( Lancet . 2023;402(10409):1261–1271. doi:10.1016/S0140-6736(23)00878-4) An analysis of global data from 2010 to 2020 found that there was not a measurable change in the rate of preterm births during that period. The analysis, led by the World Health Organization and UNICEF, is the first data published on preterm birth rates since 2015. The new estimates are crucial for understanding the burden of preterm births around the world and for determining where resources can best be targeted.

(Abstracted from Lancet 2023;402:1261–1271 Birth before 37 weeks of gestation is classified as preterm birth (PTB) and represents the highest contributor to neonatal mortality, including both short- and long-term effects. Adverse effects of PTB include higher risks of poor health, poor growth, intellectual or mental disability, early onset of chronic disease, and others.

Background Low birthweight (LBW; <2500 g) is an important predictor of health outcomes throughout the life course. We aimed to update country, regional, and global estimates of LBW prevalence for 2020, with trends from 2000, to assess progress towards global targets to reduce LBW by 30% by 2030. Methods For this systematic analysis, we searched population -based, nationally representative data on LBW from Jan 1, 2000, to Dec 31, 2020. Using 2042 administrative and survey datapoints from 158 countries and areas, we developed a Bayesian hierarchical regression model incorporating country -specific intercepts, time -varying covariates, non-linear time trends, and bias adjustments based on data quality. We also provided novel estimates by birthweight subgroups. Findings An estimated 198 million (95% credible interval 184-217 million) or 147% (137-161) of liveborn newborns were LBW worldwide in 2020, compared with 221 million (207-239 million) and 166% (155-179) in 2000-an absolute reduction of 19 percentage points between 2000 and 2020. Using 2012 as the baseline, as this is when the Global Nutrition Target began, the estimated average annual rate of reduction from 2012 to 2020 was 03% worldwide, 085% in southern Asia, and 059% in sub-Saharan Africa. Nearly three-quarters of LBW births in 2020 occurred in these two regions: of 19 833 900 estimated LBW births worldwide, 8 817 000 (445%) were in southern Asia and 5 381 300 (271%) were in sub-Saharan Africa. Of 945 300 estimated LBW births in northern America, Australia and New Zealand, central Asia, and Europe, approximately 350% (323 700) weighed less than 2000 g: 58% (95% CI 52-64; 54 800 [95% CI 49 400-60 800]) weighed less than 1000 g, 90% (87-94; 85 400 [82 000-88 900]) weighed between 1000 g and 1499 g, and 194% (190-198; 183 500 [180 000-187 000]) weighed between 1500 g and 1999 g. Interpretation Insufficient progress has occurred over the past two decades to meet the Global Nutrition Target of a 30% reduction in LBW between 2012 and 2030. Accelerating progress requires investments throughout the lifecycle focused on primary prevention, especially for adolescent girls and women living in the most affected countries. With increasing numbers of births in facilities and advancing electronic information systems, improvements in the quality and availability of administrative LBW data are also achievable.

Background The Global Nutrition Target of reducing low birthweight (LBW) by >= 30% between 2012 and 2025 has led to renewed interest in producing accurate, population-based, national LBW estimates. Low- and middle-income countries rely on household surveys for birthweight data. These data are frequently incomplete and exhibit strong "heaping." Standard survey adjustment methods produce estimates with residual bias. The global database used to report against the LBW Global Nutrition Target adjusts survey data using a new MINORMIX (multiple imputation followed by normal mixture) approach: 1) multiple imputation to address missing birthweights, followed by 2) use of a 2-component normal mixture model to account for heaping of birthweights. Objectives To evaluate the performance of the MINORMIX birthweight adjustment approach and alternative methods against gold-standard measured birthweights in rural Nepal. Methods As part of a community-randomized trial in rural Nepal, we measured "gold-standard" birthweights at birth and returned 1-24 mo later to collect maternally reported birthweights using standard survey methods. We compared estimates of LBW from maternally reported data derived using: 1) the new MINORMAX approach; 2) the previously used Blanc-Wardlaw adjustment; or 3) no adjustment for missingness or heaping against our gold standard. We also assessed the independent contribution of multiple imputation and curve fitting to LBW adjustment. Results Our gold standard found 27.7% of newborns were LBW. The unadjusted LBW estimate based on maternal report with simulated missing birthweights was 14.5% (95% CI: 11.6, 18.0%). Application of the Blanc-Wardlaw adjustment increased the LBW estimate to 20.6%. The MINORMIX approach produced an estimate of 26.4% (95% CI: 23.5, 29.3%) LBW, closest to and with bounds encompassing the measured point estimate. Conclusions In a rural Nepal validation dataset, the MINORMIX method generated a more accurate LBW estimate than the previously applied adjustment method. This supports the use of the MINORMIX method to produce estimates for tracking the LBW Global Nutrition Target.

