Malnutrition--especially, the stunting of children under five--is arguably Ecuador's biggest development challenge. Like other Andean countries (such as Peru and Bolivia), Ecuador has a persistently high stunting rate, well above what would be expected given its middle income status. Even more worrying, over the last decade, the trend reduction has virtually stopped. The study supports the development of a more coherent and effective nutrition strategy in Ecuador through an analysis of the main nutrition issues, based on in-depth statistical analysis of a large new household survey dataset (ENDEMAIN 2004) and other data sources, together with a review of qualitative evidence regarding behavioral and program-access obstacles to improved nutritional outcomes. It also reviews the existing programs and policies which aim to improve nutritional outcomes, considered the available evidence on the efficiency, effectiveness, targeting and inter-programmatic coherence of the programs and projects reviewed and suggests an agenda for policy discussions to improve these outcomes.