NUTRITION IN THE FIRST THOUSAND DAYS OF LIFE

Wednesday, 6th of June 2012

NUTRITION IN THE FIRST 1000 DAYS OF LIFE

From Save The Children

Below, statistics, key findings and recommendations from the Executive Summary. The full text is at

http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATE-OF-THE-WORLDS-MOTHERS-REPORT-2012-FINAL.PDF

Vital Statistics

Malnutrition is the underlying cause of more than 2.6 million child deaths each year.

171 million children – 27 percent of all children globally – are stunted, meaning their bodies and minds have suffered permanent, irreversible damage due to malnutrition.

In developing countries, breastfed children are at least 6 times more likely to survive in the early months of life than non-breastfed children.

If all children in the developing world received adequate nutrition and feeding of solid foods with breastfeeding, stunting rates at 12 months could be cut by 20 percent.

Breastfeeding is the single most effective nutrition intervention for saving lives. If practiced optimally, it could prevent 1 million child deaths each year.

Adults who were malnourished as children can earn an estimated 20 percent less on average than those who weren’t.

The effects of malnutrition in developing countries can translate into losses in GDP of up to 2-3 percent annually.

Globally, the direct cost of malnutrition is estimated at $20 to $30 billion per year.

Key findings

1. Children in an alarming number of countries are not getting adequate nutrition during their first 1,000 days. Out of 73 developing countries –which together account for 95 percent of child deaths – only four score “very good” on measures of young child nutrition. Our Infant and Toddler Feeding Scorecard identifies Malawi, Madagascar, Peru and Solomon Islands as the top four countries where the majority of children under age 2 are being fed according to recommended standards. More than two thirds of the countries on the Scorecard receive grades of “fair” or “poor” on these measures overall, indicating vast numbers of children are not getting a healthy start in life. The bottom four countries on the Scorecard – Somalia, Côte d'Ivoire, Botswana and Equatorial Guinea – have staggeringly poor performance on indicators of early child feeding and have made little to no progress since 1990 in saving children’s lives. (To read more, turn to pages 26-31.)

2. Child malnutrition is widespread and it is limiting the future success of millions of children and their countries. Stunting, or stunted growth, occurs when children do not receive the right type of nutrients, especially in utero or during the first two years of life. Children whose bodies and minds are limited by stunting are at greater risk for disease and death, poor performance in school, and a lifetime of poverty. More than 80 countries in the developing world have child stunting rates of 20 percent or more. Thirty of these countries have what is considered to be “very high” stunting rates of 40 percent or more. While many countries are making progress in reducing child malnutrition, stunting prevalence is on the rise in at least 14 countries, most of them in sub-Saharan Africa. If current trends continue, Africa may overtake Asia as the region most heavily burdened by child malnutrition. (To read more, turn to pages 15-21.)

Key findings

1. Children in an alarming number of countries are not getting adequate nutrition during their first 1,000 days. Out of 73 developing countries – which together account for 95 percent of child deaths – only four score “very good” on measures of young child nutrition. Our Infant and Toddler Feeding Scorecard identifies Malawi, Madagascar, Peru and Solomon Islands as the top four countries where the majority of children under age 2 are being fed according to recommended standards. More than two thirds of the countries on the Scorecard receive grades of “fair” or “poor” on these measures overall, indicating vast numbers of children are not getting a healthy start in life. The bottom four countries on the Scorecard – Somalia, Côte d'Ivoire, Botswana and Equatorial Guinea – have staggeringly poor performance on indicators of early child feeding and have made little to no progress since 1990 in saving children’s lives. (To read more, turn to pages 26-31.)

3. Economic growth is not enough to fight malnutrition. Political will and effective strategies are needed to reduce malnutrition and prevent stunting. A number of relatively poor countries are doing an admirable job of tackling this problem, while other countries with greater resources are not doing so Community health workers and midwives meet critical needs in these communities by screening children for malnutrition, treating diarrhea, promoting breastfeeding, distributing vitamins and other micronutrients, and counseling mothers about balanced diet, hygiene and sanitation. The “lifesaving six” interventions highlighted in this report can all be delivered in remote, impoverished places by well-trained and well-equipped community health workers.

In a number of countries – including Cambodia, Malawi and Nepal – these health workers have contributed to broad-scale success in fighting malnutrition and saving lives. (To read more, turn to pages 32-37.)

