Author: Allyson Garner

1,000 Days Statement on Increased U.S. Infant Mortality Rates

At 1,000 Days, we are deeply concerned by the recent CDC data revealing an increase in infant mortality in the United States for the first time in two decades. Our nation has one of the highest infant and maternal mortality rates of any wealthy country. This disheartening increase is a stark reminder of the urgent need for collective action to address the critical challenges facing maternal and child health in the United States.

The CDC found that the overall infant mortality rate increased by 3% with significant increases for mothers aged 25-29. Mortality rates also climbed for preterm babies, male infants, and for infants born in Georgia, Iowa, Missouri and Texas. The data also shows a deepening divide along racial and ethnic lines with infant mortality rates for American Indian or Alaska Native women increasing by over 20%, from 7.4 deaths to over 9 deaths per 1,000 births, while rates for White women increased by about 3% from 4.36 deaths to 4.52 deaths per 1,000 births. Infant mortality rates for infants of Black women did not drastically increase but they continue to experience the highest overall rates of mortality with nearly 11 deaths per 1,000 births, or over double the mortality rate of White infants. The significant disparities in infant mortality rates among different racial groups highlight the pervasive impact of systemic inequities on health outcomes.

1,000 Days remains dedicated to our mission of making the health and well-being of women and children in the first 1,000 days, from pregnancy to two years of age, a policy and funding priority. We call on Congress to continue investing in maternal and child health and services, recognizing that it is critical during the 1,000-day window to deliver nutrition and support for women and infants. Access to proper nutrition and comprehensive maternal health services is a right for all women and families, and it is imperative to ensure that no one is left behind. Strong policies and investments in this critical window are not only about saving lives today but also about nurturing healthier generations.

A strong start in life is every child’s right, and we are committed to working alongside partners, communities, and policymakers to create a world where all children can thrive. The CDC’s findings reinforce the urgency of our mission, and we stand ready to collaborate and advocate for the changes needed to ensure better outcomes for everyone.

Together, we can strive for a future where infant mortality is a rare and unacceptable tragedy. Join us in making a difference and securing a brighter future for the next generation.

For more insights and information, please visit the CDC report here.

1,000 Days Statement on Senate Finance Committee Paid Leave Hearing

Senate Finance Committee Holds Hearing on Paid Leave

This week, the Senate Finance Committee held a hearing on paid leave, highlighting the critical need for family and medical paid leave and how our current patchwork of paid leave policies falls short of supporting all infants and families. It also confirmed the importance of paid leave for workers, businesses, and the country.

While there have been some gains in paid family leave over the past five years, the Bureau of Labor Statistics shows that only about 1 in 4 employees (27 percent) in the private sector workforce have access to paid family leave. Access to paid family leave is lower among those receiving lower wages or working part-time. People of color also have less access to paid family leave than their white counterparts.

This lack of paid family leave means parents are often forced to choose between taking time off from work to care for their young children and earning the income they need to support their families. It means that 1 in 4 women in America return to work just 2 weeks after giving birth, putting their health and that of their infant at risk. Policies that enable parents to spend time nurturing and caring for their babies—particularly in the early weeks after birth and for babies that are born pre-term, low birthweight or with illness—are critical to the healthy cognitive, social, and emotional development of children.

We applaud state, local and business-level efforts to increase access to paid family leave, but it is not enough to address this public health crisis. We need a national paid family and medical leave program that is comprehensive and covers all workers, including small business employees and the self-employed. Paid leave is the biggest obstacle to working women in the U.S. in the 1,000-day window and can reduce racial and ethnic health disparities. Our 2020 qualitative paid leave report highlights real stories from families without access to paid leave and the detrimental impacts it had on their family, including their health and the health of their baby.

We appreciate the Senate Finance Committee’s thoughtful attention to this issue. We call on Congress to take the next step, moving legislation to enact a comprehensive national paid leave policy that supports mothers and families and ensures children get the strongest start to life.

