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Improving Nutrition for Women and Young Children 2 CHAPTER 2 2 Improving Nutrition for Women and Young Children Thomas Cristofoletti for USAID Improving nutrition for women and young children has always been at on breastfeeding, even though global USAID projects4 also mandated the core of USAID’s nutrition and health programs. This chapter presents maternal nutrition.5 Constraints included the emphasis on child survival, the history of cross-cutting approaches USAID has advanced to better a lack of simple technologies to apply, a low prioritization by Ministries of deliver nutrition services and improve dietary practices and nutritional Health, and the view that maternal nutrition was part of a larger problem of status. The chapter begins by describing USAID efforts to address maternal general food insecurity.6 Under a 1992 initiative in Africa,7 USAID assessed nutrition and three components of infant and young child nutrition: the factors affecting maternal nutrition and provided recommendations breastfeeding, complementary feeding and the nutritional care of sick for improvement. Starting in 1996, the Agency’s 10-year global infant and or severely malnourished children. These represent four of the Essential young child feeding and maternal nutrition activity focused on behavior Nutrition Actions mentioned in Chapter One. The chapter then describes change counseling in communities and health facilities; this was supported two hallmarks of USAID’s nutrition activities: a community-based focus that by detailed information for health workers in a maternal nutrition dietary includes growth monitoring and promotion, and USAID’s innovations in guide on appropriate weight gain, supplementation and nutrient intake for social and behavior change. pregnant and lactating women.8 The accurate assessment of maternal nutrition is vital for antenatal Maternal Nutrition care. Anthropometry, or the assessment of nutritional status by physical measures such as weight, weight gain, height and mid-upper arm Poor maternal nutrition has many consequences for women, including circumference (MUAC), is important for identifying individuals at risk and increased risk for maternal death, infections, anemia, compromised for evaluating the effect of care and services. An opportunity for innovative immune function, lethargy and weakness, and lower productivity. It also work on maternal anthropometry arose in the 1990s by adding a nutrition affects infant health through heightened risk of fetal and neonatal death, component to a new USAID initiative to reduce maternal mortality and intrauterine growth restriction, low birth weight and birth defects. The make pregnancy and delivery safer. USAID contributed to building an way the nutritional status of one generation of women affects their infants’ international consensus on evidence-based anthropometric measures of nutritional well-being into childhood and adulthood is often referred to as maternal undernutrition for use in primary healthcare both to identify the the intergenerational effect of malnutrition.2 risk of and to prevent poor pregnancy outcomes, such as those discussed in an important Pan American Health Organization (PAHO) publication on Nutrition-related factors are estimated to be responsible for 27 percent maternal nutrition and pregnancy outcomes.9 of maternal deaths. Maternal nutrition, especially the interrelationship between the health, nutrition and survival of mothers and their infants, Nutrition monitoring continues to provide important insights. In many has gained increased attention since the 1990s.3 While improving maternal countries, Demographic and Health Surveys measure the standard adult nutrition has been one of USAID’s nutrition programming aims, the Agency's nutrition indicator, body mass index,10 for women of reproductive age to nutrition efforts through much of the 1980s and 1990s focused largely gain a better population-level understanding of nutritional status. Since 22 Improving Nutrition for Women and Young Children Milestones in Improving Maternal, Key Global Results Infant and Young Child Nutrition y In 1991, WHO and UNICEF launched the Baby- Friendly Hospital Initiative to strengthen the promotion of breastfeeding through accrediting maternity services that are supporting mothers 1975-1979 1980-1984 to breastfeed. U.S. Congress encourages USAID The International Code of Marketing to support breastfeeding and of Breastmilk Substitutes is adopted y Community-based management of acute maternal and child nutrition USAID conducts a four-country study malnutrition (CMAM) was adopted as a global WHO and UNICEF meeting on on infant feeding practices standard of care in 2007, preventing hundreds child feeding sparks international action USAID supports clinical Lactation of thousands of child deaths. Management Education 1990-1994 1985-1989 Innocenti Meeting is held; Declaration on Bellagio meeting Breastfeeding is issued reaches consensus on Lactational USAID Contributions USAID provides Breastfeeding for Child Amenorrhea Method Survival Strategy and Report to U.S. Congress eectiveness to Global Results Baby-Friendly Hospital Initiative launched Interagency y USAID’s early recognition of breastfeeding’s globally Group for Action significance for child survival was important for on Breastfeeding Maternal nutrition anthropometry and later breastfeeding and child survival initiatives pregnancy outcomes book released (PAHO/USAID) is formed and support. 