As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition.  

The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries.  

This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade.  

Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments.  

To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda—now amplified by the COVID-19 crisis. 

Key messages

• The evidence base for direct and indirect health, agriculture and food systems, social protection, and water, sanitation, and hygiene (WASH) interventions to reduce undernutrition has grown substantially since the 2013 Lancet Series on maternal and child nutrition. However, information about the costs and cost-effectiveness of interventions delivered across sectors has not kept pace and remains a barrier to effective planning by governments. 

• The available evidence reaffirms key priorities for undernutrition, including an emphasis on the first 1000 days (early pregnancy up until the first 2 years of child life). Interventions and actions targeting this age window require renewed commitment, new insights from implementation research, and fast-tracked funding to increase coverage and improve quality of service delivery. 

• Several direct nutrition interventions are ready for scaling up in health systems and others appear promising; these policies should be considered for inclusion in national plans. Greater specificity about what direct and indirect actions health, agriculture and food systems, education, WASH, social protection, and other sectors should prioritise, in different contexts, is needed. 

• A new body of evidence from in-depth analyses of successful stunting reduction at the national or subnational level reaffirms the need for a range of sectoral actions, especially those that address the underlying determinants of undernutrition, and the need to foster enabling environments. 

• Nutrition data and accountability have improved since 2013, but more action is needed to ensure that global goals and commitments can be tracked and, more importantly, that national and subnational actions across sectors are tailored to each specific context and reach the most vulnerable groups. 

• A 2017 global Investment Framework for Nutrition estimated that, on average, an additional US$7 billion per year is required to reach global maternal and child undernutrition targets—a cost that will increase given setbacks due to COVID-19.  Donors increased spending on priority interventions between 2015 and 2017, but more funds are still needed. Data on domestic spending for nutrition show a decline for many countries during the same period. 

• There is no time to lose. For both the pandemic response and the rapidly approaching global target deadlines, nutrition actors at global and national levels must respond to the call to action to bring together resources, leadership, and coordination, along with data and evidence, to address the large remaining burden of undernutrition worldwide.