Background Reducing low birthweight (LBW, weight at birth less than 2,500g) prevalence by at least 30% between 2012 and 2025 is a target endorsed by the World Health Assembly that can contribute to achieving Sustainable Development Goal 2 (Zero Hunger) by 2030. The 2019 LBW estimates indicated a global prevalence of 14.6% (20.5 million newborns) in 2015. We aim to develop updated LBW estimates at global, regional, and national levels for up to 202 countries for the period of 2000 to 2020. Methods Two types of sources for LBW data will be sought: national administrative data and population-based surveys. Administrative data will be searched for countries with a facility birth rate ≥80% and included when birthweight data account for ≥80% of UN estimated live births for that country and year. Surveys with birthweight data published since release of the 2019 edition of the LBW estimates will be adjusted using the standard methodology applied for the previous estimates. Risk of bias assessments will be undertaken. Covariates will be selected based on a conceptual framework of plausible associations with LBW, covariate time-series data quality, collinearity between covariates and correlations with LBW. National LBW prevalence will be estimated using a Bayesian multilevel-mixed regression model, then aggregated to derive regional and global estimates through population-weighted averages. Conclusion Whilst availability of LBW data has increased, especially with more facility births, gaps remain in the quantity and quality of data, particularly in low-and middle-income countries. Challenges include high percentages of missing data, lack of adherence to reporting standards, inaccurate measurement, and data heaping. Updated LBW estimates are important to highlight the global burden of LBW, track progress towards nutrition targets, and inform investments in programmes. Reliable, nationally representative data are key, alongside investments to improve the measurement and recording of an accurate birthweight for every baby.

Correspondence to Dr Andreas Hasman; ahasman@ unicef. org © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. In efforts to restrict the spread of SARSCoV2, many lowincome and middleincome countries suspended communitybased public health and nutrition programmes in early 2020. At the time, the expectation was that disruptions due to the COVID19 response would cause significant declines in programme coverage of key services, and eventually increase preventable morbidity and mortality among the most vulnerable children. The magnitude of the pandemic’s impact on preventive vitamin A supplementation (VAS) programmes is now made visible in UNICEF’s annual programme coverage data. Regular administration of highdose VAS to children 6–59 months old every 4–6 months reduces the risk of child mortality by 12%–24% in communities where vitamin A deficiency is prevalent. Prior to the pandemic, the global VAS programme reached over 200 million children annually with the recommended two VAS doses in countries with high child mortality. Between 2016 and 2019, coverage had been hovering at around 65% of eligible children. In the year prior to the COVID19 outbreak, about 200 million eligible children benefited from the two annual doses of VAS, while 134 million missed out on at least one of the doses and therefore the full benefits of supplementation. The situation deteriorated sharply following the March COVID19 outbreak, primarily due to service delivery disruptions caused by pandemic containment measures. Based on administrative data analysed by UNICEF, there was a 19 percentage point decline in twodose VAS coverage from 2019 (from 60% to 41%; figure 1), with 62 million fewer children (ie, onethird) receiving both VAS doses in 2020. The steepest drops in coverage occurred in the first half of the year (figure 2) following recommendations to suspend mass public health and nutrition campaigns. Global VAS coverage thus fell from 72% in the first half of 2019 to 49% in the first half of 2020, while the number of children covered fell from 239 million in the first half of 2019 to 165 million in the first half of 2020 (ie, a drop of almost a quarter). In the second half of 2020, when suspensions were rescinded, 57% or 192 million eligible children were reached compared with 63% or 211 million children in the second half of 2019 (a drop of only six percentage points). Eight countries drove the sharp decline in twodose coverage in 2020: Afghanistan, Cameroon, Chad, Niger, Nigeria, Pakistan, Sudan and Tanzania. In these countries, 85 million children were missed (ie, 43% of the total number of missed children). If the eight countries were to regain the coverage achieved in 2019, global VAS coverage would be 61%. Arguably, they should be given priority attention to shore up the coverage of the global VAS programme. It is also clear that countries with the greatest need for supplementation, that is, highest child mortality, had the lowest coverage in 2020. Out of the 48 countries from which we have data, 23 have under5 Summary box

