GOAL: Prevent child and maternal deaths and restore essential health services and programmes.
“UNICEF does not go for a one-time response – we usually already have a country programme in place, with its own emergency plan. Our challenge is to figure out what additional support is needed in each situation, with the long-term goal being to establish, or strengthen, sustainable and effective nutritional programmes.” – UNICEF Project Officer, Nutrition in Emergencies, Marjatta Tolvanen, PhD
|© UNICEF/ HQ03-0051/ Noorani|
|The full monthly ration for one person that is contained in ‘food baskets’, is displayed in a market in Baghdad, Iraq.|
In the 1990s, the number of conflicts and natural disasters swelled. Today, there are 35 million refugees and displaced people in the world, 90 per cent of whom are women and children.
Malnutrition increases dramatically, and kills most rapidly, in emergencies. Most children do not die due to conflicts or natural disasters themselves, but rather to resulting food shortages, lack of safe water, inadequate health care, and poor sanitation and hygiene. The vast majority of children succumb to measles, diarrhoea, respiratory infections and severe malnutrition.
Micronutrient deficiencies can easily develop during an emergency or be made worse if they are already present. This happens because livelihoods and food crops are lost; food supplies are interrupted; diarrhoeal diseases break out, resulting in malabsorption and nutrient losses; and infectious diseases suppress the appetite whilst increasing the need for micronutrients to help fight illness.
When an emergency strikes, UNICEF’s foremost priority is to prevent death and malnutrition in the affected population, particularly in the most vulnerable groups: infants, children, pregnant women and breastfeeding mothers. UNICEF assesses the nutritional and health needs of affected populations, protects and supports breastfeeding, especially exclusive breastfeeding by providing safe havens for pregnant and lactating women; provides essential micronutrients; supports therapeutic feeding centres for severely malnourished children; and provides food for orphans. Through its strong supply capability and global on-the-ground presence, UNICEF is able to ensure rapid delivery of emergency supplies, including food.
In order to meet the recommended daily intake of micronutrients, foods are fortified with micronutrients. However, foods fortified with micronutrients may not meet fully the needs of certain nutritionally vulnerable subgroups — pregnant women, lactating women and children from 6 to 59 months of age. To address this problem, WHO and UNICEF have developed a daily multiple micronutrient formula to meet the recommended nutrient intake (RNI) of these nutritionally vulnerable subgroups. In March 2006, WHO, WFP and UNICEF issued a Joint Statement on Preventing and controlling micronutrient deficiecies in populations affected by an emergency. Guidelines in support of the implementation of the joint statement are being developed. UNICEF Supply Division is currently updating existing product specifications and identifying potential products to support country requirements during emergencies.
UNICEF and the World Food Programme (WFP) work together to strengthen and sustain the ability of households to meet their basic needs for food, care of children and women, health services, and water and sanitation. There are three types of food-related responses.
The first is general food distribution by the WFP. The second, in the event of a prolonged conflict or natural disaster, is targeted food aid for pregnant and breastfeeding women and children under five. The third is a medical response; for example, therapeutic feeding is used in severe cases of malnutrition such as marasmus, where the child is severely emaciated, and kwashiorkor, where the child has dangerous swelling of the face, feet and limbs due to lack of protein.
“I think of therapeutic feeding as the last chance to catch the train when we have missed it earlier. In many countries, the situation is very bad even without emergencies. When one occurs, it creates life-threatening circumstances.” – UNICEF Project Officer, Nutrition in Emergencies, Marjatta Tolvanen, PhD
These acute forms of malnutrition must be treated in 24-hour care facilities, either in hospitals, health centres or in therapeutic feeding centres. After recovery from severe malnutrition, these children require special support in the community to ensure they continue to grow normally.
Because UNICEF has an established presence in most countries, the organization is in a position to bring together the international community, governments and non- governmental organizations to protect children’s nutritional and other rights. UNICEF is present to work with all those involved to develop innovative programmes that prepare the way for rehabilitation and reconstruction.
By 2002, every second Afghan child was malnourished due to decades of fighting, drought and poor healthcare. Under-five mortality was estimated at 257 per 1,000 live births, or one in every four children. UNICEF worked to lower childhood mortality and to prevent further malnutrition through breasfeeding support, therapeutic and supplementary feeding programmes, nutritional surveys and education.
Between May and August 2002, the nutritional status of children under five years deteriorated in Zimbabwe due to a combination of drought, HIV/AIDS and political instability. UNICEF brought in UNIMIX porridge, a high protein porridge-like food that has been fortified with vitamins and minerals, to provide supplementary feeding to children under five and to pregnant and breastfeeding women. UNICEF also provided weighing scales and height boards to assess the impact on the nutritional status of children and women participating in the supplementary feeding scheme.
