World Bank to name and shame countries that fail their stunted children

The president of the World Bank has warned he will name and shame countries that fail to tackle the malnourishment and poor growth of their children, as part of a mission to rid the world of stunting.

Jim Yong Kim, the former physician who heads the Bank, told the Guardian he would take to the podium at the World Economic Forum in Davos every year to point the finger at governments who failed to live up to promises to tackle a scourge affecting tens of millions of children.

Kim said stunting – which refers to children with a height considerably below the average for their age – was a humanitarian disaster but also an economic issue that held back nations. Malnutrition, the lack of stimulation and toxic environments take their toll on children’s brain development, modern neuroscience shows.

For the sake of their children but also their countries’ future prosperity in a world that increasingly needs an educated workforce with technological skills, governments must take action, said Kim, adding that equality of opportunity was meaningless when children started with such disadvantage. The problem is huge. In India 38.7% of children are stunted, in Pakistan 45% and in the Democratic Republic of the Congo 70%.

“Everyone puts all their eggs in the equality of opportunity basket,” said Kim. “But we’re essentially lying when 25% of children in the world are stunted. Inequality is baked into the brains of 25% of all children before the age of five. So the only way that we can realistically say there is equality of opportunity is if we bring stunting down to zero.”

Stunting around the world

There were certainly other issues, he added, such as the competence of schools. But there was little point complaining that children in the DRC could not read a single letter after going through three or four years of schooling. “It might not be because the education’s bad,” he said.

“It’s a stain on our collective conscience. I think we can start a global movement. My goal is to cut stunting in half. We have 14 years until 2030. We can cut stunting in half in seven years and then end stunting in the world by 2030. That is the only way we can look ourselves in the mirror and say there is equality of opportunity in the world,” he said.

Kim pointed to a World Bank-supported programme in Peru as an example of what is possible. It gave conditional cash transfers to the mothers of stunted children, enabling and educating them to give their children nutritious food and stimulation through play. Similar incentives were given to health clinics to support them. If the children did well, monthly payments continued. “It was the first time we tried this aggressive, what we called a demand-side intervention. They went from 28% in the mid-2000s to 14% in seven years,” he said.

“We’re going to say to every country in the world that has a problem with stunting, we’re ready to bring you the Peru formula. We’re willing to provide financing for these conditional cash transfers. Conditional cash transfers are great anyway. They help poor people. They stimulate the economy, they are a great thing to do.

Jim Yong Kim says equality of opportunity is meaningless when children start with disadvantages as a result of poor growth. Photograph: Altaf Qadri/AP

“But you have to start making an effort at reducing stunting. Or else every year I’m going to stand up in front of all the potential investors in your country and say – you’re not making any progress on stunting. This has very serious implications for the quality of your workforce into the future,” he said.

Scientists have found that all children, regardless of race, should grow 25cm in their first year of life and 12cm in the second.

Only recently has the impact on the brain been explored. Imaging shows fewer neural connections in the brains of stunted children than in those of children who have grown well. That does not necessarily mean they are damaged for life, but their ability to learn can be impaired.

“This is probably the root of intergenerational poverty,” said Kim. “Stunted women who are malnourished become pregnant. Just because they were stunted and malnourished doesn’t mean that their children have to be, but they probably end up not having sufficient nutrition when they are pregnant and they give birth and their children are stunted and it just goes on.”

Technological change means that countries will have ever fewer low-skilled jobs in agriculture and manufacturing. “In that case, the most important infrastructure we can invest in is grey matter infrastructure,” he said.

Many people, including the Nobel economic sciences laureate Amartya Sen, have been arguing for years that investing in people is the way to growth. “I think that with the new science of stunting we have now the direct link. If you don’t have light manufacturing and you don’t have low-skilled work in agriculture, you’re left with mostly services. If you are going to compete in the service economy you’re almost certainly going to have to be digitally competent. And you’re almost certainly going to have to be able to learn throughout your lifetime.

“What I’m arguing is you need to make first and foremost an investment in your people and specifically you need to make an investment in the grey matter of your children.”

Kim believes governments will respond. In 2002, when he was head of the HIV department of the World Health Organisation, he launched a campaign to get 3 million people on antiretroviral treatmentby 2005 and let it be known which countries were lagging behind. Known as 3 by 5, it was controversial, but the initiative resulted in a rapid increase in access to the drugs. There are now 17 million people taking them.

What is stunting?