IntroductionEstimates of incident cases of severe wasting among young children are not available for most settings but are needed for optimal planning of treatment programmes and burden estimation. To improve programme planning, global guidance recommends a single ‘incidence correction factor’ of 1.6 be applied to available prevalence estimates to account for incident cases. This study aimed to update estimates of the incidence correction factor to improve programme planning and inform the approach to burden estimation for severe wasting.MethodsA global call was issued for secondary data from severe wasting treatment programmes including prevalence, population size, programme admission and programme coverage through a UNICEF-led effort. Site-specific incidence correction factors were calculated as the number of incident cases (annual programme admissions/programme coverage) divided by the number of prevalent cases (prevalence*population size). Estimates were aggregated by country, region and overall using inverse-variance weighted random-effects meta-analysis.ResultsWe estimated incidence correction factors from 352 sites in 20 countries. Estimates aggregated by country ranged from 1.3 (Nigeria) to 30.1 (Burundi). Excluding implausible values, the overall incidence correction factor was 3.6 (95% CI 3.4 to 3.9).ConclusionOur results suggest that incidence correction factors vary between sites and that the burden of severe wasting will often be underestimated using the currently recommended incidence correction factor of 1.6. Application of updated incidence correction factors represents a simple way to improve programme planning when incidence data are not available and could inform the approach to burden estimation.

Data produced by the World Health Organization, UNICEF, LSHTM and Johns Hopkins University to estimate national low birthweight (LBW) and numbers for 195 countries. LBW data was collated through a systematic review of national routine/registration systems, nationally representative surveys, and other data sources, and subsequently modelled using restricted maximum likelihood estimation with country-level random effects. Data includes a list of 1447 rate data points used as an input to the modelled estimates, yearly national-level covariates for each of the 195 countries studied from 2000 to 2015, and information on estimated low birthweight rates from 2000 to 2015 for 148 countries with data. Stata code used to generate these estimates is provided.

Background Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. Methods We sought to identify all available LBW input data for livebirths for the years 2000-16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. Findings We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14.6% (uncertainty range [UR] 12.4-17.1) compared with 17.5% (14.1-21.3) in 2000 (average annual reduction rate [AARR] 1.23%). In 2015, an estimated 20.5 million (UR 17.4-24.0 million) livebirths were LBW, 91% from low-andmiddle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). Interpretation Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2.74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Copyright (C) 2019 UNICEF and World Health Organization. Published by Elsevier Ltd.

Background: Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low-and middle-income countries (LMICs). Objective: We assessed time trends in stunting among children < 5 y of age (under-5) according to household wealth and place of residence in 67 LMICs. Methods: Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with >= 2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated. Results: Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from -19.3% in 1993 to -23.7% in 2014 and CIX increased from -6.2% to -10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively). Conclusions: The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time.

