Growing right: unpacking the WHO Child Growth Standards Development and their implementation in Colombia
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Date
27/11/2018Item status
Restricted AccessEmbargo end date
30/11/2019Author
Niño Machado, Natalia
Metadata
Abstract
Child growth reference charts have been used since the 1960s to assess children´s
growth – enabling comparison of different population groups and the implementation
of nutritional surveillance. In 2006, an important critical juncture occurred in the
history of anthropometry and nutritional assessment, when the WHO released new
growth charts for international comparison after promoting, since 1975, the use of
the charts developed by the Centers for Disease Control (CDC) and US National
Center for Health Statistics (NCHS). According to the WHO, these charts indicate
how children should grow for the best health outcome in contrast to the NCHS/CDC
charts that indicated how the average child grows. This shift from a descriptive to a
prescriptive –and rather normative – approach allowed the WHO to state that all
children in the world have the potential to grow and develop to within the same range
of height and weight, thus implying that all children should develop in specific
standardised ways, regardless of ethnicity, socioeconomic status and type of feeding.
By 2011, approximately 125 countries had adopted the WHO charts for individual
growth monitoring as well as the means of producing statistics for under- and over-nutrition,
which would be used to assess and monitor a population’s health status.
This shift between charts has direct implications for how children’s growth is
measured and how malnutrition is assessed. The adoption of the WHO charts has
immediate consequences for the calculation of underweight, overweight, stunting,
and wasting prevalence. In this sense, the adoption of the new charts considerably
changes the estimates to predict nutrition-related emergencies, the assessment of
appropriate weaning practices, and the screening and monitoring of populations at
risk or with growth deficiencies or excesses.
In my doctoral research, I use Colombia as a case study to unpack how a standard
developed by an international organisation is negotiated, adopted and constantly
transformed once it is scaled down to a specific country. Using the theoretical
approach to standards by authors such as Star, Bowker, Timmermans, Berg, and
Epstein, in this dissertation I show how, far from being ‘stable’ and ‘value-free’ (as
the World Bank would describe them), growth charts are political tools of
measurement, charged with specific values regarding children’s bodies.
Given that Colombia had previously used the NCHS charts, this research explores
how the WHO charts have been adopted within individual growth monitoring
programmes in Colombia. I also describe how the change in charts has destabilised
the production of under and over-nutrition indicators by national bodies, such as the
Ministry of Health and the Instituto Nacional de Salud. My data includes twenty-eight
interviews with policy makers, experts and civil servants who actively
participated in the process of adopting and adapting the standards in Colombia at the
national level; seventeen interviews with nurses and doctors; observation of 158
anthropometric assessments of children under five years old within six health
facilities in the Caribbean region that were implementing a growth monitoring
programme. By exploring how the WHO charts are interpreted and used in practice,
this research contributes to the study of standards and standardisation as a field of
study in its own right.