In Bolivia, malnutrition afflicts about 25 percent of children under 3 and 12-24 percent of women. It contributes to high death rates, immune deficiency, learning disabilities, and low work productivity. Malnutrition and its effects are particularly severe among poor, rural, and indigenous populations. Malnutrition is both caused by and causes poverty. Malnutrition is caused not so much by lack of food as by lack of purchasing power and by household behaviors toward feeding and caring for young children. Other contributing factors include contaminated water, disease, high fertility, and women's low educational and social status. Most nutrition programs in Bolivia are neither targeted to the individuals most in need (poor children under 2 and pregnant women), nor do they use proven best practices. The most effective nutrition programs worldwide, designed to prevent malnutrition in children under 2, include community-based growth promotion, promotion of breastfeeding and other nutrition education, food fortification with iron, and vitamin A supplement programs. Increasing the availability of water and sanitation services to rural households is also helpful. On the other hand, school feeding programs are very expensive, ineffective, and poorly designed. Program management problems, training needs, and the leadership vacuum are discussed. General recommendations and an action plan for 2003-04 are presented. (Contains 92 references.) (Author/SV)