Objective: Prevalence ranges to classify levels of wasting and stunting have been used since the 1990s for global monitoring of malnutrition. Recent developments prompted a re-examination of existing ranges and development of new ones for childhood overweight. The present paper reports from the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring. Design: Thresholds were developed in relation to SD of the normative WHO Child Growth Standards. The international definition of 'normal' (2 SD below/above the WHO standards median) defines the first threshold, which includes 2.3% of the area under the normalized distribution. Multipliers of this 'very low level (rounded to 2.5%) set the basis to establish subsequent thresholds. Country groupings using the thresholds were produced using the most recent set of national surveys. Setting: One hundred and thirty-four countries. Subjects: Children under 5 years. Results: For wasting and overweight, thresholds are: 'very low (<2.5%), 'low' (approximate to 1-2 times 2.5%), 'medium' (approximate to 2-4 times 2.5%), 'high' (approximate to 4-6 times 2.5%) and 'very high' (> approximate to 6 times 2.5%). For stunting, thresholds are: 'very low' (<2.5%), 'low' (approximate to 1-4 times 2.5%), 'medium' (approximate to 4-8 times 2.5%), 'high' (approximate to 8-12 times 2.5%) and 'very high' (> approximate to 12 times 2.5 %). Conclusions: The proposed thresholds minimize changes and keep coherence across anthropometric indicators. They can be used for descriptive purposes to map countries according to severity levels; by donors and global actors to identify priority countries for action; and by governments to trigger action and target programmes aimed at achieving 'low' or 'very low' levels. Harmonized terminology will help avoid confusion and promote appropriate interventions.

Age-appropriate complementary feeding practices are far from optimal among low- and middle-income countries with available data. The evidence on the association between feeding practices and linear growth is mixed. We sought to systematically examine the association between two indictors of dietary quality-dietary diversity and animal source food (ASF) consumption (WHO, 2008)-and stunting (length-for-age z-score) employing existing data from 39 Demographic and Health Surveys. Data on 74,548 children aged 6-23 months were pooled and multiple logistic regression models, adjusting for child, maternal, and household characteristics, employed to assess the association between dietary quality and stunting. Stratified models by child age and by World Bank country-income classifications (World Bank, 2015) were also applied. Children aged 6-23 months consuming zero food groups in the previous day had a 1.345 higher odds of being stunted when compared to the reference group (≥5 food groups); those who did not consume any ASF in the previous day had a 1.436 higher odds of being stunted compared to children consuming all three types of ASF (egg, meat, and dairy). We estimated that 2,629 cases of stunting would have been averted (12.6% of those stunted) among the population studied if all children had consumed five or more food groups. Outcomes by country-income groupings showed larger associations of diet diversity and ASF consumption for upper- and lower-middle income countries compared to low-income countries. In summary, dietary diversity and ASF consumption were associated with stunting, with associations varying by stratified groups.

Insufficient quantities and inadequate quality of complementary foods, together with poor feeding practices, pose a threat to children's health and nutrition. Interventions to improve complementary feeding are critical to reduce all forms of malnutrition, and access to data to ascertain the status of complementary feeding practices is essential for efforts to improve feeding behaviours. However, sufficient data to generate estimates for the core indicators covering the complementary feeding period only became available recently. The current situation of complementary feeding at the global and regional level is reported here using data contained within the UNICEF global database. Global rates of continued breastfeeding drop from 74.0% at 1 year of age to 46.3% at 2 years of age. Nearly a third of infants 4-5 months old are already fed solid foods, whereas nearly 20% of 10-11 months old had not consumed solid foods during the day prior to their survey. Of particular concern is the low rate (28.2%) of children 6-23 months receiving at least a minimally diverse diet. Although rates for all indicators vary by background characteristics, feeding behaviours are suboptimal even in richest households, suggesting that cultural factors and poor knowledge regarding an adequate diet for young children are important to address. In summary, far too few children are benefitting from minimum complementary feeding practices. Efforts are needed not only to improve children's diets for their survival, growth, and development but also for governments to report on progress against global infant and young child feeding indicators on a regular basis.