World Food Day 2023 Highlights an Opportunity for the US to Lead on Preventing & Treating Malnutrition

World Food Day 2023 looks similar to recent past food days as the world continues to grapple with high rates of food and nutrition insecurity due to long lasting impacts of the pandemic, climate shocks and stressors, conflict, and inflation. Although much attention has been paid to rising rates of malnutrition, unfortunately, in 2023, malnutrition continues to impact tens of millions of children around the world. New child malnutrition estimates from UNICEF released in May 2023 found that stunting impacted 22.3% or 148.1 million children under 5 globally and wasting threatened the lives of 6.8%, or 45 million children under 5 globally.

To meet the Sustainable Development Goals related to food security and nutrition, targeted interventions and significant investments must be made to reverse the current malnutrition trends and speed up progress. Due to the compounding crises impacting malnutrition, it is estimated that to stay on track with reaching global nutrition targets, at least $10.8 billion each year from 2022 to 2030 is needed.

A new study published just last week in The Lancet shows how dire nutrition needs are, specifically within the 1,000-day window. These new data from WHO, UNICEF, and the London School of Hygiene and Tropical Medicine found that 1 in 10 babies worldwide are born early, with major impacts on health, survival, and eventual economic impact. Since prematurity is the leading cause of death in children’s early years, there is an urgent need to strengthen prenatal care for mothers that protect both mom and baby, focus on malnutrition prevention in early life, and provide postpartum care that nurtures mom and supports breastfeeding.

In addition to the efforts to treat malnutrition, further attention should be paid to prevention of malnutrition in the first place. Over the last year, USAID has not only released the implementation plan for the Global Malnutrition Prevention and Treatment Act (GMPTA), but also released a position paper on child wasting in June 2023 which outlined specific, actionable steps on how the USG will continue its investments and commitments to reduce and prevent malnutrition globally. Some of these steps include: strengthening nutrition as part of primary health care, building a better understanding of the specific pathways through which food systems can most effectively and efficiently prevent child wasting, improving access to RUTF for treatment and SNFs for prevention, supporting the development of sustainable financing strategies for health systems and the procurement of SNFs, and conducting joint cross-sectional and cross-bureau analyses and/or implementation research in nutrition priority countries.  

Necessary investments would help to close the nutrition insecurity gaps seen in the most vulnerable populations, including women and children. Our advocacy community continues to seek additional monetary investments from the US Government to improve nutrition security. Malnutrition is the underlying cause of nearly half of all childhood deaths under 5, however, it only received under 1.5% of US global health funding in FY2023 while AIDS, malaria, and tuberculosis collectively netted roughly 72%. For FY24 funding requests, our global nutrition advocacy community requested $300M for the nutrition sub-account which would save the lives of 30,303 children annually according to the World Bank’s Nutrition Investment Framework. Efforts to reduce funding for this account undermine progress made to address malnutrition and will put lives at risk.

As Congress continues to draft FY24 appropriations bills ahead of the November 17th continuing resolution deadline, we urge them to protect and defend investments aimed at improving the health and nutrition of vulnerable populations, like women and children, particularly in the first 1,000 days. In addition, FY25 budgets and appropriations bill should include investments that both prioritize preventing and treating malnutrition. To accelerate progress on preventing and treating malnutrition, Congress and the US Government must solidify their role as a leader in putting health and nutrition first.

World Health Organization Updated Guidelines on the Prevention & Management of Acute Malnutrition

In July 2023, the World Health Organization (WHO) released updated guidelines for the management section of wasting and nutritional oedema, also known as acute malnutrition, in infants and children under 5. An update of the prevention section of the guidelines is expected this fall. The guidelines build on the 2013 guidelines by further enhancing care of infants and children with wasting and nutrition oedema as these conditions lead to higher mortality rates and other negative health outcomes. The guidelines were drafted and completed as one of the key commitments of WHO to the Global Action Plan for Child Wasting which was released in 2019 by the United Nations (UN) Secretary-General. The guidelines include four areas of focus:

  • Management of infants less than 6 months of age at risk of poor growth and development,
  • Management of infants and children 6-59 months with wasting and/or nutritional oedema,
  • Post-exit interventions after recovery from wasting and/or nutritional oedema, and
  • Prevention of wasting and nutritional oedema from a child health perspective (to be developed).