Childhood stunting is a huge problem worldwide, affecting an estimated 162 million children under five in 2012. These are children whose height is considerably below the average for their age. They are below the 5th centile on the child growth charts of the World Health Organisation – which means that fewer than 5% of healthy children would be expected to be their size.

Undenutrition is the prime cause of stunting. Children can be born to a malnourished mother, so they have not grown properly in the womb, or they can have too little nutrition in the first years of life. Stunting can also be the result of recurrent infections such as diarrhoea in places where sanitation is poor. If children are stunted at the age of two, it is unlikely that their growth will catch up with the norm. They are likely to be small and underweight.

Stunted children tend to have poor cognitive development, with underdeveloped brains. Malnourished children also have little energy, resulting in apathy and a lack of curiosity, which means they are unable to learn and are unlikely to be able to escape poverty.

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World Bank to name and shame countries that fail their stunted children

"Eggs in the bank": how one clinic is making egg freezing less expensive

Rhiannon Beauregard, 33, is visiting New York for a few days. But the sex and marriage therapist is not here for a vacation, to see the sights or visit friends in the city where she once went to college. She is here to freeze her eggs.

Beauregard lives in Austin, Texas where she runs her own practice, but has opted to come to New York to use the services offered by Extend Fertility. The clinic is the first of its kind – focusing only on egg freezing and not offering any other fertility services and treatments such as in vitro fertilization. By doing that, the clinic has been able to cut costs of its services to $ 5,000 while offering personalized service to each one of its clients.

One of the barriers to egg freezing becoming mainstream is the cost. The procedure was still deemed to be experimental until just a few years ago and was mostly an accepted way to extend fertility for older women, cancer patients or those diagnosed with fertility disorders.

Since it is considered to be an elective procedure, egg freezing is typically not covered by health insurance. The average cost of the procedure is about $ 10,000 with an additional $ 2,000 to $ 5,000 for the necessary medication and another couple of thousand dollars for storage. If the frozen eggs are actually to be used for IVF later on, that would cost an additional $ 12,000.

Related: Silicon Valley tries egg-freezing perks. How about just hiring more women?

Altogether, that adds up to more than $ 25,000 – not exactly chump change. Aware of the costs, two years ago, Facebook and Apple announced that they would cover up to $ 20,000 in costs for any female employee that wanted to freeze their eggs.

While Extend Fertility is unable to cut the costs of medicine (the clients are required to pay for it on their own) or the future costs of IVF, its founders hope that by cutting the cost of the initial procedure in half they will make the procedure accessible for more women.

“It’s expensive either way. We know that,” says Joshua Klein, co-founder and chief medical officer of Extend Fertility. He points out that $ 5,000 is still half as expensive as $ 10,000 and adds that the Extend is “working with financing partners” so that those interested could opt to pay $ 200 or $ 300 a month for a while instead of a one-time payment. “We are trying to be innovative and thoughtful about that,” he says.

Joshua Klein, co-founder and chief medical officer of Extend Fertility. Photograph: Extend Fertility

Should women view egg freezing as some kind of down payment on their future? Klein would prefer that they think of it an investment for both the future and the present. Many women worry about meeting the right guy because “they hear that biological clock ticking loudly”, he says. That ticking is a stress factor in their lives. By freezing their eggs and knowing that they have preserved their fertility, they can silence that ticking and receive the immediate benefit of “peace of mind”.

On 8 August, two days before the clinic officially opened, Beauregard was on the fourth day of her pill regiment.

Beauregard has to inject herself daily with some very expensive drugs. Prior to starting the regimen, she had to come off her birth control pills, which resulted in a couple of days of feeling “weepy”. She is bloated and on the mornings that she goes in for checkups at Extend, she ends up watching an ultrasound of her uterus – staring at her eggs instead of a baby.

However, she says, the staff at Extend have been extremely supportive. Every client is assigned their own fertility specialist and is available to accompany them to all of their meetings. The Extend office, just a block or two south of Central Park, also does not resemble a typical fertility clinic. The walls are light blue. The rooms look more like small conference rooms with round tables and a handful of chairs. There are no big tables with stirrups, no posters with uteri or models of babies nestled in a uterus.

A meeting room at Extend Fertility. Photograph: Courtesy of Extend Fertility

“Even the way this room is set up, we are trying to build into our experience the idea that this is not an illness thing, that we are not trying to cure a disease,” says Klein, sitting in one of the meeting rooms. “Here we don’t want to make people feel that they have a problem. They are just a woman living in the 21st century, coming to the doctor about preserving options for the future. It shouldn’t feel like a problem.”

