demographic change
Unexplained

12. Conclusions
• Ethiopia’s rapid progress stems from improved birth sizes and hence
improved maternal nutrition
• However, most of the improvement in maternal nutrition seems
related to improvements in sanitation (but caveats …..)
• Further analysis needed, but DHS suggests rapid expansion of simple
pit toilets, not hard infrastructure (community led total sanitation?)
• Improvements in urban areas more enigmatic – model doesn’t
perform well, but does suggest asset accumulation is the main factor
• Still more work to be done!

13. Conclusions
On the policy front, Ethiopia shares some similarities:
Strong economic growth
Major improvements in sanitation (All three countries use CLTS)
Community-based health workers
All saw significant fertility decline (Ethiopia on its way)
But also differences:
 Bangladesh made huge gains in girls’ secondary education
 Nepal achieved much more success in innovative health extension:
e.g. used transport subsidies to reach remote areas

14. Case studies available on the IFPRI website:
We sincerely hope that this work promotes some cross-country and within-
country learning on achieving and sustaining success against undernutrition
*Ethiopia (still a work in progress….)
http://www.ifpri.org/sites/default/files/publications/esspwp70.pdf
*Bangladesh:
http://www.ifpri.org/sites/default/files/publications/ifpridp01358.pdf
*Nepal:
http://www.ifpri.org/sites/default/files/publications/ifpridp01384.pdf