Ongoing crises such as climate change, the COVID-19 pandemic, conflict, and rising costs of food have exacerbated rates of malnutrition, particularly among those under 5 years of age. Currently, over 45.4 million infants and children under 5 years of age experience wasting each year. Governments and other stakeholders have struggled to make progress on Sustainable Development Goal 2 which is to reach “Zero Hunger” by 2030. The new guidelines include 19 total recommendations, 12 of which are new and 7 of which are updated, along with 10 good practice statements. Key recommendations and good practice statements for each focus area include:

Focus area: Management of infants less than 6 months of age at risk of poor growth and development

  • Admission, referral, transfer and exit criteria for infants at risk of poor growth and development:
    • Referring infants for inpatient care if they have one or more Integrated Management of Childhood Illness (IMCI) danger signs, acute medical problems, or conditions under severe classification as per IMCI, nutritional oedema, or recent weight loss. If they do not meet any of the above criteria, an in-depth assessment should be conducted to determine if inpatient admission or outpatient management is necessary and guidelines are provided on transitioning from inpatient care to outpatient care as well as to transferring out of, and/or ending outpatient care due to improved health status and growth and development.
    • Follow-up visits, with possible reduced frequency of visits, should continue until 6 months of age followed by referral to appropriate services.
  • Management of breastfeeding/lactation difficulties in mothers/caregivers of infants at risk of poor growth and development
    • Comprehensive assessments should be conducted by health care providers and best practices for managing breastfeeding/lactation challenges should be followed.
  • Supplemental milk for infants at risk of poor growth and development
    • For infants less than six months of age with severe wasting and/or nutritional oedema who are admitted for inpatient care should be breastfed where possible and support should be provided to the mothers or female caregivers. If an infant is not breastfed, support should be given to the mother or female caregiver to re-lactate. If this is not possible, wet nursing should be encouraged. A supplementary feed should be provided when clinically necessary. An assessment of the physical and mental health status of mothers or caregivers should be promoted and relevant treatment or support provided.
  • Interventions for mothers/caregivers of infants at risk of poor growth and development
    • To optimize growth and development in infants at risk of poor growth and development, a comprehensive assessment and support is recommended to ensure maternal/caregiver physical and mental health and wellbeing.

Focus area: Management of infants and children 6-59 months of age with wasting and/or nutrition oedema

  • Admission, referral, transfer, and exit criteria for infants and children with severe wasting and/or nutritional oedema
    • Referring infants and children (6-59 months) with severe wasting and/or nutritional oedema for inpatient care if they have one or more Integrated Management of Childhood Illness (IMCI) danger signs, acute medical problems, severe nutritional oedema, or poor appetite (failed appetite test). If they do not meet any of the above criteria, an in-depth assessment should be conducted to determine if inpatient admission or outpatient management is necessary and guidelines are provided on transitioning from inpatient care to outpatient care as well as to transferring out of, and/or ending outpatient care due to improved health status and growth and development. Continuity of care is vital for the safe and effective follow-up of infants and children with severe wasting and/or nutritional oedema. Ongoing medical and psychological support services are key and one important aspect of discharge panning is assessing the child’s home environment to ensure environmental health aspects (water, sanitation, hygiene), food security, economic stability, and the mental and physical health of caregivers.
  • Identification of dehydration in infants and children with wasting and/or nutritional oedema
    • Classifying hydration status in children with wasting and/or nutritional oedema to provide and monitor appropriate treatment.
  • Rehydration fluids for infants and children with wasting and/or nutritional oedema and dehydration but who are not shocked
    • Providing appropriate rehydration fluids, like Rehydration Solution for Malnourished Children (ReSoMal) or Oral Rehydration Solution (ORS).
  • Hydrolyzed formulas for infants and children with severe wasting and/or nutritional oedema who are not tolerating F-75 or F-100
    • There is insufficient evidence to recommend switching to hydrolyzed formulas if they are not tolerating F-75 or F-100 milks.
  • Ready-to-use therapeutic foods (RUTF) for treatment of severe wasting and/or nutritional oedema
    • RUTF should be given in specific quantities that will provide 150-185 kcal/kg/day until anthropometric recovery and resolution of nutritional oedema; or 150-185 kcal/kg/day until the child is no longer severely wasted and does not have nutritional oedema, then the quantity can be reduced to provide 100-130 kcal/kg/day, until anthropometric recovery and resolution of nutritional oedema.
  • Dietary management of infants and children with moderate wasting
    • Nutrient dense diet should be provided to meet extra needs or recovery of weight and height and for improved survival, health, and development.
    • Those with moderate wasting should be assessed comprehensively and treated wherever possible for medical and psychosocial problems leading to or exacerbating this episode of wasting.
    • Specially formulated foods (SFF) interventions with counseling should be considered with a number of clinical factors, including failing to recover from moderate wasting, co-morbidities, and others, in addition to social factors like poor maternal health and wellbeing.
    • SFF as well as counseling and the provision of home foods for them and their families should be considered.
    • For those needing supplementation with SFF, lipid-based nutrient supplements (LNS) are the preferred type. When not available, Fortified Blended Foods with added sugar, oil, and/or milk are preferred compared to Fortified Blended Foods without these attributes. Additionally, SFF should be given to provide 40-60% of the total daily energy requirements needed to achieve anthropometric recovery. High-risk moderate acute malnutrition is defined with a mid-upper arm circumference (MUAC) of 11.5 to <11.9 or weight-for-age (WAZ) <-3.5.
  • Identification and management of wasting and nutritional oedema by community health workers
    • Assessment, classification and management or referral of infants and children 6-59 months of age with wasting and/or nutritional oedema can be carried out by community health workers as long as they receive adequate training, and regular supervision of their work is built into service delivery.

