UNICEF is committed to doing all it can to achieve the Sustainable Development Goals (SDGs), in partnership with governments, civil society, business, academia and the United Nations family – and especially children and young people.
Nearly half the children in the Lao People's Democratic Republic have some form of nutrition-related illness.
Less than a year later, her second child died immediately after birth.
“I had no idea why,” Thien explains, clutching her back as she recalls the pain of childbirth. “At the time, I didn’t know anything.”
Three months into her third pregnancy, she suffered a miscarriage.
Her story is emblematic of many mothers her age in the Lao People’s Democratic Republic (PDR), especially in the country’s rural and remote areas.
Child mortality rates in Lao PDR rank among the highest in the region, with nearly 79 deaths per 1,000 children (live births) prior to their fifth birthday, according to 2013 figures.
Fortunately, Thien’s story didn’t end with her third pregnancy. Today she is 30 and has four children ranging in age from 2 to 6 years. She is also five months pregnant.
She admits, however, that her surviving children’s health has not always been as good as today.
“Things have been difficult,” she says. “I was always tired. My children were thin and unhealthy.”
Malnutrition remains one of the most serious threats to children’s health in Lao PDR. Nearly half the country’s children have some form of nutrition-related illness. In Saravane province, stunting, or low height for age as a result of chronic malnutrition, affects 54 per cent of children under 5, one of the highest rates in the country.
Along with addressing issues of poor hygiene, water, and sanitation and limited access to health services, the Lao Government is determined to build an effective response to malnutrition.
Paths to progress
“We know the challenges, but we are also seeing changes,” explains Loth Lanaphane, Director of the Tahuak Health Centre, the health facility closest to Thien and her family. “This used to be an extremely difficult place to live, especially because of the roads. Certain villages were situated in very remote locations and accessible only by mobile doctors during the dry season. There were no local health centres like today.”
Lao Women's Union Volunteeers are trained to conduct house visits and provide guidance on infant and young child feeding.
Newer roads, he says, coupled with the construction of health centres such as this one, have literally paved the way for progress.
In 2012, Mr. Loth was trained to identify malnourished children in his health centre’s zone. Thien’s son, Thing, was one of 13 identified in a first round of screenings for children under 5. The health centre staff provided a treatment course of eeZeePaste, a therapeutic food designed to treat and replenish a child’s nutrient levels.
The training and providing of supplements are part of a four-year, five-country programme, supported by UNICEF, with funding from the European Union (EU), aimed at benefitting 30 million children and 5 million pregnant and lactating women in Bangladesh, Indonesia, Lao PDR, Nepal and the Philippines.
In Lao PDR, the estimated target is approximately 730,000 children and 187,000 mothers. But the initiative, which started in 2011, has gone beyond simply screening children and providing therapeutic treatment. In addition to micronutrient supplementation and deworming, trainings have addressed exclusive breastfeeding for the first six months of a child’s life; continued breastfeeding and appropriate introduction of complementary foods after six months; good hygiene practices; and parenting techniques to inspire children’s interest in eating.
This knowledge is passed on to Thien and other mothers through quarterly village visits by health-staff and reinforced by a trained, community-based volunteer.
Today, only three of the initial 13 children identified in the zone as malnourished in 2012 remain in need of treatment and follow-up, says Mr. Loth.
“With the assistance of these initiatives, the trend is definitely falling,” he says.
Thien credits her remaining children’s survival, especially her youngest ones, primarily to better eating habits, resting and performing less physical labour while pregnant – advice from both the health staff and the local health volunteer. The latter has provided her with counseling at least twice each month during and after her pregnancies, she says.
“I don’t cut things out of my diet like I used to, and when I fall sick I go to the health centre,” Thien says.
It is precisely what the EU-UNICEF nutrition partnership aims to achieve.
“We’re especially pleased to be hearing this type of information,” says Dr. Uma Palaniappan, Nutrition Specialist at the UNICEF office in Lao PDR. “It means the trainings we’re supporting are working. Evidence shows the importance of adolescent and maternal nutrition for the health of the mother and for optimal fetal growth and development.”
Extending the impact
In Lao PDR, the EU-UNICEF initiative was extended in 2014 to the end of 2015, with the aim to carry forward and ensure ongoing successes on the ground, and also to improve the systems that secure their availability.
“It’s going to take 5 to 10 years, but we have an opportunity here to do something absolutely essential,” explains Michel Goffin, Chargé d'Affaires of the European Union Delegation to Lao PDR.
Mr. Goffin explains that while initial emergency-type activities such as food supplements are part of the short-term response, he stresses this is not the ultimate goal.
“It’s not always about a lot of money,” he says. “It’s not about vitamins or simply the stuff you can add to food. It’s largely about behaviours and cultural issues.”
Surviving and thriving
Thien is grateful for the changes she has seen in recent years.
“In the past, there were so many difficulties,” she says. “These days, my children don’t often fall sick, and even when they do we take them to be checked in time and they receive proper treatment.”
With a glimmer of pride, she says that perhaps at least one of her children will grow up to be a teacher, civil servant or even a doctor.
“As for this pregnancy, I know now how to look after myself.”