Stunting begins in womb amid maternal nutritional deprivation

February 16, 2026

Healthcaretoday, Dr Naveen Nair Gangadaran, Child health, Stunting awareness, child nutrition, First 1000 Days, growth monitoring, nutrition matters, child nutrition, breastfeeding, Iron tablets, pregnancy,

Maternal undernutrition, unfinished iron supplements, shortened breastfeeding, and a lack of essential micronutrients such as iron, zinc, and high-quality protein in the first 1,000 days compromise bone strength and brain development in a child.

By Dr Naveen Nair Gangadaran,
Pediatrician,
Hospital Tuanku Ja’afar Seremban.

In a bright Year 2 classroom, the morning routine is a series of small, invisible hurdles for eight-year-old Maya. When the teacher asks the students to hang their school bags on the wall hooks, the room fills with the sound of shuffling feet and chatter. For most, it is a mindless task. For Maya, it is a moment of daily dread.

She stands on her tiptoes, her small fingers straining toward the plastic hook. Her bag, heavy with textbooks she struggles to carry, feels like an anchor. A classmate breezes past, easily hanging a bag a full head above Maya’s reach.

To a stranger, Maya is "the cute, petite girl." But in the medical records of a doctor, Maya represents a national crisis. She is one of the 20-25% of Malaysian children under five who are stunted, a figure that has stubbornly refused to drop over the last decade.

The anatomy of the gap
Stunting is often misunderstood as "just being short." In reality, it is a clinical condition where a child’s height-for-age is more than two standard deviations below the WHO Child Growth Standards. But the tragedy isn't in the centimeters; it’s in what those missing numbers represent.

When Maya was a toddler, her body faced a "nutritional budget cut."
Imagine Maya’s story beginning long before she stepped into that classroom. During pregnancy, her mother skipped meals so the family could stretch their monthly budget. Iron tablets went unfinished because they caused nausea. After birth, breastfeeding was cut short when her mother had to return to work early. By six months, Maya’s meals consisted mainly of diluted porridge and biscuits -filling, but nutritionally hollow. Each compromise seemed small at the time. But together, they quietly sculpted her growth trajectory. The First 1,000 Days, the critical window from conception to two years of age, her intake of essential micronutrients like iron, zinc, and high-quality protein was insufficient.

Faced with a shortage of resources, Maya’s body made a survival choice: it prioritized vital organ function over bone growth and brain development.

Hidden damage: While Maya struggles to reach the bag hook, her brain is also struggling to keep up. Stunting is linked to reduced "grey matter" and slower neural processing.
Learning issues: In class, Maya finds it harder to focus. While her peers are grasping the fundamentals of multiplication, Maya is often fighting off a fog of fatigue. Studies show that stunted children are more likely to repeat grades and drop out of school earlier than their peers.

The impact is not confined to textbooks. On the sports field, Maya is often the last to be picked. Her shorter stride makes her slower in races, her smaller frame less competitive in games. Over time, these repeated exclusions chip away at confidence. Teachers may mistake her quietness for disinterest, not realizing it stems from fatigue and self-doubt.

A paradox in the land of plenty
The most jarring fact about Malaysia’s stunting rate is that it persists despite our economic growth. According to the Global Nutrition Report, Malaysia faces a "triple burden" of malnutrition: the simultaneous existence of obesity, anemia, and stunting, with no progress seen. It is a paradox of plenty. We are a nation obsessed with food, yet 1 in 5 of our children are nutritionally starved.

Why is the needle moving in the wrong direction? For many families like Maya’s, it isn't always a lack of food, but a lack of the right food.

In many urban poor and rural households across Malaysia, the day begins with a hurried mug of Milo and a few pieces of cream crackers, high in sugar, low in the protein needed for a growing frame. Lunch is often a "comfort" of white rice drizzled with kicap manis and perhaps a side of fried flour scraps, providing energy but zero iron or zinc. Dinner frequently defaults to a shared pot of instant noodles, the salty broth stretching to fill the stomachs of three or four siblings.

These meals satisfy hunger, but they fail the bones and the brain. While a tray of eggs or a bag of anchovies may cost more at the checkout counter than a bundle of instant noodles, the long-term debt of the cheaper option is staggering. It is a price paid in stunted physical growth, frequent illness, and lost cognitive potential that no amount of catching up can fully fix.

The economic time bomb
The "shorthand" of stunting follows Maya far beyond the playground. If we don’t intervene, the ‘height ceiling’ will limit her entire adult life.

The Global Nutrition Report highlights that the economic consequences of malnutrition are staggering. Stunted children grow into adults who earn, on average, 20% less than their non-stunted counterparts. They are also at a significantly higher risk of developing non-communicable diseases (NCDs) like diabetes and hypertension.

For Malaysia, this isn't just a health issue; it’s a productivity drain. When a fifth of the future workforce starts life at a physical and cognitive disadvantage, the entire nation’s trajectory is lowered.

The economic ripple extends further. Stunted children are more prone to chronic illnesses later in life, increasing national healthcare expenditure. As adults, reduced physical capacity and cognitive performance translate into lower productivity. When millions of children grow up this way, the nation doesn’t just lose height but it loses economic altitude.

Breaking the cycle
Recess bell rings. Maya watches her friends sprint toward the canteen. She follows at a slower pace, her smaller stride requiring twice the effort to cover the same ground. She isn't just trailing behind on the pavement; she is trailing behind in a race she didn't know she was running.

To save the "Mayas" of the future, Malaysia needs more than just school milk programs. We need:

Aggressive early intervention: Focusing on maternal nutrition and the "First 1,000 Days."
Food security vs. nutrition security: Shifting the national conversation from "having enough to eat" to "eating enough of what matters."
Universal screening: Ensuring that every child’s growth is tracked with the same urgency as a fever.

Parents need practical guidance, not blame. Simple shifts; adding eggs, anchovies, lentils, tofu, or fortified cereals can dramatically improve protein and micronutrient intake without breaking budgets.

Schools can serve as nutritional equalizers. Breakfast programs, fortified milk, and nutrition education can bridge gaps children bring from home.

Growth charts should not be paperwork but rather they are early warning systems. Every clinic visit is an opportunity to detect faltering growth before it becomes permanent. The most powerful tool for your child’s health is already in your hands. Take a look at the growth charts in your Child's Health Record Book (Buku Rekod Kesihatan); if the curve is flattening, it’s time to have a conversation with your doctor about 'nutrient security' rather than just 'full stomachs. Food subsidy policies also must evolve from calorie security to nutrient security, incentivising protein, dairy, and fresh produce.

Stunting is a silent thief. It steals height, it steals potential, and it steals the future of a nation. As Maya finally sits down at her desk, still catching her breath from the walk, she looks at the measuring tape her teacher has taped to the wall for a science project.

Maya is still at the bottom of the measuring tape today. But her story does not have to define the next generation. With the right policies, informed parents, vigilant teachers, and proactive healthcare systems, the stunting paradox which haunts our nation can be lifted. The question is not whether Malaysia can afford to act BUT it is whether we can afford not to.

Stunting begins in womb amid maternal nutritional deprivation

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