Understanding age-old tradition to end malnutrition

The Challenge

In a country rich with food options, why are children still malnourished?

The Context

With a quarter of Tajikistan’s men working abroad, the women who remain at home shoulder a considerable workload. Overworked mothers must fit child care into very full days, often delegating responsibility to family members who may not be aware of the most up-to-date child-rearing practices. Childcare undertaken by grandparents or older siblings offers a mother valuable support – but it also means a baby often misses nutritional and health milestones during her crucial first 1,000 days of life.







More than 20% of children under five in Tajikistan are stunted, the highest rate in Europe and Central Asia.

Traditional customs offered to newborns at 40 days can interfere with exclusive breastfeeding.

1 in 4 families has at
least 1 male working
abroad in Russia.

Takijistani women take on more family
responsibilities, which puts added
pressure on​ new mothers.

Only 9% of children under two years old in Tajikistan have a healthy diet.

What We Heard

We started in the footsteps of mothers who used local health services. What are their barriers? What are their opportunities? Our team listened to rural mothers and their families, collected video diaries, and plunged into a broad range of data from food security, economics, nutrition, anthropology and health.

We learned that in rural Tajikistan, women bear the brunt of housework, including working in the family farms, the livelihood of nearly every rural family. Grandmothers become the primary caretakers of young children and rely on traditional knowledge, recipes and practices to care for children. While many of these practices are beneficial to children, crop production and the diversity of food available to most Tajikistani families have changed significantly in the last decades. Grandparents were not taking advantage of all the resources that, like household vegetable gardens, are literally in their backyard. Health and other services are also not set up to make it easy for good nutrition to be practiced.

Our Solution

In collaboration with Tajikistan’s Ministry of Health and UNICEF, we identified five key moments that could transform the first 1,000 days of life for a mother and her child, ultimately helping reverse the rate of stunted growth amongst Tajikistani children. While they are distilled from complex public health strategies, we worked hard to make healthy behaviour during these five moments simple and doable. Our strategy was designed to bolster a mother’s skills and her self-confidence, and offer her greater access to services, people and new ideas.

Co-created through a number of collaborative experiences, our strategy and an accompanying field guide for practitioners supports Tajikistani mothers and their wide circle of friends, family and providers who assist them in raising their children. The end result: healthier, happier babies and children who maintain their powerful traditions, while growing into more productive adults.

See the tool ›

  1. Childhood stunting in Tajikistan: quantifying the association with wash food security health and care practices World Bank Group, 2017.
  2. Migration and Development in Tajikistan
  3. Tajikistan Demographics and Health Survey, 2017.
  4. Tajikistan Demographics and Health Survey, 2012.


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