1995-1999 2000-2004 y From the early 1980s, USAID research and promotion helped advance the Lactational The Baby- USAID issues its Breastfeeding Policy Amenorrhea Method, a 98 percent effective Friendly Hospital Initiative begins PAHO publishes Complementary method of short-term family planning. in the U.S. Feeding Guiding Principles y The Agency’s support for lactation management education was a foundation for the Baby- 2010-2015 2005-2009 Friendly Hospital Initiative. The Lancet publishes Follow-up Innocenti Meeting is held; the declara- y CMAM for children with severe acute Maternal and Child tion on infant and young child feeding is issued Nutrition Series (2013) malnutrition was successfully scaled up The Lancet publishes Maternal and Child and institutionalized in several sub-Saharan Undernutrition Series (2008) Breastfeeding and countries and Yemen. Child Health Series CMAM is endorsed by WHO and other U.N. agencies appears in Acta Paediatrica (2015) WHO indicators on infant and young child feeding y Between 1990 and 2014, the average exclusive are finalized breastfeeding prevalence doubled across 20 USAID priority nutrition countries.1 2016-2020 The Lancet publishes Breastfeeding Series (2016) WHO publishes breastfeeding guidelines for maternity and newborn services UNICEF/ WHO publish revised Baby-Friendly Hospital Initiative implementation guidance 23 CHAPTER 2 gaps in addressing the barriers represent a challenge. Proven interventions during pregnancy, such as iron and folic acid tablets for all women, and balanced energy and protein dietary supplements for undernourished populations, are described in USAID guidance and in the 2016 WHO recommendations on antenatal care funded by USAID.15 USAID has used this guidance to help countries improve health worker counseling tools and develop e-learning courses for students and health professionals. In the 1990s, USAID developed a set of recommendations for improving nutrition among adolescent girls and young women. These recommendations included improving educational opportunities and school safety for girls, discouraging gender differences in food intake, and offering appropriate family planning for adolescents.16 Data compiled for USAID in 2015 indicated that, while there has been progress in the nutritional status of reproductive-age women, adolescent girls’ nutrition still lags (e.g., in South Asia, underweight status may be as high as 40 percent),17 along with the continuing problems of anemia and inadequate micronutrient intake. In 2018, a meeting co-sponsored by USAID and PAHO A young Nepali woman, led to a call for seven priority actions to improve research and programming 4 months pregnant with her first child, is related to adolescent nutrition, which was committed to by over 100 weighed by an auxillary international organizations.18 Over the long term, USAID’s investments nurse midwife during her regular antenatal in improving girls’ nutrition in the first 1,000 days will accrue to better care visit at the health adolescent and women’s nutrition. post in Dang. Dave Cooper for USAID Infant and Young Child Feeding Since the 1970s, breastfeeding has been recognized as offering an unequaled advantage for child health and survival, for disease prevention, for infant and young child nutrition and development, and for its role in the 2000s, maternal overweight has posed a new risk and underscored the birth spacing. The optimal practice is exclusive breastfeeding for 6 months, need to address both undernutrition and overweight and obesity. Between with no other liquids given, not even water. Appropriate complementary 2005 and 2015, USAID supported collaborative research on simple yet valid feeding, along with continued breastfeeding, from 6 months of age onward indicators of the diversity of women’s diets in resource-poor settings.11 has received much attention over the past 20 years, due to increased Dietary diversity represents the number of different foods or food groups awareness and growing evidence of its importance.19 Infant and young child consumed over a given period of time.12 For example, one indicator of
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