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Enhancing child nutrition Working to close nutrition gaps in the Europe and Central Asia RegionAt first glance, it would seem safe to assume that children living in the Europe and Central Asia Region enjoy good levels of nutrition. Yet this is a Region characterized by nutrition gaps, with some children in some countries missing out on the proper nutrition they need to grow and thrive. It is a Region with a double burden of malnutrition undernutrition found alongside obesity. Children from marginalized communities are at particular risk of undernutrition, including the stunting that leaves them too short for their age and the micronutrient deficiencies that threaten their health and hamper their full development. Many of the problems start with the poor nutrition of women, even before they conceive, with women who are already suffering from micronutrient deficiencies more likely to have premature births. The problems continue into the earliest years of a childs life, with poor rates of exclusive breastfeeding in the Region and often inadequate feeding practices that put children at risk of either stunting or obesity. These problems are compounded by the fact that child nutrition is simply not a development priority in many parts of the Region. UNICEF works with partners across the Europe and Central U NIC EF/A RMEN IA/2 018/ OSIP OVA IN FOCUS: ENHANCING CHILD NUTRITION Toward 2030SDG 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture Avet, age 4, knows that salt matters. I always help my mom with the cooking; I add the salt, he said. My mother always tells me that we only need a little salt just one pinch. Avet is fortunate. As a result of universal salt iodization, he has effective protection against one of the worlds main causes of learning disabilities. Even mild forms of iodine deficiency a condition that can be particularly threatening during pregnancy and in early childhood leads to damage. Two decades ago, in Armenias mountainous areas, 50 per cent of all pregnant women and 40 per cent of schoolchildren had thyroid-related conditions a sign of iodine deficiency. But the country has been free of iodine deficiency since 2006, thanks to a partnership between the Ministry of Health, UNICEF and the countrys main salt manufacturer to achieve universal salt iodization. The Iodine Global Network points to Armenias success as a model for others to follow. 1 Enhancing child nutrition 2 Fast facts Approximately 12 per cent of the children in Central Asia and the Caucasus are stunted, rising to as high as 17 per cent in some areas. Stunting has a direct impact on learning outcomes in a childs early years. It can cause severe irreversible physical and cognitive damage, which can last a lifetime and even affect the next generation. The Region is seeing the worlds biggest rise in obesity among young children. Central Asia has the second highest prevalence of over-weight children under the age of five worldwide (approximately 11 per cent). Every year, more than 4 million children in the Region do not receive exclusive breastfeeding for the first six months of their lives, even though breastfeeding will protect them against health hazards such as undernutrition, micronutrient deficiencies and obesity. The Region also has some of the lowest rates of early initiation of breastfeeding newborns who breastfeed within one hour of birth in the world. In Azerbaijan, for example, 20 per cent of newborns are breastfed during their first hour of life, falling to only 14 per cent of newborns in Montenegro. In parts of Central Asia, less than half of all children are eating the diverse diet they need for healthy development. Asia Region to make child nutrition a priority and to close the nutritional gaps that put children at risk of a life-time of poor health and stifled development. Tajikistan Albania Armenia Uzbekistan Turkmenistan Azerbaijan Kazakhstan Kyrgyzstan Romania Georgia Turkey Montenegro Bulgaria Moldova Serbia FYROM Belarus Ukraine Bosnia and Herzegovina Double burden of malnutrition in Europe and Central Asia Region 0 5 10 15 20 25 30 nOverweight (%)nWasting (%)nStunting (%) Source: UNICEF State of the Worlds Children Report, 2016. Enhancing child nutrition 3 Vast returns on investment in anemia preventionInvestments in preventing anemia produce high economic returns. It is estimated that an investment of $600 million USD is needed in the Europe and Central Asia Region to meet the Global Nutrition Target for anemia by 2025. It is estimated that each dollar invested in this package of prevention interventions yields approximately $12 in economic returns. ChallengesThere has been some progress on child nutrition across the Europe and Central Asia Region, but there are still significant disparities that must be addressed. Approximately 68 per cent of children in the Region are deprived of exclusive breastfeeding during their first six months, missing out on the best nutritional start in life. The widespread use of breastmilk substitutes and the commercialization of ready-to-use baby foods also poses an additional threat to their nutritional well-being, undermining breastfeeding in a region with the second lowest rates of exclusive breastfeeding worldwide. Children living in some parts of the Region face greater nutritional deprivation. This