What are the challenges?
© UNICEF/ HQ97-0359/ Balaguer|
A row of small children, each holding a cup, stand against a wall waiting to receive a portion of bread and fortified milk brought by visitors from UNICEF to the village of Churitaca, Bolivia.
UNICEF is working with partners to achieve the 2010 goal of reducing malnutrition among children under five years old by at least one third, with special attention to children under two. In addition, the activities to address proper feeding also contributes to the 2010 goal of reducing child mortality by two-thirds.
The good news is that child malnutrition rates in the developing world fell from 32 per cent to 28 per cent during the 1990's, with 8 developing nations reducing malnutrition levels by 25 per cent or more. These include Bangladesh, China, Indonesia, Mexico and Vietnam.
The goal of eliminating vitamin A and iodine deficiencies by 2000 was also set at the Summit. Tremendous progress has been made through food fortification and supplementation. The number of households in the developing world consuming iodized salt has risen from less than 20 per cent in 1990 to over 70 per cent today. Half of the world’s children are receiving vitamin A supplements, saving an estimated 300,000 lives each year.
The support at the Summit for breastfeeding and complementary feeding was echoed at the Special Sesson on Children 11 years later, with a call to “protect, promote and support exclusive breastfeeding of infants for 6 months and continued breastfeeding with safe, appropriate and adequate complementary feeding up to two years or beyond.
However, almost half of all children in South Asia are still malnourished, the absolute number of malnourished children has increased in sub-Saharan Africa and the number of maternal deaths in pregnancy and childbirth remains the same. There are a number of key challenges.
Inadequate maternal nutrition and care
"Wherever women are in control of resources at family level, in general there is far less malnutrition. Wherever women are oppressed, wherever women are not treated as equals, then you tend to get more malnutrition.” – Roger Shrimpton, Senior Nutritionist with UNICEF partner Helen Keller International.
The low status of women, poor maternal nutrition, inadequate prenatal care and the disproportionate burden of physical labour borne by mothers are some of the greatest impediments to improving nutritional status. When discrimination against women is prevalent, so is poor nutrition, regardless of economic growth. Two-thirds of the world’s 150 million malnourished children live in Asia. Each year 11 million low birth weight (less than 2,500 grams) babies are born in South Asia and 3.6 million in sub-Saharan Africa. Two important reasons for the very high malnutrition and low birth weight in South-Asia are women’s limited access to education and employment.
Very little progress has been made towards the goals of halving maternal mortality or decreasing iron deficiency anaemia in women by one-third of 1990 levels, goals set at the UN General Assembly Special Session on Children in May 2002. Every year, 515,000 women still die during pregnancy and childbirth. [SOWC, 2002] When the mother of a newborn infant dies, the child's chances of survival are significantly reduced. As many as 50 per cent of pregnant women suffer from iron deficiency anaemia. These women may give birth to premature or low birth weight infants who have inadequate iron stores, hence, are at greater risk of infection, weakened immunity, learning disabilities, impaired physical development and, in severe cases, death.
Improving infant and young child feeding
“Initating breastfeeding is not the major problem – over 90 per cent of women worldwide start breastfeeding. The problem is the immediate societal and commercial pressure to stop.” – UNICEF Senior Advisor, Infant & Young Child Feeding and Care, Dr. Miriam Labbok
An estimated 1.3 million lives are lost each year due to inadequate exclusive breastfeeding and another 600 thousand from lack of continuation of breastfeeding with proper complementary feeding. In addition, one third of malnutrition is caused by improper infant and young child feeding. The good news is that breastfeeding rates are no longer decreasing, but have increased, from 1990 when 34 per cent of infants were being exclusively breastfed for the first six months, to 39 per cent today. While some gains were made in the duration of breastfeeding, poor infant feeding practices are still widespread.
Many mothers do not continue breastfeeding for the recommended two years or longer, instead they replace breastmilk with substitutes. Formula feeding is an expensive, not nutritionally equivalent, and often dangerous alternative to breastmilk, particularly in unhygienic environments. Studies indicate that a bottle-fed child living in poverty is up to 14 times as likely to die of diarrhoea and four times more likely to die of pneumonia than an exclusively breastfed infant.
We have the tools to meet the challenge. Full implementation of the Global Strategy for Infant and Young Child Feeding, including the International Code of Marketing of Breastmilk Substitutes, which would help protect against commercial influences that discourage breastfeeding, and the Baby-Friendly Hospital Initiative and community activities, which can promote and support improved infant and young child feeding.
Maintaining and expanding on micronutrient progress
One of UNICEF's greatest nutritional achievements of the 1990s was the dramatic reduction in vitamin A and iodine deficiencies. The task now is to expand upon existing iodine and vitamin A programmes and ensure they can be sustained for years to come.
Thanks to salt iodization, nearly 91 million newborns a year in the developing world are being protected against severe mental impairment. However, 30 per cent of households are still not consuming iodized salt, leaving 41 million newborns at risk of brain damage and impaired learning capability. Both governments and salt producers have to be committed to iodization to meet the goal of elimination of iodine deficiency by 2005.
More than 40 countries in the developing world are reaching over 70 per cent of children with at least one high-dose vitamin A supplement. However, over 100 million children are still vitamin A deficient. [WHO] Many countries give vitamin A supplements during national polio immunization days, which will be discontinued as the world nears its goal of polio eradication. The remaining children must be reached and another delivery mechanism must be found. Lastly, greater efforts must be made to reduce iron deficiency which today it is the most pervasive nutritional problem in the world, affecting four to five billion people and between 40 to 50 per cent of children under five.
Meeting nutritional needs in emergencies
Child malnutrition increases drastically, and kills most rapidly, in emergencies. Most children do not die due to conflicts or natural disasters, but rather to resultant food shortages, lack of safe water, inadequate health care, and poor sanitation and hygiene. These creates life-threatening circumstances in which the vast majority of children then succumb to a deadly combination of measles, diarrhoea, respiratory infections and severe malnutrition. Breastfeeding, with its protective properties, becomes even more vital under these conditions.
The number of conflicts and emergencies increased in the 1990s from Afghanistan to Zimbabwe. Of the 35 million refugees and displaced people in the world, 90 per cent are women and children. [SOWC, 2002] By 2002, one out of every two Afghan children was malnourished due to decades of fighting, drought and poor health care. In Southern Africa, a food crisis threatened to become a major humanitarian catastrophe in six countries: Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe.
The high nutritional toll of HIV/AIDS
"Even if we could provide a plow and seeds to harvest every bit of land, there aren't enough able-bodied people to do the work.” – UNICEF Senior Programme Officer, Kimberly Gamble-Payne
Natural disasters, decades of conflict, economic decline, cuts in social services and the HIV/AIDS pandemic have overwhelmed families in Southern Africa, leaving them with few coping mechanisms. Children orphaned by HIV/AIDS and children living in households with infected family members have a much greater chance of going hungry.
An estimated 800,000 children under 15 contracted HIV in 2001, about 90 per cent through mother-to-child transmission. [UNICEF FS HIV and Infant Feeding] While there is about a 5-15 per cent chance that a HIV-infected mother will transmit the virus during breastfeeding, the risks of not breastfeeding can be even greater. Mothers must be informed and counseled on their feeding options. HIV-infected children or those orphaned by HIV/AIDS are at high risk of malnutrition and require special attention.