The inter-agency team released new joint estimates for child stunting overweight underweight wasting and severe wasting (May 2017 edition) using the same methodology as in previous years. These new estimates supersede former analyses results published by UNICEF WHO and the World Bank Group. Given that country data are at maximum available from surveys conducted in the year previous to when the modelling exercise takes place in 2017 the joint estimates were derived up to 2016 with extrapolation for stunting until 2025.

The Lancet's Series on breastfeeding1Victora CG Bahl R Barros AJD et al.The Lancet Breastfeeding Series GroupBreastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.Lancet. 2016; 387: 475-490Summary Full Text Full Text PDF PubMed Scopus (3313) Google Scholar, 2Rollins NC Bhandari N Hajeebhoy N et al.The Lancet Breastfeeding Series GroupWhy invest, and what it will take to improve breastfeeding practices?.Lancet. 2016; 387: 491-504Summary Full Text Full Text PDF PubMed Scopus (1075) Google Scholar has shown the nutritional, immunological, and developmental inferiority of breastmilk substitutes, and the contribution of breastfeeding to the survival and health of children and their mothers in all countries. It does not, however, address the needs of the infants most vulnerable to nutritional, immune system, growth, and developmental compromise; those born preterm, growth retarded, or who are sick. These infants and their mothers need special protection and support to enable breastfeeding and feeding with breastmilk, yet paradoxically they are often denied rights normally accepted unconditionally for full term infants. The common practices in neonatal units worldwide of separation of mothers and infants, routine supplementation and fortification, and targets for weight gain, disrupt the essential close maternal–newborn contact and are counter to the evidence on the conditions needed to establish breastfeeding.3Flacking R Lehtonen L Thomson G the SCENE groupCloseness and separation in neonatal intensive care.Acta Paediatr. 2012; 101: 1032-1037Crossref PubMed Scopus (284) Google Scholar, 4Renfrew MJ Craig D Dyson L et al.Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis.Health Technol Assess. 2009; 13: 1-188Crossref PubMed Scopus (143) Google Scholar It is hard to imagine an environment that is more antagonistic to breastfeeding. A transformational shift is needed in the way we care for these infants and their parents. This change includes the development of parents and staff as partners in care,5Jianga S Warrea R Qiua X et al.Parents as practitioners in preterm care.Early Hum Dev. 2014; 90: 781-785Crossref PubMed Scopus (51) Google Scholar promotion of kangaroo mother care as standard, and tackling barriers to its implementation,6Vesel L Bergh A-M Kerber KJ et al.On behalf of the KMC Research Acceleration Group. Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions.BMC Pregnancy Childbirth. 2015; 15: S5Crossref PubMed Scopus (80) Google Scholar and adherence to the International Code on the Marketing of Breast-milk Substitutes to limit claims about specialised formula that lack evidence.7McFadden A Mason F Baker J et al.Spotlight on infant formula: coordinated global action needed.Lancet. 2016; 387: 413-415Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar Studies have shown a substantial related economic benefit, so resource use should be no barrier. Increased use of breastfeeding and feeding with breastmilk for these babies and mothers would contribute to progress on Sustainable Development Goal 3 in relation to infant and maternal survival, health, and wellbeing. Concerted action by researchers, funding agencies, health professionals, and advocacy groups is long overdue. MR received grants from National Institute for Health Research Health Technology Assessment. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effectThe importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. Full-Text PDF Why invest, and what it will take to improve breastfeeding practices?Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. Full-Text PDF Breastfeeding in the 21st century – Authors' replyWe appreciate the interest raised by our Series.1 Dylan Walters and colleagues rightly point out that the standard international indicator for exclusive breastfeeding (proportion of infants aged 0–5 months who are fed exclusively with breastmilk) is distinct from the proportion of infants who are exclusively breastfed until they reach 6 months of age. While we agree that new approaches are needed to estimate the latter from survey data, the former is the only internationally comparable indicator currently available for low-income and middle-income countries, with the advantages of not depending on recall nor relying on modelling. Full-Text PDF

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the "new normal." Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account.