includes children living in Tajikistans Gorno-Badakhshan Autonomous Oblast where more than 6 per cent of children under five have acute malnutrition, which threatens their survival. Between 12 and 17 per cent of children in Central Asia, parts of the Caucasus and in Central and Eastern Europe are stunted. The effects of stunting are devastating for a childs development, and can include a lower IQ, a weakened immune system and greater risk of serious diseases later in life. Stunting is caused by the lack of a good quality and diverse diet. It is also connected to high rates of premature births, as well as frequent episodes of acute malnutrition during the first 1,000 days of life. There are serious disparities in childhood stunting within countries: in Bosnia and Herzegovina, Montenegro, Serbia and the North Macedonia, stunting rates in Roma settlements are far above the national average. And in every country across the Region, girls, children living in rural areas and the poorest children are more likely to be stunted than others. School-age children and adolescents also face nutrition challenges. Although nutrition resources and programmes have traditionally been directed towards young children and pregnant women, we do know that obesity among adolescents increased in 16 of the 27 European countries included in the Euro Region of WHO between 2002 and 2014. The number of obese adolescents is continuing to rise in many countries and regions. This is particularly the case in Eastern Europe where, until recently, obesity prevalence was lower than in other parts of Europe. Because of the lack of data on adolescent nutrition, there is often a lack of interest in the issue among policymakers. There is, therefore, limited expertise or resources for adolescent nutrition programmes in the Region, which is a lost opportunity to bolster health, development and economic progress. Child nutrition is not being prioritized across the Region and is, therefore, chronically under-resourced. While most countries in the Region have a national nutrition plan, less than half of these plans have a fully costed-out budget, making it less likely that they will receive funding. Only 12 per cent of countries have dedicated national nutrition managers, and the Regions nutrition workforce is not equipped with the relevant expertise and skills needed to address complex nutrition issues. In addition, nutrition science is not a defined discipline, nor does it have a presence at any level of preventive primary health care or in education and research institutions. In Central Asia and the Caucasus, for example, not one academic institution offers an undergraduate or post graduate degree on nutrition. U NIC EF/U N04 0553 /CYB ERM EDIA Mother Macadan Ana Maria with her daughters Florina, 7 months and Madalina and Ioana, both 10 years old. The family lives in Bacau County, Romania where they are supported through UNICEFs Community Services for Children. The programme provides vulnerable families with a minimum package of services. These services include helping to ensure healthy early childhood development through advice and support on good nutrition, adequate care and access to education. Enhancing child nutrition 4 Our aimUNICEF supports action to improve nutrition from a childs earliest years through adolescence and, in the case of women, motherhood. This approach places children, adolescents and women at the centre of our nutrition advocacy, programming and research. Our ambition is to safeguard the nutrition of children and prevent the double burden of undernutrition and obesity for both girls and boys in every context, aiming for a nutritious and balanced diet for every child. Our ActionsUNICEF supports action to improve nutrition for young children, adolescents and mothers in the Europe and Central Asia Region, aiming to ensure that every child has the best possible nutritional start in life. This requires a focus on the systems that are in place or that need to be created to safeguard the nutrition of each child. UNICEFs systems approach in the Region aims to strengthen the capacity of national and sub-national systems to deliver nutrition-specific interventions to children from birth to adulthood and build programmes that are sensitive to their nutritional needs at every stage of life. Our approach prioritizes four delivery systems that are crucial for the achievement of Sustainable Development Goal 2 End Hunger by 2030: The Primary Health Care system The Food system Early Childhood Development The Education system The Social Protection system The Primary Health Care system We support Infant and Young Child Feeding (IYCF), which includes exclusive breastfeeding and the timely introduction of diverse and healthy complementary feeding (the introduction of other foods and liquids in addition to breastmilk for children aged six months to two years). In addition, UNICEF is also promoting a healthy and diverse diet for the children during their early year before school. This strategy aims to prevent both stunting and obesity in the priority countries. We provide intensive support to Armenia, Azerbaijan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan that have the Regions highest levels of child undernutrition, including stunting. We also support nutrition counselling during critical periods of life