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Author: Allyson Garner

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.  

https://data.unicef.org/resources/jme-re 1

Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women

Photo credit: Paula Bronstein/Getty Images/Images of Empowerment

Published: March 2023 

Publication: Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women 

Authors: United Nations Children’s Fund (UNICEF) 

Background: 

In the 12 hardest-hit countries, the number of pregnant and breastfeeding women and adolescent girls suffering from acute malnutrition has soared from 5.5 million to 6.9 million – or 25 per cent – since 2020.  

More than 1 billion adolescent girls and women worldwide suffer from undernutrition which includes underweight and short height, micronutrient deficiencies, and anemia.  

Globally, 51 million children under 2 are stunted. Almost half of all stunting early childhood originates during pregnancy or in the first six months of life – a time when children are entirely dependent on their mothers for nutrition.  

Summary: 

The report analyzes the current status, trends and inequities in the nutritional status of adolescent girls and women of reproductive age (15-49 years), the barriers they face in achieving a nutritious diet, utilizing essential nutrition services, and benefiting from nutrition and health-focused practices. Data were analyzed from more than 190 countries and territories, representing more than 90% of adolescent girls and women from around the globe. 

Findings: 

  • Progress on addressing adolescent girls’ and women’s nutrition is not advancing quickly enough and has been deprioritized. The current global food and nutrition crisis may slow progress even further and no region is on track to meet the 2030 global targets to reduce anemia in adolescent girls and women by half and low birthweight in newborns by 30%. 
  • Prevalence of undernutrition and anemia is highest in the lowest income regions and disadvantaged adolescent girls and women are more likely to experience it. The prevalence of underweight among adolescent girls and women belonging to the poorest households is double the prevalence in the wealthiest households (14% v. 7%). 
  • Poor nutrition is generational. The nutritional status of a mother, including weight, height, and low birthweight, are consistent predictors of stunting and wasting in early childhood. Child undernutrition is concentrated in the same regions as maternal undernutrition.  
  • The global food and nutrition crisis is worsening the health and nutrition in adolescent girls and women. Adolescent girls and women have been disproportionately impacted by the COVID-19 pandemic and its impact on livelihoods, income, and access to nutritious food. They are also disproportionately impacted by conflict, climate change, poverty, and other economic shocks.  
  • Diets of adolescent girls and women are not diverse enough to meet nutritional needs. Fewer than 1 in 3 adolescent girls and women have diets meeting the minimum dietary diversity in the Sudan, Burundi, Burkina Faso, and Afghanistan. In other countries, the percentage of women being able to access nutritionally adequate, diverse diets, continues to fall.  
  • Gender and social inequalities have further slowed progress on improving nutrition in adolescent girls and women. Child marriage and adolescent pregnancy have profound negative impacts for nutrition in adolescent girls and their children. Often, women do not have the ability to make their own decisions, including those that would enhance their education and employment opportunities. 
  • The nutrition programs and services designed to address undernutrition have not reached the number of women or adolescent girls impacted or has not met the full nutritional needs of these populations. Only 2 in 5 pregnant women benefit from iron and folic acid supplementation for the prevention of maternal anemia and only 29 low- and middle-income countries provide multiple micronutrient supplements, or prenatal vitamins. Conflict and humanitarian crises like the one in Afghanistan, have made these gaps in coverage grow even larger. 
  • There are policy gaps in addressing undernutrition in adolescent girls and women. Of the eight key policies reviewed that address adolescent girls’ and women’s nutrition, only 8% of countries have all of the policies while 39% have only four or less. 

Governments, development and humanitarian partners, the private sector, civil society organizations, and research and academia sectors must work together to strengthen nutrition governance, activate the food, health and social protection systems, and transform harmful social and gender norms to deliver nutritious and affordable diets, essential nutrition services and positive nutrition and care practices for adolescent girls and women everywhere. 

Key Quotes: 

“Women and girls need access to nutritious and affordable diets, including fortified foods, and essential nutrition services before and during pregnancy and while breastfeeding.” 