Focus area: Post-exit interventions after recovery from wasting and/or nutritional oedema

  • Support for mothers/caregivers should be provided after infants and children are treated for wasting and/or nutritional oedema. This can include counseling and education, responsive care, and safe water, hygiene, and sanitation interventions.
  • Psychosocial stimulation should continue to be provided by mothers/caregivers after transfer from inpatient to outpatient treatment.
  • Cash transfers in addition to routine care may be provided to decrease relapse and improve overall child health during outpatient care and after exit from treatment, depending on contextual factors such as cost.
  • In infants and children with severe wasting and/or nutritional oedema who are HIV negative, daily oral co-trimoxazole prophylaxis should not be provided after transfer from inpatient treatment and/or exit from outpatient treatment as part of routine care.

Additional standing WHO recommendations and best practice statements on wasting and nutritional oedema were also carried over from previous guidelines, including classifying nutritional status according to WHO child growth standards, providing children with severe wasting and/or nutritional oedema the recommended daily nutrient intake of vitamin A throughout treatment period, promotion and support for exclusive breastfeeding in the first 6 months and continued breastfeeding until 24 months and beyond, and others.

In addition to these guidelines, WHO will be putting out operational guidance to accompany them. As policymakers, governments and governmental agencies, program implementers, non-governmental organizations and other civil society organizations, and healthcare workers aim to reduce and prevent wasting and nutrition oedema in infants and children, they should rely on these guidelines to develop and implement evidence-based policies, programs, best practices, and regulations.

Protecting, Promoting and Supporting Breastfeeding

We know that babies get the best start in life when they are exclusively breastfed for the first 6 months, and continue breastfeeding with complimentary feeding until they are 2 years old, following World Health Organization guidelines established in 2018.

As World Breastfeeding Week and National Breastfeeding Month begin, 1,000 Days celebrates the progress made to support mothers in breastfeeding their babies, while also recognizing the additional steps that need to be taken to truly support all those who wish to initiate and sustain breastfeeding. From policy changes to individual support, more action is needed to achieve breastfeeding goals globally. In the US, a recent win for breastfeeding mothers is the PUMP for Nursing Mothers Act, PUMP for Nursing Mothers Act, which extends the right to receive break time to pump and a private place to pump at work to more nursing employees. Another win for breastfeeding science globally is the 2023 Lancet Breastfeeding series which reinforces the power of breastfeeding, policy changes needed to protect breastfeeding, and calls out intrusive marketing strategies utilized by formula companies to diminish breastfeeding.