such as pregnancy and the early years, to promote a healthy diet. In addition, in Armenia, Bosnia and Herzegovina, Georgia, Kazakhstan, Montenegro and Serbia, UNICEF supports the promotion of healthy and diverse diet during childrens early years to prevent obesity. The Food system UNICEF supports large-scale food fortification programmes, such as Universal Salt Iodization (USI) and Flour Fortification to control micronutrient deficiencies among children and women, aiming for safer pregnancies and healthier children. We push for the enforcement of USI as well as legislation and programmes to boost the quality and consumption of iodized salt. We also develop standards for countries on the prevention and management of other micronutrient deficiencies such as iron deficiencies and neural tube defects (NTD), such as spina bifida, caused by a lack of folate among children, adolescents and mothers. Tackling iodine deficiencyMany countries in the Europe and Central Asia Region have made considerable advancements in lowering the rates of Iodine Deficiency through Universal Salt Iodization. For example, across the Region, the percentage of households using Iodized salt has increased from 26 percent in 2000 to 55 percent in 2009 and 70 percent in 2017. This significant improvement has been made by legislating mandatory salt iodization while ensuring households have access to appropriately iodized salt. Public-private partnerships have also contributed significantly to this success. Enhancing child nutrition U NIC EF/U N01 4320 0/VA S Ivanka Djordjevic, a visiting nurse with at the Jovanovic family in Pirot, Serbia, meets with Tea, who experienced developmental delays from birth. Ivanka made regular visits to the Jovanovic family to help the parents learn about nutrition and creating a stimulating environment for Tea. Thanks to this intervention, Tea is now meeting her developmental milestones. UNICEF and Serbias Ministry of Health are ensuring visiting nurses like Ivanka can support parents with information on baby development, including nutrition. Child nutrition is about much more than the amount of food on the table. It is about making sure that mothers have the nutrition they need for a healthy pregnancy, that young children have the breastmilk that gives them the best start in life, and that growing children have the range of foods, including micronutrients, that they need for healthy growth and development and to prevent non-communicable diseases in later in life. It is also about prioritizing child nutrition at national level, backed by the necessary resources. Afshan Khan, Regional Director for UNICEF in Europe and Central Asia 5 Enhancing child nutrition 6 On the prevention of obesity, UNICEF advocates for the full implementation of the International Code of Marketing of Breastmilk Substitutes as well as legislation to control the marketing of foods and non-alcoholic beverages to children. We also advocate for increased taxes on sugary and sweet beverages and junk food, as well as subsidies for healthy foods. Early Childhood Development In order to survive, thrive and reach their full potential, all children need nurturing care during their early years. Nutrition, together with good health care, responsive caregiving, safety and security, and opportunities for learning, is a key component of the Nurturing Care Framework which takes a holistic view of the developing child. Developed by WHO, UNICEF, the World Bank and associated partners, the Framework recognizes that parents and families are the primary providers of nurturing care and that it is critical that policies, programmes and services are strengthened to support them in their caregiving role. Optimal nutrition in early childhood, which includes breastfeeding, is critical for healthy growth. At the same time, feeding young children in a responsive and interactive way can contribute to their cognitive, social and emotional development. Caregivers need support not only for what to feed young children but also for how to feed them. The Education system UNICEF works through schools to prevent obesity among school-age children and adolescent girls and boys, to promote physical activity and to create a healthy nutritional environment in schools. Our work includes the promotion of nutritional policies for education and building the capacity of school staff. In addition, the engagement of young people in the promotion of healthy nutrition not only benefits them, but they can also play a key role in sharing their knowledge about healthy diets with their families. The Social Protection system UNICEF advocates for and supports a focus on nutrition as part of wider social protection programmes, where synergies across approaches to tackle poverty and malnutrition can have a more sustainable impact on the well-being of children. For example, we help countries to define what should be included in a basic food basket that should be available for each child to secure optimum nutrition (and that, in turn, helps to determine levels of social benefits), and develop dietary-based guidelines that are sensitive to the nutritional needs of children and adolescents. In addition, capacity building support is provided to countries to enhance public financing for child nutrition. We also focus on the precarious nutrition of children caught in crises, such as