Maternal and Child Nutrition
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Published June 6, 2013 See:
http://www.who.int/nutrition/publications/lancetseries_maternal_and_childundernutrition/en/
Executive summary
Maternal and child undernutrition was the subject of a Series of papers in The Lancet in 2008. Five years after the initial series, we re-evaluate the problems of maternal and child undernutrition and also examine the growing problems of overweight and obesity for women and children, and their consequences in low-income and middle-income countries. Many of these countries are said to have the double burden of malnutrition: continued stunting of growth and deficiencies of essential nutrients along with the emerging issue of obesity. We also assess national progress in nutrition programmes and international efforts toward previous recommendations. Read the entire Executive Summary here.
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Series Papers
Maternal and child undernutrition and overweight in low-income and middle-income countries
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Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?
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Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?
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The politics of reducing malnutrition: building commitment and accelerating progress
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Articles
Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis
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Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies
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Dear MPs, please heed Lancet and debate the Food Security Bill
by G Pramod Kumar Jun 14, 2013
Even as the UPA government is trying to enact the National Food Security Bill one last time through the Parliament, two significant global initiatives on nutrition happened last week.
One of them is a a new series by the prestigious medical journal Lancet on maternal and child nutrition; and the second, a G8 summit on hunger which is aptly titled “nutrition for growth”.
The messages from both unequivocally endorse Indians’ undeniable need for food security and nutrition – if the non-UPA politicians, the food-security-malnutrition naysayers are willing to listen. Even from the pure utilitarian perspective of growth, it is absolutely unavoidable.
The focus of both is the same: that without nutrition and food security, the world is screwed up – sick and under-nourished mothers, stunted and dead children and a future workforce that is too weak to work and earn.
One estimate is that malnutrition will cost 11% of the GDP in Asia and Africa. And what does the Food Bill ask for? Just above 1 per cent of the GDP.
While the Lancet series helps us to cut the clutter, the G8 Summit is a warning against importing donor countries’ prescriptions because they will make the situation worse.
Ca the Food Bill save lives? Reuters
As Lancet notes in its preface to the series, which comprises extensive analyses of data over the last five years, reviews and modelling studies, “if maternal and child nutrition is optimised, the benefits will accrue and extend over several generations.”
The Maternal and Child Nutrition Study Group of the Johns Hopkins Bloomberg School of Public Health, which did the Lancet series, emphasises ten interventions targeted at women of reproductive age, during pregnancy, and to infants and children. They calculate the effects of these interventions in 34 countries across Africa, Asia, and the Middle East, which account for 90 per cent of the global burden of undernutrition.
Their key message is “the importance of the first 1000 days from conception to two years. What goes right and what goes wrong for fetal and child nutrition during this period has lasting and irreversible consequences for later life.” The series also talks about the importance of nutrition throughout the life-cycle.
Significantly, India’s Food Security Bill also takes this “human life cycle approach by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity and for matters connected therewith or incidental thereto. ”
Here are ten key points from the Lancet series that we have teased out for our parliamentarians and food security denialists
1. Prevalence of stunting of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere. Under-nutrition is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011
2. Poor growth of the foetus, due to the poor nutrition and health of the mother, is a major reason for stunting of children and deaths of infants. Restricted foetal growth causes more than 800,000 neonatal deaths and 20 per cent of stunting in children younger than 5 years.
3. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.
4. The adolescent girl is especially vulnerable to the effects of under-nutrition – since they are future mothers, they are critical to both maternal and child health. Therefore, they offer a special opportunity as well.
5. Community and schools are great delivery platforms for the implementation of interventions
6. The cost of intervention —an additional $9·6 billion annually for the 34 countries identified—is much less prohibitive than they might at first seem.
7. Current total of deaths in children younger than 5 years can be reduced by 15 per cent if populations can access ten evidence-based nutrition interventions at 90 per cent coverage.
8. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. Continued investments in nutrition-specific interventions to avert maternal and child under-nutrition and micro-nutrient deficiencies for the poor can make a great difference.
9. If this improved access is linked to nutrition-sensitive approaches—i.e. women’s empowerment, agriculture, food systems, education, employment, social protection, and safety nets—they can greatly accelerate progress in countries with the highest burden of maternal and child under-nutrition and mortality.
10. These interventions, if scaled up to 90 per cent coverage, could reduce stunting by 20·3 per cent (33·5 million fewer stunted children) and can reduce prevalence of severe wasting by 61·4 per cent.
The Lancet series also lists ten specific interventions (iron and folic acid, iodine, calcium, energy and protein supplementation and food security in which 25 per cent of energy needs coming from proteins, etc).
Interestingly some of these elements are included in the Indian bill while some are grossly missing.
The G8′s suggestions on the subject may not work. Reuters
Some elements are also part of the efforts at the state levels. For instance, targeting adolescent girls as future mothers to improve maternal and child health has been in vogue in Tamil Nadu since the 1990s. Similarly community and schools as platforms for delivery have also been part of the efforts in the states.
The Indian legislation also lists the other sectoral interventions for advancing food security (Schedule III of the Bill). The insights from Lancet papers show how progressive some of the Indian states have been (e.g Tamil Nadu despite its struggle with a stagnant maternal and infant mortality rates) and how the Food Bill might be a step backward for them.
Now, the second initiative, namely the G8 summit where “eradication of hunger” was the main focus. In contrast to the constructive and specific policy guidance by Lancet, the rich nations’ prescription is what countries such as India should avoid.
The G8’s private-sector reliant food security fixes look dangerous.
Critics say the policies endorsed at the summit will make the problem of hunger worse because of the thinking that “the market knows best”. As this Guardian report noted, the summit failed to address the wider context that starvation is a symptom of a larger problem involving land, health, power and ecological damage.
The G8′s new alliance for food security and nutrition, an initiative that mobilises private capital for investment in African agriculture doesn’t get this point and is rightfully opposed by civil society.
Ironically, this anti-hunger initiative will foster more hunger.
It “will lock poor farmers into buying increasingly expensive seeds, allow corporate monopolies in seed selling, and escalate the loss of genetic diversity in seeds, opening the door to genetically modified crops by stopping farmers’ access to traditional local varieties and forcing them to buy private seeds,” according to Friends of the Earth, quoted by The Guardian.
It is also called a “new wave of colonialism” that targets food systems for corporate profit. This is a point that market and cash-for-food messiahs wouldn’t appreciate.
Anyway, it’s time to go back to the parliament and look at India’s Food Security Bill that is far from perfect. The evidence in favour of food security is too overwhelming to ignore and an optimum document on the issue based on informed debates can be a great beginning.
An imperfect bill through an ordinance will be an opportunity lost. It’s hight time the BJP forgot Modi for a few days and went back to the Parliament.