Even though breastfeeding is the best way to protect newborns from malnutrition, infections, and disease, only 48% of babies around the world are exclusively breastfed based on data from 2015-2021. Breastfeeding support is recognized as a “Power 4” nutrition intervention, showcasing how critical it is for mothers and babies in low- and middle-income countries to support health and nutrition. Not only is breastfeeding counseling impactful on health and nutrition outcomes, but it is also one of the most cost-effective nutrition interventions, yielding up to $35US in economic returns with a $1US investment.

Across the United States Agency for International Development’s 14 priority geographies, breastfeeding counseling rates remain low. On average, in these areas, only 45% of mothers are receiving breastfeeding counseling in the 2 days after delivery. Breastfeeding counseling, whether individually or in a group setting, can help ensure mothers have the support they need while also helping them gain confidence and overcome challenges in their breastfeeding journey.

Governments, development partners, UN agencies, and non-government organizations have pledged to improve nutrition globally, particularly through increased investments in breastfeeding, as outlined at the 2021 Nutrition for Growth Summit. Additionally, the Global Breastfeeding Collective identified policy priorities for countries to implement to support, protect and promote breastfeeding:

  • Increase funding to raise breastfeeding rates from birth through two years.
  • Fully implement the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.
  • Enact paid family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.
  • Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.
  • Improve access to skilled breastfeeding counseling as part of comprehensive breastfeeding policies and programs in health facilities.
  • Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.
  • Strengthen monitoring systems that track the progress of policies, programs, and funding towards achieving both national and global breastfeeding targets.

As global leaders and governments continue to address the rising rates of malnutrition, which is impacting more than 1 billion adolescent girls and women worldwide, attention should be hyper-focused on breastfeeding support and counseling, through increased investments and policy changes, to support the health and nutrition of both current and future generations.


Nutrition is a Feminist Issue

Nutrition only featured in three of the 75+ sessions and events of the Women Deliver conference which brought over 6,0000 advocates, activists and decisionmakers to Kigali, Rwanda, last week. But what Women Deliver demonstrated is that nutrition is part of a much bigger framework, and an integral component of the feminist agenda. Here are three reasons why maternal nutrition is a feminist issue:

  1. The gender nutrition gap is real, widening, and solvable:  It is the political failure to meet the unique nutritional needs of women and girls and ensure their access to nutritious diets, nutrition services, and nutrition care. More than 1 billion adolescent girls and women worldwide suffer from undernutrition, including detrimental lifelong effects of the consequences of wasting and stunting, micronutrient deficiencies, and anaemia, according to UNICEF’s Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women report. Malnourished mothers give birth to small and vulnerable newborns with immediate and long-term consequences for individual and societal development and growth. Today, approximately 20 million infants are born with low birthweight globally.  Cultural norms, social roles, economic disparities, and discriminatory practices create and sustain this gender nutrition gap. 1,000 Days was among 40+ organizations to launch Closing the Gender Nutrition Gap: An Action Agenda for Women and Girls. It aims to unite stakeholders in the nutrition, health and gender communities to take specific actions that improve women’s and girls’ nutrition while advancing maternal, newborn and child health and gender equality. The Action Agenda prioritizes actions for healthy diets, access to healthcare and social protection, gender equality and creating an enabling policy environment.
  • Adequate nutrition and breastfeeding are part of a woman’s right to bodily autonomy,  which UNFPA defines as  ‘the power and agency of individuals to make choices about their bodies without fear, violence or coercion’. While the concept is often used to advocate for reproductive justice, it goes beyond sexual and reproductive health and services and encompasses access to the wide range of care and services necessary to keep our bodies, minds and spirits healthy and whole – including nutrition – as per the Positive Women’s Network framework. UNFPA announced the Kigali Call to Action: United for Women and Girls’ Bodily Autonomy  for accelerated investments and actions, with women-led organizations and the feminist movement at the centre. Bodily autonomy is a strong platform to call for the right to breastfeed, as well as access to diverse and nutritious foods for all pregnant and lactating women, babies and toddlers. It is also a powerful aggregator to build a solidarity front against regressive forces. 
  • Maternal health is divisive and divided: As advocates calling attention on specific aspects of a woman’s health and wellbeing, we risk positioning women as a set of issues to be solved and competing for attention and space.  This does not only diminish our voice and reduce our impact, but it also leaves a vacuum for the opposition to fill, with clear, unified anti women’s rights messages.  Calling for reproductive justice, access to antenatal care, newborn and child health, respectful care, nutrition services, exclusive breastfeeding are not competing agendas, but all contribute to redressing the systemic inequalities that women face and that prevent them from reaching their full potential. Feminism, as a social justice movement, provides a larger and stronger platform to join forces and advance women’s nutrition, including nutrition for pregnant and lactating women.

