The Persistent Effects of Stunting

Last registered on August 08, 2023


Trial Information

General Information

The Persistent Effects of Stunting
Initial registration date
June 29, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 10, 2023, 4:56 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
August 08, 2023, 4:24 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.


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Primary Investigator

Center for Global Development

Other Primary Investigator(s)

PI Affiliation
World Bank
PI Affiliation

Additional Trial Information

In development
Start date
End date
Secondary IDs
Prior work
This trial is based on or builds upon one or more prior RCTs.
The consensus in the literature is that stunting has negative associations with cognitive achievement (Sanchez, 2017; Lopez-Boo and Canon, 2014; Outes-Leon, Sanchez and Porter, 2011; Hoddinott et al., 2011; Maluccio et al., 2009; Walker et al., 2005), educational attainment (Hoddinott et al., 2011; Martorell et al., 2009; Alderman, Hoddinott and Kinsey, 2006), long-term economic outcomes (Grantham-McGregor et al., 2007; Thomas and Strauss, 1997; Galasso and Wagstaff, 2017), and even adult physical health (Alderman, 2011). However, virtually all this evidence has been generated from observational studies (such as Dewey and Begum, 2011) with the possibility that these estimates are upward biased (in absolute value) due to the influence of unobserved confounders such as parental choices of child investment, home environment, and even unobserved aspects of income and wealth. Another common approach to the identification of long-run stunting impacts leverages child- or household-level shocks, however these estimates also run the risk of confounding by other child development inputs also affected by the shock. To the best of our knowledge, only one prior study (analyzed in Hoddinott, 2011 and Maluccio et al., 2009, among others) estimates the consequences of early-life stunting with the identified counterfactual inference of randomized variation. This study covered only 4 villages in Guatemala.

Building on the large-scale randomized impact evaluation of the Pantawid cash transfer program in the Philippines, this proposed study should thus contribute rigorously-identified evidence on the causal relationship of stunting, which is a widely-used indicator of childhood nutritional status, with medium-run health, cognitive, and socioemotional outcomes. This research will constitute a major piece of evidence to the (thus far nascent) experimental literature on the role that early nutrition investments or insults play in overall child development. It will also contribute to the design of better investments in productive human capital.

External Link(s)

Registration Citation

Filmer, Deon, Jed Friedman and Eeshani Kandpal. 2023. "The Persistent Effects of Stunting." AEA RCT Registry. August 08.
Experimental Details


In this new research, we propose to return to the 130 treated and control communities that constituted the experimental sample of Pantawid (Chaudhury, Friedman, and Onishi 2013) to assess the height of children in both treated and control areas and from non-beneficiary households, as well as cognitive, educational and health related outcomes. The question asked by this study is: what are the medium run effects of early life nutritional deficits proxied by stunting? Stunting is associated with early life cognitive impairment, but does this association persist approximately ten years later?

To answer this question, we will compare the cohort of non-beneficiary children in treated villages who faced the general equilibrium effects documented in Filmer et al. (2023) in utero or in the first 1000 days of life to the same cohort in unaffected control communities. Comparing non-beneficiary cohorts in treated communities to the same cohort in similarly-poor households in communities that were randomized out of the program leverages the exogenous variation generated by randomized treatment assignment. This comparison will allow us to answer whether early-life impacts on stunting are sustained, or, conversely, whether catch-up growth at later ages can reverse the heretofore presumed persistence of stunting by age 3 into later life. Recent work with the Young Lives data suggests the possibility of some catch-up growth but not among the most stunted children (Georgiadis, 2017; Singh, 2017). If we find that stunting by age three does not predict assessed height by ages nine to twelve well, we will examine the possible mechanisms that led the reversal of early life patterns. To do so, we will rely on a reconstructed history of household resources, work patterns, and other activities. Recent evidence from Jamaica (Gertler et al., 2014) and Colombia (Baez and Camacho, 2011; Duque, Rosales-Rueda, and Sanchez, 2018) shows that cognitive deficits associated with stunting can be overcome through stimulation activities, suggesting that this relationship may not be as rigid as originally believed. Conversely, of course, one could see improvements in stunting but not in cognition if there is a differential elasticity of height or cognition to nutrition in the later years of childhood. This component of the study would thus test the hypothesis that early child nutritional deficits have serious long-term developmental impacts. This study should convincingly identify the impact of early life stunting on both later childhood height-for-age and cognitive outcomes.

Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
Height-for-age z scores, school attendance, cognitive and socioemotional skills
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The proposed study will follow up with approximately 650 children from treated and control villages, who lived in households that were not eligible for the transfer (if in a treated village) or would not have been eligible for the transfer (if in a control village). These children were between 6 and 36 months old at the time of the 2011 survey and will be between 9 and 12 years of age at the time of the proposed follow up. As described above, the assignment to treatment or control villages was randomized and community characteristics across treatment and control exhibited a high degree of balance. Household eligibility for the transfer was determined by a 2008 listing database on household wealth. Therefore, this sample remains experimental and will enable us to rigorously identify the medium-run effects of early life stunting.

We estimate effects by comparing ineligible households (non-poor but with young children) in treated villages to those in control villages. In 2012, after the first-round impact evaluation, the control villages were included in the Pantawid program. Thus, the identification of impact between treatment and control groups concerns the three-year experimental period when the cohort of children born 2008 – 2010 were differentially exposed to the program.

The data we intend to use are from the 2011 survey, a planned 2023-24 follow up, administrative data on school enrollment and test scores, and the Philippine’s household expenditure survey, the FIES. The 2011 survey was conducted by the World Bank, including members of the team proposing the current study. All best practices in data collection were followed, and the survey yielded high quality data, including on anthropometry.

Several categories of outcomes are of potential relevance to the proposed study. The first set, of course, are anthropometric outcomes, which will determine whether early life changes in stunting persist. In addition, evidence suggests that early life investments in, or indeed insults to, health and nutrition lead to sustained effects on cognitive ability. Therefore, we will measure cognitive outcomes as well as possibly relevant socioemotional and other non-cognitive outcomes. Cognitive and socioemotional tests appropriate for this age group include Raven’s Progressive Matrices to measure non-verbal cognitive ability, reading comprehension and vocabulary tests as well as specially designed games to assess behavioral dimensions such as persistence and curiosity. We will also seek to measure recent disease incidence to understand whether the CCT or early-life stunting affect the predisposition to chronic disease.
Experimental Design Details
Not available
Randomization Method
Medium-run (14 year follow up) effects of randomization done in office by a computer in 2009
Randomization Unit
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
Sample size: planned number of observations
650 non-beneficiary children
Sample size (or number of clusters) by treatment arms
65 treated villages, 65 control villages; approximately 350 non-beneficiary children in treated villages and 300 in control villages
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Institutional Review Boards (IRBs)

IRB Name
University of the Philippines Manila Research Ethics Board (UPMREB) Review Panel 1
IRB Approval Date
IRB Approval Number
UPMREB 2022-0530-01
Analysis Plan

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