Shivani Kaul, April 8, 2026

Shivani Kaul is the winner of the 2025 Graduate Student Paper Award from the Association for the Anthropology of Policy (ASAP). This piece is drawn from her award-winning paper.

“How to raise the world’s IQ.”

“Cheap fixes could help 450m people stand taller and think quicker.”

Recent headlines in The Economist reflect a growing policy concern about global child malnutrition, particularly stunting during the “First 1000 Days” of life. For many global health policymakers, infant stunting—when a child is much shorter than the standardized height-for-age—signals not only compromised health but lost future IQ and economic productivity. In this framing, a child’s height becomes a proxy for national development. Today, clinicians measure infants with low-cost anthropometric tools and plot their height and weight on standardized growth charts drawing from multinational cohort studies. Infant growth is thus turned into a universal biomedical metric, pegged to the future growth of national economies.

The First 1000 Days agenda exemplifies this dominant bioeconomic logic: human growth matters insofar as it yields productive citizens. Funding networks like the Gates Foundation support interventions designed to optimize early nutrition. As scholars of global health have observed, interventions with humanitarian intentions also sustain imperialist financial ties, neocolonial hierarchies, and racialized exclusions. And yet policies do not travel intact. As they move, they are translated. And in translation, alternative logics can emerge. Indeed, ethnographies of early nutrition interventions across the Global South indicate diverse national contexts generate distinct policy objectives and actions.

How has this agenda been translated into practice in ecologically sensitive settings that have never been colonized directly, like Bhutan? How do practitioners redesign these interventions, and what might their translations suggest about growing humans otherwise? Drawing on 18 months of collective, multimodal ethnographic research conducted from 2019 to 2020 and in 2023 with 57 mothers, 51 health workers, and 28 other feeding experts across five sites, my co-researchers and I observed not wholesale rejection but something more subtle: partial refusal. Through everyday practices, mothers and health workers in Bhutan redesigned the bioeconomic imperative into a relational, land-based logic of tendrel (interdependent) human growth.

Partially Refusing “Scaling Up”

Since 2010, the Scaling Up Nutrition (SUN) movement has mobilized governments, corporations, and civil society around the First 1000 Days agenda. Drawing from Lancet publications, SUN frames this period from conception to age two as an epigenetic “window of opportunity” to shape future health and productivity.

Yet out of a wide range of possible nutrition interventions—from land reform to maternity allowances—SUN emphasizes 13 “high impact” and cost-effective solutions targeting maternal and child bodies. Among them is Sprinkles, a powdered micronutrient mix developed in the 1990s by Toronto physicians to fortify foods and address nutritional deficiencies like anemia with support from the Heinz Corporation.

While more than 65 countries have signed up with SUN, Bhutan has not. In 2016, representatives from the Royal Government of Bhutan attended a SUN finance meeting in Bangkok—but declined membership. They cited the need for further research on existing interventions like maternity leave and behavior change campaigns before committing to SUN financial planning and monitoring requirements.

This partial refusal is telling. Bhutan, known for its constitutional commitment to Gross National Happiness and small GDP, navigates global development discourses without the direct pressures and medical infrastructures elsewhere established through colonization. Nevertheless, policymakers there worry about losing future human capital due to malnutrition and cite stunting metrics in planning discussions. Over the last decade, the government has implemented several First 1000 Days interventions—including micronutrient distribution and regular infant anthropometry.

SUN publications tout these devices as universally effective. But how do they hold up when implemented in the planet’s most mountainous country, amid rural out-migration and accelerating climate change? What frictions emerge when global metrics meet Himalayan ecologies?

Partially Refusing Micronutrients and Metrics

We encountered three striking tensions during fieldwork.

1. Sprinkles as a Polarizing Substance

Sprinkles generated scientific debate and mixed reception. One health assistant explained that a 2019 local pilot produced uneven results, contrasting with glowing media reports. And while some mothers reported children accepted micronutrients, many said their babies refused or vomited it. For example, one mother in Samtse contrasted her two-year-old daughter’s vomiting of Sprinkles with her older son’s refusal to eat without it.  In our sensory experimentation with micronutrients, we tasted a metallic odor resembling mothers’ complaints and health workers’ speculation that high iron concentrations repel sensitive infant palates. Though evidence for Sprinkles’s efficacy is considerable, microbiological studies suggest high iron in micronutrient powders can irritate child microbiomes, and critical nutritionists urge caution in light of harmful patterns in some malaria-endemic parts of the planet.

2. The Labors of Growth Monitoring

“Growth monitoring” on WHO charts was also controversial. First 1000 Days protocol requires eight antenatal and four postnatal visits. For farming and working mothers, these visits demand significant time and money, especially in mountainous regions without public transport. Thus, not all pregnant women completed recommended visits.

Health workers too faced mounting tasks associated with growth monitoring: holding down crying infants on anthropometric boards, instructing mothers in complementary feeding and micronutrient dosing, and tracking sachet distribution and expiration. Staff shortages—exacerbated by skilled worker emigration and rural outreach campaigns—meant some backlogged measurements were plotted only after hours.

3. Ontological Doubts

Some health workers questioned the universal applicability of WHO growth standards, describing their usefulness to categorize Bhutanese children as “debatable.” Several health workers shared that in their clinical experience, child height—unlike weight—was shaped more by family history and geographic region than responsive to individual diet.