Senate FY24 Agriculture Appropriations Bill Prioritizes Nutrition for Children and Families

1,000 Days commends the Senate Committee on Appropriations for prioritizing families in need both domestically and globally in their FY24 Agriculture Appropriations bill. In contrast to the House version, the Senate’s proposed bill-based funding on levels agreed to in the debt ceiling deal reached earlier this month is a superior starting point. Of note, the Senate’s bill funds the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) at $6.3 billion, maintaining current food package benefits and participation levels. The bill also acknowledges the importance of global nutrition programs through funding for international food assistance programs. It provides $1.8 billion in funding for Food for Peace, Title II programs and $248.3 million for the McGovern-Dole International Food for Education and Child Nutrition programs, maintaining enacted levels from FY2023. These programs can improve nutrition within the 1,000-day window through evidence-based nutrition interventions. At a time when stunting is impacting 148 million children under 5 globally and wasting is threatening the lives of 45 million children, it is critical that investments meet the moment to reverse the trend of increasing rates of malnutrition. With malnutrition costing the world $3.5 trillion in lost productivity and healthcare costs annually, Congress has the ability to change the trajectory of malnutrition which impacts current and future generations.

How well, or how poorly, mothers and children are nourished and cared for during the 1,000-day window has a profound impact on a child’s ability to grow, learn and thrive. The Senate’s bill invests in federal programs that can significantly improve nutritional outcomes during this vital period of development for children. As the appropriations process moves forward, we urge Congress to base final funding decisions on the Senate proposal, helping families both domestically and internationally to have access to nutritious foods and services.

Bills We are Watching this Children’s Week

As we kick off the 2023 Children’s Week, we feel a mixture of excitement for the opportunities to improve children’s nutrition and concern about policy and funding proposals that undo progress to protect the health and wellbeing of children and their families in their 1,000-day window.

The nutrition that people receive leading up to and throughout their pregnancy, as well as the nutrition their babies receive in the earliest years of life, has a profound impact on a child’s ability to grow, learn, and thrive. In honor of Children’s Week, 1,000 Days is highlighting some legislation that we support focused on children, mothers, and birthing people. It is our hope that with these bills enacted, moms, babies, and their families will receive the support and resources they need to begin to build a healthier future.

The Wise Investment in Children Act of 2023 (WIC Act of 2023) (H.R.3364/S.1604) expands eligibility to receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This would extend the certification period for infants to up to two years and increases the certification time under the program for postpartum women to a period of up to two years.

Modern WIC Act of 2023 (H.R.2424/S.984) would build on lessons learned during the pandemic and modernize WIC to allow remote access. The remote flexibility implemented during the public emergency contributed to a 12% increase in child participation since 2020.

WIC Healthy Beginnings Act (H.R.3151/S.974) requires USDA to make information on infant formula procurement under WIC publicly available. This increases transparency and promotes competition within the sole-supplier model.

Black Maternal Health Momnibus Act (H.R.3305/S.1606) will address the maternal mortality crisis in the U.S. through historic investments that comprehensively address every driver of maternal mortality, morbidity, and disparities in the United States. The Momnibus Act includes twelve individual bills that among other actions will make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition and extend WIC eligibility in the postpartum and breastfeeding periods.

