Governments, donors and others must step up to protect current and future generations from the devastating effects of malnutrition, as well as to prevent acute food insecurity.

By Saskia Osendarp , Gerda Verburg , Zulfiqar Bhutta , Robert E. Black , Saskia de Pee , Cecilia Fabrizio , Derek Headey , Rebecca Heidkamp , David Laborde & Marie T. Ruel

As the devastation in Ukraine continues to unfold, many of the warnings about the global food crisis precipitated by the war have focused on the risks of famine and severe food insecurity. The Food and Agriculture Organization (FAO) of the United Nations, for instance, projected last month that between 8 million and 13 million more people could become undernourished in 2022–23 — meaning that they will be unable to acquire enough food to meet the daily minimum energy requirements over one year. There are already more than 800 million undernourished people globally1.

Another major concern is the possibility of severe price increases and disruptions to global systems for food, fertilizer and fuel, leading to millions more malnourished people in low- and middle-income countries (LMICs).

Women and children are particularly affected by the food shortages and high food prices resulting from the war against Ukraine. They are especially vulnerable to malnutrition: children’s nutritional needs are high relative to their body size, and women’s are high when pregnant or lactating. Furthermore, existing gender inequality and gender power imbalances — which can be exacerbated during crises — mean that women have less agency to direct resources towards feeding themselves and their children2. Lastly, these groups have already been disproportionally affected by the combined effects of other conflicts, climate change and the COVID-19 pandemic.

The impact of malnutrition might be less immediately visible than that of hunger. But left untreated, malnutrition can increase the risk of illness and death in the short term, and ultimately have multi-generational and irreversible effects. In fact, providing nutrition interventions in early life leads to extremely high estimated returns on investment — up to US$35 for every $1 spent3. This exceeds the returns on investment for other global health initiatives, including childhood vaccinations in the poorest countries — estimated in 2019 as saving $21 for every $1 spent4.

In mid-March, the FAO called on governments to avoid implementing restrictions that could hamper the global trade in food, fertilizer and fuel1. UN agencies are also urging governments to continue to expand various social protection programmes offered during the COVID-19 pandemic. These include the distribution of cash or food, or food vouchers for households in need1.

We applaud these efforts. But more is needed. Governments of LMICs, donors and other funders must invest now to safeguard people’s access to nutritious foods. Not doing so will mean immediate effects on child growth, development and immunity, and an increase in child deaths in the coming months. In the longer term, a global malnutrition crisis could lead to lifelong effects on education, diet-related chronic diseases and a decline in people’s capacity to thrive and contribute to their countries’ economic growth.

Crisis in context

Even before the COVID-19 pandemic, in 2019, 144 million children under 5 years old were stunted (meaning their height was low for their age), and 47 million had acute malnutrition, known as wasting5 (meaning their weight was low for their height). Meanwhile, 240 million women were underweight (with a body mass index of less than 18.5), and 468 million had anaemia6.

Record-high price hikes and disruptions in the trade of food, fertilizer and fuel threaten to further increase the global number of malnourished people, especially women and children, in three ways.

This commentary was first published in Nature’s Journal