conflicts and other emergencies, and those in families affected by HIV. One innovative sub-regional partnership is the Regional Nutrition Capacity Development and Partnership Platform in Central Asia and the Caucasus. This aims to raise the profile of nutrition in national strategies, policies and programmes. This partnership brings on board a wide range of national partners including Ministries of Health, Education, Agriculture and Finance, as well as UN agencies and academia. The platform will develop the building blocks of the food and nutrition sector in the region. It has six main aims Enhance the leadership and governance of the Regions food and nutrition sector. Strengthen region-wide policy advocacy for better financing for nutrition by making the case for investment. Strengthen the nutrition workforce by defining standard organizational structures at the levels of primary healthcare, specialized consultative healthcare, and professional training, as well as equipping workers with the U NIC EF/U N04 0446 /PAN JETA Children eating fruit and vegetables at a food workshop in Foca, Bosnia and Herzegovina. Working with relevant ministries across the country, UNICEF supports the development of nutrition strategies and guidelines for the promotion of healthy lifestyles. Key government commitments on nutrition adopted by every country in the Europe and Central Asia Region in addition to SDG 2The Convention on the Rights of the Child, 1989 Article 24.2(c): States Parties will combat disease and malnutrition, including through the provision of adequate nutritious foods. Article 24.2(e): States Parties will ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition and the advantages of breastfeeding. Enhancing child nutrition 7 An unfinished agenda Child nutrition remains unfinished business across the Europe and Central Asia region. As well as needing more resources, child nutrition urgently needs more attention from policy makers, development and donor partners and communities to push it further up the list of national priorities. UNICEF seeks to leverage increased resources for children across the region, through meaningful partnerships and advocacy. A key priority is strengthening work with all partners, based on a common agenda for children and adolescents. From maternal nutrition to breastfeeding, and from micronutrients to research on adolescent nutritional health, the Region has a lengthy to do list. UNICEF and its partners have already demonstrated the impact of programmes to safeguard and promote child nutrition. The task ahead is to take these programmes to scale across the Region. World Health Assembly (WHA) 2016 members have also committed themselves to six targets for 2025: 1. a 40 per cent reduction in the number of children under five who are stunted 2. a 50 per cent reduction of anaemia in women of reproductive age 3. a 30 per cent reduction in low birth weight 4. no increase in childhood overweight 5. an increase of at least 50 per cent in the rate of exclusive breastfeeding in the first 6 months 6. the reduction and maintenance of childhood wasting to below 5 per cent. The UN Decade of Action on Nutrition 2016 to 2025 UNICEF has committed to support the UN Decade of Action on Nutrition to: Prevent stunting, wasting and all forms of undernutrition in early childhood. Prevent anemia and all forms of undernutrition in school-age children and adolescents Prevent anemia and all forms of undernutrition in pregnant women and lactating mothers. Prevent overweight and obesity in children, adolescents and women. Provide care for children with severe acute malnutrition in early childhood, in all contexts. U NIC EF/U N03 8720 /PIR OZZI Children have a meal in the dining room of an inclusive kindergarten in Yerevan, Armenia. UNICEF has been supporting the national iodization programme in Armenia and in 2006, the country was declared free of iodine deficiency. knowledge, skills and competencies for effective nutrition and food policy and programming. Reinforce a multidisciplinary (i.e., health, agriculture, education, social protection and finance) approach to address the double burden of malnutrition as a major risk factor for non-communicable diseases. Reinforce region-wide collaboration to generate hard evidence and guidelines based on that evidence, and share lessons on what works to inform policymaking and scale up nutrition programmes Improve information and research on nutrition and exchange knowledge across the region and beyond. Enhancing child nutrition 8 UNICEF Europe and Central Asia Regional Office 5-7 avenue de la Paix CH-1211 Geneva 10 Switzerland Telephone: +41 22 909 5111 ecaro@unicef.org www.unicef.org/eca March 2019 U NIC EF/U N05 5280 /LIS TER Amir is in the arms of his mother, Sozul Eisheeva, in the Karakol hospital in Issyk-Kul province, Kyrgyzstan. Between 12 and 17 per cent of children in Central Asia, parts of the Caucasus and in Central and Eastern Europe are stunted. The effects of stunting can include a lower IQ, a weakened immune system and greater risk of serious diseases later in life. UNICEF raises awareness on the importance of breastfeeding for a healthy start in life as well as a diverse and healthy diet for mothers and children. mailto:ecaro%40unicef.org?subject= http://www.unicef.org/eca

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