For some, it might be a combination of the two. A while back Beauregard was diagnosed with polycystic ovary syndrome (PCOS) – an disorder that affects hormone production and can affect woman’s fertility in women of reproductive age. She was 32 at that time and single.

“I didn’t really have any plans to go out and find me a partner to have a child with,” she says. She began thinking about what would happen over the next 10 years. PCOS can lead to complications during pregnancy, increased chances of miscarriage, infertility and high levels of estrogen, which can cause cancer of the uterine lining.Beauregard realized that if she wants to have children in the future, she might have to undergo treatments such as IVF at that time. “I started to think about what the difference would be between now and later and the biggest difference between now and later is that after 35 my eggs start to … age, I guess, for the lack of better term.”

Klein agrees.

“We know without a shadow of the doubt that when you freeze eggs when you are younger, you are going to be putting away something that’s much, much, much more likely to be helpful for you than if you wait to do it as a reactionary measure when you are older,” he says.

According to him, the profile of women interested in egg freezing is slowly shifting from “panic-mode 40-year old” to “a proactive smart-thing-to-do-because-I am-a-young-aspiring-woman 30-year-old”. Fertility company EggBanxx, which targets younger career-focused women with slogans like “Lean in, but freeze first!”, estimates that by 2018, 76,000 women will have frozen their eggs.

Beauregard says she would have eventually considered freezing her eggs even without the PCOS diagnosis.

“Since I am single now I don’t want to put that kind of pressure on a new relationship,” she says. “If I hadn’t frozen my eggs, it would be one of the first things we talk about: ‘Hey, how do you feel about kids? Because we have to start making decisions in the next four to five years.’ I feel like a lot of pressure has been lifted off of me.”

Related: I had my eggs frozen. I wish someone had told me how difficult it was | Eleanor Morgan

The cost was the only thing that made Beauregard think twice. While researching her options, she often felt that this was a moneymaking scheme for doctors and clinics.

The $ 5,000 price tag at Extend seemed affordable in comparison. Despite that, the procedure and the drugs cost all her savings.

“Most women in their mid-30s do not have a large savings to fall back on and because we do not have any other support like a partner. The big risk for me was less about the procedure and more about ‘OK, I don’t have any savings left’,” she says. Then laughing, she continues: “There is a risk of walking out into the world with some eggs in the bank but no money.”

‘I drained my savings to do this.’ Photograph: Royalty Free/Getty Images

Beauregard admits she underestimated the cost of the drugs, which she assumed would be a few hundred dollars. It turned out to be closer to a couple of thousand dollars, instead. Additionally, she has to pay for storing of her eggs. At Extend, storage for one year costs $ 450. For five years, it’s $ 2,000 and $ 3,500 for 10.

To Talia Zapolanski, freezing her eggs is akin to an insurance policy.

Zapolanski, who worked in finance for 11 years and now works for a real estate investment firm, had been thinking of doing this for about a year and had gone in for a consultation at another hospital before being referred to Extend by a friend of one of the clinic’s doctors.

“I definitely know that I want children. That’s something I feel strongly about. I haven’t found the right person yet. I am not dating anyone now and I don’t know when I will find the right person,” says the 33-year-old New Yorker. “You start hearing a lot more about egg freezing these days and I thought I would look into it. It seems like a good idea. Hopefully I will be able to, when the time comes, get pregnant and have kids the natural way but you never know.”

Egg freezing should not be one of those things that we don’t talk about, according to both Beauregard and Zapolanski.

“When I was telling people that I was freezing my eggs, a lot of people didn’t know what to say. It makes people uncomfortable – eventually they will get curious about it, but a lot of people are a little dumbfounded that I am so open about it,” said Beauregard. “I want to make sure that people feel comfortable talking about these options.”

Zapolanski says she has encouraged “no less than five friends to go do the same”.

Recently, when she was visiting Los Angeles, she shared with a friend from college that she recently froze her eggs.

“She kind of paused and looked at me in shock that I had shared that and she said: ‘I am glad you said that, I am about to go through the process and I am so nervous about and I have nobody to talk to’,” she said. “It’s a very taboo subject.”

"Eggs in the bank": how one clinic is making egg freezing less expensive

ten "Healthy" Habits That Drain Your Bank Account

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ten "Healthy" Habits That Drain Your Bank Account