House FY24 Agriculture Appropriations Bill will Stall Progress, Decrease Access for Families in Need

1,000 Days is dismayed by the House Appropriations Committee’s fiscal year 2024 Agriculture Appropriations bill released today. This bill under delivers in providing nutrition assistance to those in need and rolls back successful program improvements implemented during the pandemic. Of concern, the bill would reduce funding levels for WIC below current levels, with proposed funding $800 million below the FY24 President’s Budget request. This would result in fewer women and children being served, and possible waitlists for those that qualify for the program. The proposed House Agriculture Appropriations bill ends the increased fruit and vegetable benefits that have been provided to families since April 2021, further reducing nutrition benefits provided to WIC participants. These benefits have had multiple benefits, especially for young children, including increased fruit and vegetable consumption in WIC toddlers and a broader variety of fruit and vegetable purchases by parents. The bill also undermines the science-based review process for the WIC food package, preventing USDA from updating the foods provided to include more fruits, vegetables, seafood, and whole grains.

The proposed bill is short-sighted, cutting benefits to pregnant women, infants and children when investment in the 1,000 days between pregnancy and a child’s 2nd birthday sets the foundation for all the days that follow. 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. Research has proven that WIC saves lives. WIC reduces fetal deaths and infant mortality; reduces low birthweight rates and increases the duration of pregnancy; and it improves the growth of nutritionally at-risk infants and children. We call on Congress to fund WIC at $6.35 billion in fiscal year 2024, providing essential nutrition services during this critical timeframe.

New Series in the American Journal of Public Health Identifies 1,000-Day Window as Untapped Potential to Improve Health of Families

Opportunities, Challenges Identified for Pregnant People and Babies 0-2

(WASHINGTON D.C.) Over the last two decades, science has shown that the 1,000-day window, the time between a pregnancy and the baby’s second birthday, is most critical for brain development and when good nutrition has the greatest influence on future health. Today, on the heels of the first White House Conference on Hunger, Nutrition, and Health in more than 50 years, The American Journal of Public Health released a special series that identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth.

“Prioritizing the health of babies, younger children, and mothers will reap significant returns on investment, setting the foundation for the health of our nation,” said Ambassador Susan Rice, White House Domestic Policy Advisor, in one of the editorials in the series. “Everyone has a role to play—the private sector; state, local, tribal, and territory governments; civil society; academia; philanthropy; and other partners.”

The 70-page series with more than 15 authors outlines the role of Early Childcare and Education (ECE) settings to strengthen overall support systems for low-income families and influence the healthy growth and development of children; how to improve breastfeeding outcomes without leaving anyone behind; new analysis on COVID’s impact for people who gave birth during the height of the pandemic; investments needed to achieve nutrition security; and new opportunities for pediatricians to better support families in their care with nutrition advice and access.

“This special issue sets the stage for what we know about nutrition in the first 1,000 days in the U.S. and what is needed to move forward. Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1,000 days as inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life,” said Dr. Ruth Petersen, MD, MPH, Director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention (CDC), guest editor of the series and an author (R. Petersen).  The series identifies:

  • Gaps in data of nutrition status and eating behaviors through pregnancy, infancy and toddlerhood (H. Hamner), including micronutrient deficiencies such as iron status, which leaves women vulnerable to poor maternal outcomes (M.E. Jefferds).
  • Steps to improve nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so no one is left behind (R. Perez-Escamilla).
  • Impacts of early disparities from historically underserved communities, especially racial disparities that stem from systemic racism in food access, education, housing, health care and employment that have been exacerbated by the COVID-19 pandemic (S. Bleich).
  • Efforts to counter repeated exposure of marketing of unhealthy foods and drinks (J. Harris),  and address overconsumption of ultra-processed food through government policies (J. Krieger).
  •  Opportunities to leverage federal and state programs and policies, such as ECE funding streams, state licensing regulations, state quality improvement programs, and accrediting organizations to strengthen nutrition security in childcare settings. (C. Dooyema).
  • Actions key sectors can take immediately, including childcare, healthcare and the philanthropic sector, as well as policy recommendations for the U.S. government (B. Thomas).  

“What happens in the first 1,000 days sets the foundation for every day that follows. How well or how poorly mothers and children are nourished and cared for during this time has a profound impact on a child’s ability to grow, learn and thrive,” said Blythe Thomas, initiative director of 1,000 Days, an initiative of FHI Solutions. “Achieving nutrition security during the first 1,000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather. We invite all to join us in prioritizing and realizing the opportunity presented by this AJPH supplement.”

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