In fact, elder nurses recalled a “reversed” norm: until a decade ago, unusual tallness prompted concern in Bhutan. Today’s pressure to increase height felt historically novel. But health workers’ doubts didn’t reflect rejection of biomedicine. Rather, they signaled friction between universal metrics and situated knowledge about bodies shaped by ecology and history.

A Different Logic of Intervention

Despite these ‘feeding tensions,’ neither mothers nor health workers fully rejected micronutrients or metrics. Instead, they redesigned them.

1. Growing Subsistence Tastes

Mothers and health workers were open to Sprinkles but not necessarily invested in maximizing vitamin intake or height. A common sign of health for them was good appetite for “balanced” foods. Balanced did not mean vitamin-maximizing; it often meant limiting children’s contact with and desire for costly ultra-processed foods—noodles, juice, candies—instead cultivating pleasure in what they could grow.

Health workers similarly promoted land-based foods. One Thimphu nurse developed complementary food recipes during the pandemic, respecting both biomedical standards for dietary diversity and customary norms to feed infants powder made from local barley and wheat called kabchi. She even recorded cooking demonstrations for YouTube from the hospital.

And in Samtse, Tarayana fieldworkers supported cultivation of foxtail millet, once a more common first food across Bhutan. Millets are protein-rich and nutritionally complex compared to monocrop wheats. Among Lhop communities, they are also used in ritual offerings—especially around death and as first foods for infants. Kabchi, millet, and alcohol based on these grains are also offered to feed land deities believed to protect infants across valleys. Mothers and health workers advocated combining these biomedical and sacred materials. Thus, feeding babies entwines heritage seed knowledges, ritual observances, and ecological stewardship.

2. Longevity, not only Height

For many participants we interviewed, one preferred indicator of health was longevity rather than height. A longer life allows growth in spiritual merit, not just of human capital. Elder feeding experts recalled the historical importance of longevity practices associated with particular deities, valleys, and ecological elements rather than measures to mitigate stunting.

This reflects the inappropriateness of stunting as health metric, noted now among some critical nutritionists. Evolutionary biologists have similarly argued that stunting has not been associated with illness, poverty, or disadvantage in comparative human history over 10,000 years. Shorter stature is also associated with higher longevity. From this position, shorter stature could reflect adaptation in particular socioecological circumstances.

In this vein, several physicians we met suggested regionally informed growth charts might more accurately reflect local variation. Clinicians in India have also argued for regional charts to avoid unnecessary pathologization. Recent studies of global demographic data even suggest shorter height is more common at high altitudes. Thus, child growth is not reducible to caloric or micronutrient intake. It is shaped by altitude, climate, agricultural systems, and labor patterns. Height is one expression of these entanglements—not their master indicator.

3. Tendrel and Partial Refusal of Lenchak

This alternative logic of growth resonates with a concept in Dzongkha we often heard in Bhutan: tendrel (interdependent origination). Rooted in Buddhist philosophy and often applied in Sowa Rigpa (Tibetan medicine), tendrel holds that phenomena arise through multiple contingent causes. Entities are relational, emerging from partial connections to their surrounding ecologies. Paradoxically, this relational ontology also acknowledges the problem of lenchak (karmic retribution due to repeating toxic attachments), which must be limited to generate liberation for multiple sentient beings—not only humans. For example, rather than focusing on feeding infants more nutrients alone, limiting toxic lead exposures and ensuring clean water systems also become significant.

When evaluated through this logic, micronutrient powders and child metrics are not totally refused. They are weighed relationally. Do these interventions support the flourishing of infants, families, farmers, deities, and ecologies? Or do they deepen the risk of lenchak—toxic dependency on remote corporations and unsteady supply chains?

Our research demonstrated that targeted solutions touted as cheap, quick fixes resulted in uneven outcomes and new dependencies. Micronutrients helped some children while hooking or harming others. Supplying Sprinkles entails supply chains linking clinics to the Ministry of Health, UNICEF, and the Piramal Corporation in India. By contrast, kabchi has shorter supply chains and thicker relational value: feeding babies, sustaining climate-resilient crops, and supporting farmers. Offering kabchi to deities reinforces these ecologies of relations.

Growing Humans Otherwise

In Bhutan, metrics and micronutrients did more than extend state control over the First 1000 Days. They incited partial refusal and redesigned interventions, signaling a different logic of growth. Rather than maximizing height, IQ, and human capital, many practitioners we met prioritized longevity, relational balance, and limits to corporate dependency. Growth was understood not only as biological optimization or economic investment but as an ecosocial process unfolding within specific landscapes and histories.

Our findings generate further questions: how might this more-than-human approach inform health and development policy done differently elsewhere? Rather than fetishizing the accumulation of height, IQ, and future human capital, what if researchers evaluated interventions centering longevity and limits to corporate dependencies? What other evidences, actors, and disciplines might be invited to the policy design table then?

Partial refusal does not dismantle global nutrition regimes. But it unsettles their inevitability. It suggests that humans can be grown otherwise—not necessarily in the secular, bioeconomic image of Man—but as beings emerging from complex ecological, social, and spiritual relations. For anthropology, this invites reconsideration of liberal assumptions about autonomous subjects and universalizing interventions. For global health, it offers a reminder: micronutrients and metrics may travel widely, but human growth itself is a relational process. Policymakers might then attend to healthy soils, waters and breathing companions alongside micronutrient distribution—tending planetary wellbeing rather than productivity alone.