The world is in a nutrition crisis. Malnutrition directly affects one in three people, making it one of the most prominent issues affecting global health.
Of the 667 million children under the age of five, researchers estimate that 159 million are either chronically malnourished or stunted. That is almost a quarter of children globally. 
In Rwanda that number is even higher. On average, 37 percent of children under 5 are chronically malnourished. 
A common misconception is that malnutrition results from a lack of food to eat. However, the world produces more than enough to feed the entire global population. In fact, one third of all food produced (1.3 billion tons) is never consumed.  So why then is hunger so prevalent?
To truly understand and address this problem, we need to examine the root causes rather than continue to look to technical innovations that increase food production as the main solution.
In fact, a number of complex interrelated factors go beyond food production and may impact a family’s ability to feed their children. Some of these key factors include:
Poverty is unquestionably a driving factor in the lack of resources to purchase or otherwise obtain food. People living in poverty struggle to afford nutritious food for themselves and their families. Often, families also lack access to important agricultural inputs such as seeds and fertilizers, making it nearly impossible to cultivate the crops that could feed themselves and their children. Malnutrition and poverty also exist in a cycle – children who are malnourished face cognitive impairment and are less likely to perform well in school in addition to suboptimal functioning as productive adults. As a result, they will struggle to earn enough income to purchase nutritious foods or won’t have the productive capacity to grow the food needed to feed their families and advance their situation. Poverty, combined with other socioeconomic and political barriers, creates the bulk of food insecurity around the globe. 
2. Lack of Knowledge
Level of maternal education is one of the most important factors contributing to the nutritional status of women and children globally. Because decisions about food quality and quantity, household hygiene practices, and disease management are often made by the mother, maternal education is crucial for improving the health status of the family. However, in many resource-poor environments where educational attainment may be low, we also see a relative lack of knowledge around nutrition. For example, when knowledge about the importance of vitamins and nutrients is lacking, many families fail to consume even inexpensive and available foods that are rich in these same vitamins and nutrients.
Vestine Bayavuge, a GHI graduate from Shingiro Health Center, remarks “I was born a farmer, I would cultivate crops for two purposes, either for selling at markets or for home consumption. I never considered the nutritional benefits of crops before,” thus highlighting the importance of nutritional knowledge in addition to the resources themselves. Datvia Nyirarukumdo, from Busogo, echoes this statement, “We’ve had a good harvest of potatoes and beans and everything else. But we used to think that nutritious food was composed of potatoes and beans only… I didn’t know the benefits of growing vegetables and I couldn’t cook them.” The link between knowledge and improved health outcomes is well documented and plays a significant role in explaining why malnutrition is not simply an issue of food security.
3. Gender Imbalances
Social and economic inequalities between men and women often stand in the way of balanced nutrition. More often than not, malnutrition disproportionality affects women. In households that are vulnerable to food insecurity, women are at greater risk of experiencing malnutrition than men. Malnutrition in mothers, especially those who are pregnant or breastfeeding, can create a cycle of deprivation that increases the likelihood of a low birth weight child as well as childhood malnutrition.  Women are typically the primary caregivers for their children, and if they do not have the freedom to make household decisions their child’s health will be negatively impacted. Studies show that when women have the authority and ability to make decisions in the household, a higher proportion of family income will go to food, nutrition supplements, and health care.
Gender imbalances and the low status of women in the household may increase the likelihood of domestic and gender based violence. Domestic violence has been strongly associated with a woman’s inability to make decisions for herself and her family, including the choice of types and quantities of food she prepares. Additionally, the link between domestic violence and nutritional deficiencies may reflect the effects of physical manifestations of psychological stress. 
Furthermore, lack of decision-making power may also mean that women have less influence to make decisions regarding family planning. When women have fewer children they can invest more time and resources into each child. Increased birth spacing also allows mothers to harmonize childbirth and breastfeeding schedules, which has direct implications for nutritional status. Agnes Mukankuranga, mother of five from Rubungo, cites family planning as a critical intervention to improve malnutrition in her household. “As regarding birth spacing, I would stop breastfeeding when my child was only one year old because I was pregnant again. When you stop breastfeeding and you don’t have resources to provide food, your children can become malnourished. That is what happened in my family. My children are all one year apart. But since I started [family planning], they started to improve.”
4. Disease and Infection
Malnutrition and infection are strongly interdependent. While malnutrition can cause increased susceptibility to infection, infection also contributes to malnutrition – creating a vicious cycle. The consequences of an inadequate dietary intake include weight loss, damage to mucus membranes surrounding vital organs, impaired growth and development in children, and lowered immunity. This combination makes it much easier to become infected by various pathogens. Once infected, nutritional status is further aggravated by diarrhea, poor absorption of nutrients, loss of appetite and diversion of nutrients for the immune response, all of which lead to further nutrient loss and damage to defense mechanisms. This, in turn, causes reduced dietary intake. 
Chronic exposure to pathogens from contaminated environments can worsen health outcomes and damage the intestine, impairing long-term nutrient absorption. As a result, even if an individual were consuming enough food with the correct nutrients, the body wouldn’t be able to use and process those nutrients effectively. In addition to parasitic infections, such as malaria and worms, other infections like tuberculosis and HIV are intricately linked to nutritional status. Therefore, clean and safe water, hygienic living conditions, and access to health care are huge determinants in an individual’s overall health status. GHI’s Health Manager, Angeline Mumararungu, emphasizes this relationship, stating “early childhood illnesses can prevent children from thriving.”
At GHI, our program model is designed to address these interrelated factors that contribute to malnutrition in the home, as well as many more not included in this list. In addition to trainings on nutrition and agriculture we cover topics ranging from common illnesses, HIV/AIDS, gender-based violence, listening and communication, hygiene, traditional healing, family planning, mental health, and more. In doing so, we formally recognize that there is no straightforward link between agricultural yield and health outcomes, thus more accurately reflecting the lived realities of our partner families. By addressing these root causes head on – and making sure our partner families have the knowledge, skills, and inputs they need to thrive – we are taking real steps towards eradicating chronic childhood malnutrition in Rwanda.
 Report Finds Malnutrition Rates in Rwanda have Improved, But More Work is Still Needed, World Food Program. 2016
 Global Nutrition Report, International Food Policy Research Institute. 2016
 What Causes Hunger? World Food Program.
 Domestic violence associated with chronic malnutrition in women and children in India, Harvard School of Public Health. 2008
 The Interaction Between Nutrition and Infection, Clinical Infectious Diseases. 2008