The State of the World's Children 1998: Focus on Nutrition

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The right to good nutrition

However far-reaching the benefits of nutrition may be, ensuring good nutrition is a matter of international law, articulated in variously specific language in international declarations and human rights instruments dating back to the adoption of the Declaration of the Rights of the Child in 1924 (Panel 4).

Under the 1979 Convention on the Elimination of All Forms of Discrimination against Women, for example, States parties must ensure that women receive full and equal access to health care, including adequate nutrition during pregnancy and lactation. And the 1990 World Summit for Children, with a Plan of Action that recognized the devastating effects of malnutrition on women and their children, set specific nutritional goals for children and women, including access to adequate food during pregnancy and lactation; the promotion, protection and support of breastfeeding and com plementary feeding practices; growth monitoring with appropriate follow-up actions; and nutritional surveillance.

But the right to nutrition receives its fullest and most ringing expression in the 1989 Convention on the Rights of the Child, whose 191 ratifications as of late 1997 make it the most universally embraced human rights instrument in history.

Under the Convention, which commits States parties to realize the full spectrum of children's political, civil, social, economic and cultural rights, virtually every government in the world recognizes the right of all children to the highest attainable standard of health, to facilities for the treatment of illness and for the rehabilitation of health -- specifically including the right to good nutrition and its three vital components: food, health and care.

Under the Convention's pre-eminent guiding principle, good child nutrition is a right because it is in the "best interests of the child."

Article 24 of the Convention specifies that States parties must take "appropriate measures" to reduce infant and child mortality, and to combat disease and malnutrition through the use of readily available technology and through the provision of adequate, nutritious foods and safe drinking water.

The world is obligated to ease child malnutrition on the basis of international law, scientific knowledge, practical experience and basic morality.

The ravages caused by malnutrition on individuals, families and societies are preventable. The measures needed to reduce and end it are becoming increasingly well understood. And the gains for humanity from doing so -- in greater creativity, energy, productivity, well-being and happiness -- are immeasurable.

Why time is of the essence

A child's organs and tissues, blood, brain and bones are formed, and intellectual and physical potential is shaped, during the period from concep tion through age three.

Since human development proceeds particularly rapidly for the first 18 months of life, the nutritional status of pregnant and lactating mothers and young children is of paramount importance for a child's later physical, mental and social development. It is not an exaggeration to say that the evolution of society as a whole hinges on the nutrition of mothers and children during this crucial period of their lives.

The healthy newborn who develops from a single cell -- roughly the size of the period at the end of this sentence -- will have some 2 billion cells and weigh an average of 3,250 grams.18 Under optimal conditions, the infant will double its birthweight in the first four months of life; by its third birthday, a healthy child will be four and a half times as heavy.

Brain cells proliferate at the rate of 250,000 a minute, beginning in the third week of gestation.19 By the time of birth, a child will have 100 billion neurons, linked by synapses, the complex nerve junctions that begin forming in the 13th week of gestation.20

Proliferating most rapidly after birth, in large part because of the stimulation and care a child receives, millions upon millions of these junctions will be forged by the time a healthy child reaches the age of two and a half. Physical, mental and cognitive development depend on these communication links between neurons. Without them, messages would dead-end, muscles would not flex, and the complex processes of thought and learning would not be possible.

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Growth during the foetal stage depends on how well nourished a woman was before pregnancy, as well as how much weight she gains while she is pregnant. Gains in weight are essential for the development of new maternal and foetal tissues, and for maternal body maintenance and energy.

Since the foetus relies entirely on the mother for nutrients, pregnant women not only need to gain weight but also must maintain an optimal intake of essential nutrients such as iron and iodine.

But fulfilling these interlocking food, health and care needs can be a struggle for many women in the developing world, where economic, social and cultural factors may be a barrier to good nutrition.

Currently about 24 million low-birthweight babies are born every year, which is about 17 per cent of all live births. Most are born in developing countries, where the main cause of low birthweight is not premature birth, as it is in the industrialized world, but poor foetal growth.

Low-birthweight babies, defined as weighing less than 2.5 kilograms, are at greater risk of dying than in fants of average weight. If they survive, they will have more episodes of illness, their cognitive development may be impaired, and they are also more likely to become malnourished. Evidence is also mounting that low birthweight predisposes children to a high risk of diabetes, heart disease and other chronic conditions later in life.


Photo: Women need rest and protection from overwork during pregnancy. As long as the unequal division of labour so common around the world persists, the caring practices vital to the nutritional well-being of children will suffer. In Niger, a pregnant woman carries several large bowls of sorghum.


The measures that are essential for an expectant mother -- care and rest, a reduced workload and a well-balanced diet that affords ample energy, protein, vitamins, minerals and essential fatty acids -- are equally important when a woman is breastfeeding her child.

Breastfeeding perfectly combines the three fundamentals of sound nutrition -- food, health and care -- and is the next critical window of nutritional opportunity after pregnancy. While not all children are breastfed, it remains an important protection for children.

Because breastmilk contains all the nutrients, antibodies, hormones and antioxidants an infant needs to thrive, it plays a pivotal role in promoting the mental and physical development of children.

Breastfed infants not only show better immune responses to immuni za tions, but their intake of breastmilk also protects the mucous membranes that line their gastrointestinal and respiratory tracts, thus shielding them against diarrhoea and upper respiratory tract infections.21

In countries where infant mortality rates are high or moderately high, a bottle-fed baby in a poor community is 14 times more likely to die from diarrhoeal diseases and 4 times more likely to die from pneumonia than a baby that is exclusively breastfed.22

Breastfeeding also has cognitive benefits. In one study, breastfed subjects generally had IQs that were about 8 points higher than children who had been bottle-fed, and higher achievement scores as well.23 Nutritionists theorize that the effect may be the result of the growth-promoting long-chain fatty acids of breastmilk. It may also be related to the fact that breastfed infants have fewer infections and, as healthier infants, they take a greater interest in their environment and thus learn more than ill infants.

However, for mothers infected with HIV, breastfeeding's enormous value as a bulwark against malnutrition, illness and death must be weighed against the 14 per cent risk that they may transmit the virus to their infants through breastmilk -- and the vastly greater risk, especially in poor communities with inadequate water and sanitation, that feeding their children artificially will lead to infant deaths from diarrhoeal dehydration and respiratory infections.

During the second half of a child's first year, synaptic growth in the prefrontal cortex of the brain, the seat of forethought and logic, consumes twice the amount of energy required by an adult brain. Much of this synaptic growth is believed to result from the caring stimulation that an infant and young child receives -- the nurturing, feeding and learning play in which parents engage their children.

After about six months, for optimal growth and development, a child needs to be fed frequently with energy-rich, nutrient-dense foods. The failure to make such investments at the right time can never be remedied later. An adequate intake of micronutrients, especially iodine, iron, vitamin A and zinc, remains crucial.

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