4. We know how to save millions of children. Save the Children has highlighted six low-cost nutrition interventions with the greatest potential to save lives in children’s first 1,000 days and beyond. Universal coverage of these “lifesaving six” solutions globally could prevent more than 2 million mother and child deaths each year. The lifesaving six are: iron folate, breastfeeding, complementary feeding, vitamin A, zinc and hygiene. Nearly 1 million lives could be saved by breastfeeding alone. This entire lifesaving package can be delivered at a cost of less than $20 per child for the first 1,000 days. Tragically, more than half of the world’s children do not have access to the lifesaving six.

(To read more, turn to pages 23-26.)

5. Health workers are key to success. Frontline health workers have a vital role to play in promoting good nutrition in the first 1,000 days. In impoverished communities in the developing world where malnutrition is most common, doctors and hospitals are often unavailable, too far away, or too expensive.

6. In the industrialized world, the United States has the least favorable environment for mothers who want to breastfeed. Save the Children examined maternity leave laws, the right to nursing breaks at work, and several other indicators to create a ranking of 36 industrialized countries measuring which ones have the most – and the least – supportive policies for women who want to breastfeed. Norway tops the Breastfeeding Policy Scorecard ranking. The United States comes in last. (To read more, turn to pages 39-43.)

Recommendations

1. Invest in proven, low-cost solutions to save children’s lives and prevent stunting. Malnutrition and child mortality can be fought with relatively simple and inexpensive solutions. Iron supplements strengthen children’s resistance to disease, lower women’s risk of dying in childbirth and may help prevent premature births and low birthweight. Six months of exclusive breastfeeding increases a child’s chance of survival at least six-fold. Timely and appropriate complementary feeding is the best way to prevent a lifetime of lost potential due to stunting. Vitamin A helps prevent blindness and lowers a child’s risk of death from common diseases. Zinc and good hygiene can save a child from dying of diarrhea. These solutions are not expensive, and it is a tragedy that millions of mothers and children do not get them.

2. Invest in health workers – especially those serving on the front lines – to reach the most vulnerable mothers and children. The world is short more than 3 million health workers of all types, and there is an acute shortage of frontlineworkers, including community health workers, who are critical to deliveringthe nutrition solutions that can save lives and prevent stunting. Governments and donors should work together to fill this health worker gap by recruiting, training and supporting new and existing health workers, and deploying them where they are needed most.

3. Help more girls go to school and stay in school. One of the most effective ways to fight child malnutrition is to focus on girls’ education. Educated women tend to have fewer, healthier and better-nourished children. Increased investments are needed to help more girls go to school and stay in school, and to encourage families and communities to value the education of girls. Both formal education and non-formal training give girls knowledge, self-confidence, practical skills and hope for a bright future. These are powerful tools that can help delay marriage and child-bearing to a time that is healthier for them and their babies.

4. Increase government support for proven solutions to fight malnutrition and save lives. In order to meet internationally agreed upon development goals to reduce child deaths and improve mothers’ health, lifesaving services must be increased for the women and children who need help most. All countries must make fighting malnutrition and stunting a priority. Developing countries should commit to and fund national nutrition plans that are integrated with plans for maternal and child health. Donor countries should support these goals by keeping their funding commitments to achieving the Millennium Development Goals and countries should endorse and support the Scaling Up Nutrition (SUN) movement. Resources for malnutrition programs should not come at the expense of other programs critical to the survival and well-being of children.(To read more, turn to page 45.)

5. Increase private sector partnerships to improve nutrition for mothers and children. Many local diets fail to meet the nutritional requirements of children 6-24 months old. The private sector can help by producing and marketing affordable fortified products. Partnerships should be established with multiple manufacturers, distributors and government ministries to increase product choice, access and affordability, improve compliance with codes and standards, and promote public education on good feeding practices and use of local foods and commercial products.

The food industry can also invest more in nutrition programs and research, contribute social marketing expertise to promote healthy behaviors such as breastfeeding, and advocate for greater government investments in nutrition.

6. Improve laws, policies and actions that support families and encourage breastfeeding. Governments in all countries can do more to help parents and create a supportive environment for breastfeeding. Governments and partners should adopt policies that are child-friendly and support breastfeeding mothers. Such policies would give families access to maternal and paternal leave, ensure that workplaces and public facilities offer women a suitable place to feed their babies outside of the home, and ensure working women are guaranteed breastfeeding breaks while on the job. In an increasingly urban world, a further example is that public transportation can offer special seats for breastfeeding mothers.