In December 2002, millions of children were at risk of malnutrition and disease due to drought in the Horn of Africa. UNICEF flew in emergency aid supplies to supplement its existing humanitarian programmes in the region. Hundreds of acutely malnourished children were fed in UNICEF-supported feeding centres in Ethiopia and Eritrea. In the Afar region of Ethiopia, a measles and vitamin A campaign covered 600,000 children.
Maternal nutrition and low birth weight
GOALS: Reduce the maternal mortality ratio by at least one third by 2010. Reduce low birth weight by at least one third by 2010, pay special attention to the nutritional needs of girls and women.
"A woman giving birth has her one foot in the grave." – A Filipino saying
A child’s nutritional future begins with the mother’s nutritional status in adolescence and in pregnancy. Low birth weight occurs because of poor maternal health and nutrition and poor foetal growth. Latest estimates suggest that 18 million low birth-weight babies – those weighing less than 2.5 kilogrammes – are born every year, accounting for about 14 per cent of all live births. The vast majority – 11 million – are born in South Asia with 3.6 million in sub-Saharan Africa. These infants may suffer from infections, weakened immunity, learning disabilities, impaired physical development and, in severe cases, die not long after birth.
A mother chronically undernourished from youth will likely give birth to an underweight baby, perpetuating the intergenerational cycle. Aggravating factors during pregnancy can include inadequate diet or rest, smoking, infections, cultural practices that discourage women from gaining weight and long hours of physical labour. Timing and frequency of pregnancies are also of great importance, with high risks encapsulated in the phrase ‘too young, too old, too many or too close.’
The 1990 World Summit for Children set decade goals of halving maternal mortality and reducing iron deficiency anaemia in women by one-third. Very little progress has been made toward either. Every year, 515,000 women still die during pregnancy and childbirth. As many as 50 per cent of pregnant women suffer from iron deficiency anaemia, which may be responsible for as much as 20 per cent of maternal deaths. Eliminating malnutrition in mothers can reduce disabilities in their infants by almost one third.
Inadequate intake of other micronutrients – vitamin A, iodine, folate, zinc – also has a profound impact on both the mother and feotus during pregnancy. Vitamin A deficiency is linked to maternal death. Inadequate folate during the first months of pregnancy can cause neural tube birth defects, such as spina bifida. It can also increase the risk of the baby being born with low birth weight and the mother dying. Iodine deficiency increases the risk of stillbirth and miscarriage and can cause severe learning disabilities in children. Zinc deficiency can result in extended labour, which increases the odds of the mother dying and can impair foetal development.
Key to reducing low birth weight and reducing maternal mortality is improved nutritional and societal status of girls and women. Discrimination against women is an important risk factor for malnutrition, and is one explanation for the extremely high rates of malnutrition and low birth weight in South Asia, where women lack access to education and have low levels of employment.
Related Maternal Nutrition
It is important to ensure a mother's own health since she is clearly a vital part of the mother-infant feeding twosome, or dyad. Supporting breastfeeding means caring for her as well as for her infant. The mother's nutrition affects her health, energy and well-being.
The breastfeeding mother should eat about 500 additional calories more each day than before she was pregnant. It is best that these calories come as part of a normal, healthy diet, with adequate protein, vitamins and minerals. Foods rich in iron, calcium, vitamin A, and folic acid are recommended, with iodized salt. Special and expensive foods are not necessary.
In other words, a mother needs an extra share of the best foods available to the family, just as she did in pregnancy. She needs these foods right through two years of breastfeeding, not just in the first months.
If a mother is moderately malnourished, she will continue to make milk of good quality, better than infant formula. If she is severely malnourished, the quantity of breastmilk produced for each feeding may be diminished. In both cases, for the health of the mother and the child, it is safer and better to feed the mother adequately while helping her to continue breastfeeding.
When supplies of food or vitamin supplements are available it is best to give them to the breastfeeding mother rather than the infant. This will improve the mother's health and well-being, ensure adequate vitamins in her milk, and protect the infant from the risks of artificial feeding.
The mother's dietary intake will not generally increase how much breastmilk she can produce in a day. Her nutritional status before and during pregnancy are important for milk content, but generally only of marginal impact since her body will ensure that the breastmilk receives the available vitamins and minerals. If a mother is concerned whether she is giving her baby enough milk, this can be assessed by ensuring that the infant is urinating at least 5-7 times a day, and producing stool according to age and diet. The mother should know that eating enough of the available foods, increasing variety when possible, and increasing the frequency of breastfeeding, day and night, will support and increase her breastmilk production.
UNICEF works in many areas to support maternal nutrition; one focus is a Low Birth Weight Prevention Initiative, with pilot studies on multi-micronutrient supplements for pregnant women. It will be piloted in 11 countries - Pakistan, India, Bangladesh, Nepal, Indonesia, Philippines, Viet Nam, China, Tanzania, Madagascar and Mozambique. The initiative will complement UNICEF’s Care for Women and Children Initiative, which focuses on women’s education, workload, physical health and nutrition status, emotional well-being, reproductive health, and care during pregnancy and lactation.