A Promising Future for Child Nutrition?

This ProgBlog article by Robbie Lawrence, Wikichild Coordinator, is part of the Wikiprogress Health Series.

"In June, the Prime Minister will host the Nutrition and Growth event ahead of the G8; we hope Mr Cameron takes this timely opportunity to pledge significant investment in nutrition programmes and show real leadership in improving children’s futures, as well as those of their communities and their countries.” David Bull, UNICEF UK

Wikichild is currently focusing on nutrition as part of the wider Wikiprogress spotlight on health this month. On Monday, UNICEF released ‘Improving Child Nutrition: The achievable imperative for global progress’ which reports that significant advances have been made in the fight against stunting – the long term effect of hunger and malnutrition. Citing successes in eleven countries - Ethiopia, Haiti, India, Nepal, Peru, Rwanda, the Democratic Republic of the Congo, Sri Lanka, Kyrgyzstan, Tanzania and Vietnam, the report shows that stunting and other forms of undernutrition can be brought down by improved understanding of the problem and the implementation of practical measures that target pregnant mothers and children in the first two years of their life.

According to UNICEF, one in four of all children suffer from stunting because they haven’t had the right nutrients in the critical 1,000-day window following conception. Malnutrition, through lack of both macronutrients and certain micronutrients has long-term negative impacts on brain and nerve development and function, including mental activity, and the acquisition of skills needed to interact well socially. This impairment is often reflected in lower IQs and poorer performance at school (Save the Children). The damage done to a child’s body and brain by stunting is irreversible. It brings down performance at school and later at work, and heightens children’s risk of dying from infectious diseases.

‘Improving Child Nutrition’ builds on UNICEF’s earlier report ‘Tracking Progress on Child and Material’ by highlighting new developments and showing that attempts to improve nutrition programs are working. An estimated 80 per cent of the world’s stunted children live in just 14 countries spanning across Africa and Asia, and by working in communities within these nations, UNICEF and other organizations have reduced stunting by applying a series of steps including, improving women’s diet, early and exclusive breastfeeding and providing minerals and appropriate food to new mothers.

These programs all have common elements: political commitment, national policies and the presence of trained community workers to deliver information and aid. To use two examples of their success; we can look at Ethiopia, where stunting has been cut from 57 percent to 44 percent in the first decade of this century through the implementation of a national nutrition program, and at the Maharashtra state in India where the percentage of stunted children fell from 39 percent in 2005 to 23 percent in 2012 due to the support of frontline workers. 

Such progress is undoubtedly promising, and presents a unique opportunity for future global frameworks to further alleviate the problem of undernutrition. UNICEF itself acknowledges that there is still a great amount of work to be done if the World Health Assembly’s new global target of reducing the number of stunted children under the age of five by forty percent by 2025 is to be achieved. 

More recently, inequality has been a hot topic on the Wikichild, Wikiprogress and Wikigender platforms so we are well versed in the hidden realties that large, all encompassing goals such as this can mask, but it is encouraging that new approaches are targeting individual countries and communities, allowing accurate data systems to be developed that can describe and monitor changes in the circumstances of different population groups.

Furthermore, tools like the Hunger and Nutrition Commitment Index (released last week) provide greater transparency and public accountability by measuring what governments achieve, and where they fail, in addressing hunger and undernutrition. Even Duncan Green has commended the HANCI, stating that ‘it could become one of the more useful annual league tables’, as it forces governments to be ‘slapped’ if they underperform. 

Nutrition should remain at the center of the global development agenda leading up to Post 2015. The evidence laid out in UNICEF’s report and the momentum generated by their successes shows that improving child and maternal nutrition is an achievable necessity for global progress.

Robbie Lawrence

Wikichild Coordinator

Early stimulation and micronutrients interventions: the next frontiers to break the cycle of child poverty

Why should we put more money into early childhood development interventions? Does this help children in secondary education? Should we invest in preschool programmes or more in home stimulation or parenting classes? What is most cost-effective?  These are key questions that policymakers are grappling with at a time when early childhood development is emerging as a priority issue for many developing countries.

Evidence recently presented at a 3ie UCL conference on “Promises for Preschoolers” is clearly calling for more investment in young lives at an early age. These are crucial years where strategic investments can make a huge difference in generating success in adulthood.

More than 200 million children under the age of five in developing countries are not fulfilling their developmental potential. Currently the focus has been more on pre-schoolers  from age three to six, but there are some gaps that emerge quite early in children from zero to three.

For Sally Grantham McGregor who is a leading expert in the field and led a long-term evaluation of a large scale home visit intervention in Jamaica and now recently in Colombia, early stimulation can have significant benefits for the child’s development, education and long-term livelihood. In the case of Jamaica, preliminary findings reveal that these positive effects also rub off the next generation  (view interview with Sally Grantham McGregor on early stimulation).

“The trade-off is not between investing in children under three as opposed to pre-schoolers, but at the moment the money is not going to the under three”. Grantham McGregor also stressed that nutrition interventions can benefit children development if conducted before the child turns two and early stimulation is critical till age five.

While there is growing evidence on the impact of early childhood development, 3ie Executive Director Howard White said “we need more evidence to show the long term effects of such interventions in reducing poverty. 3ie is also planning to finance more follow-up evaluations to see if the benefits are sustained through to second grade and in later life.” (view interview with Howard White from the Promises for Preschoolers conference).

Micronutrients supplementation is another type of intervention that can provide tremendous gain for children suffering from malnutrition, particularly in countries in Africa and South Asia.  DfID Chief Economist Stefan Dercon called this the “next frontier”. “We still have an awful lot to do in the space of under nutritional stunting and this is where I think we know increasingly what to do and how to do it” (view video “Micronutrients: the next frontier?”).

However, Jere Behrman from University of Pennsylvenia pointed out that “one has to pay much more attention to the context and look at tailoring the type of intervention to the specific needs and demand in the country”. Orazio Attanasio from University College London also said “there are big challenges in nutrition intervention both because the child may be affected by parasites and because administering the right supplements can be difficult in the field and mothers may not give them to their children” (view video  interview with Orazio Attanasio on the next frontier for early childhood development).

For Orazio Attanasio the “gap is to start thinking of integrated intervention and how one can design a programme where you start very early and follow the child when he or she gets to school. There you need to engage and coordinate with different ministries and agencies”.

Christelle Chapoy

3ie International Initiative for Impact Evaluation