The Family Act (H.R.3481) would provide employees a family and medical leave insurance monthly benefit payment of two-thirds of the employee’s regular pay, limited to a maximum of $4,000, for no more than 60 days of qualified caregiving. The bill also established the Office of Paid Family and Medical Leave within the Social Security Administration.

No Surprise Bills for New Moms Act (H.R.3387) would automatically cover newborns with health insurance for the first 30 days and create a standard for enrollment after that period. It eliminates confusion for new parents by establishing a uniform 60-day enrollment period after that first month. The bill would also have all health plans and insurers notify parents if they receive a bill for an uncovered newborn.

We also continue to remain focused and engaged in the appropriations process for FY2024. Non-defense discretionary programs, which disproportionately serve young children, families, and those most in need across the country, will face the brunt of spending caps and cuts. We must protect programs that support children and families and build off the recent successful increased investments in the first 1,000 days. In doing so, we are letting our children and our nation’s future the opportunity to thrive. How well or how poorly mothers and children are nourished and cared for during the 1,000-day window has a profound impact on a child’s ability to grow, learn and thrive.

Unpacking the Joint Child Malnutrition Estimates 2023 Edition

On May 18, 2023, UNICEF, the World Health Organization (WHO), and the World Bank Group released the Joint Child Malnutrition Estimates, which are published every other year. The new report examines progress to reach the 2025 World Health Assembly (WHA) global nutrition targets and Sustainable Development Goal (SDG) target 2.2 to end all forms of malnutrition. Specifically, the 2030 target is to reduce the number of children under 5 who are stunted by 50% and to reduce and maintain childhood wasting to less than 3%. Given the crises that low- and middle-income countries are experiencing, including conflict, disasters from climate change like severe droughts or flooding, and lasting impacts from the COVID-19 pandemic, it is not surprising, but still alarming, to see that tens of millions of children are affected by stunting and wasting:

  • Stunting impacted 148.1 million children under 5 globally in 2022, or 22.3%.
  • Wasting threatened the lives of 45 million children under 5 globally in 2022, or 6.8%.

Unfortunately, at the midpoint of the SDG period, the stunting target will not be met if the current trajectory of progress continues. The assessment of progress is not even possible for about one quarter of countries as only about one third of all countries are ‘on track’ to halve the number of children affected by stunting by 2030. Similar to stalled levels on stunting but more severe, an assessment of progress towards the wasting target is not possible for almost half of the countries.

The disparities of stunting and wasting and lack of progress lies predominantly in Africa and Southern Asia. In 2022, more than half of all children under 5 affected by stunting lived in Asia and two out of five lived in Africa. Additionally, 70% of all children under 5 affected by wasting lived in Asia and more than one quarter lived in Africa. If the current trajectory continues, an estimated 128.5 million children will be stunted in 2030, with about half of those living in Western and Middle Africa.

Globally, the annual average rate of reduction (AARR) for stunting based on the current trend from 2012 to 2022 is only 1.65 percent per year. But an AARR of 6.08 is required from now to 2030 to achieve the global target of reducing the number of children with stunting to 88.9 million. This rate of reduction is almost four-fold higher than what has been achieved in the last decade.

As countries move further away from the targets, and investments in critical nutrition interventions continue to be limited or reduced, the child malnutrition targets will become more challenging to achieve. Work must now be accelerated to catch up to the lack of progress which in turn is more costly. To compound this issue, the report also highlighted the dire need for addressing reporting and data gaps in countries and regions to measure and indicate progress on child malnutrition.

The report underscores the importance of reminding  decisionmakers, like legislators and policymakers, and program implementers that all forms of malnutrition are preventable and that it is not too late to get countries and regions on track to meet these critical targets. Nutrition interventions are relatively inexpensive to implement and have an extremely high return on investment (ROI), with every $1 invested yielding up to $35 in economic returns. As malnutrition costs the world $3.5 trillion in lost productivity and healthcare costs each year, smart investments in global nutrition now would support billions of children to reach their full potential and help end the cycle of poverty and malnutrition once and for all. By ensuring all children and families have access to nutritious foods and essential health and nutrition services through proven nutrition interventions, substantial progress can be made to reduce and prevent stunting and wasting. 1