Posted Date: January 25, 2023
Anticipated Period of Performance: February 15 – June 15 2023
Proposals Due: February 10, 2023
The Consultant will facilitate engagement with the Domestic Nutrition Community and coordinate with the 1,000 Days’ Policy & Advocacy Director.
Breastfeeding bills to look for in the 118th Congress
Success in breastfeeding is everyone’s responsibility. In anticipation of the 118th Congress (2023), we’ve pulled together a short list highlighting the breastfeeding-related bills we support, because we know increased breastfeeding support is multifaceted and multisectoral. It envelops a wide range of environments from birthing spaces to places of work and even the halls of Congress. We believe these bills will improve policies and increase investments to enable more people to reach their breastfeeding goals.
Federal Nutrition Programs
The Wise Investment in Children (WIC) Act
This bill would extend eligibility for postpartum women to receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to two years postpartum, extend the program certification window to two years to reduce attrition, and allow children to receive WIC benefits through their sixth birthday.
Access to Donor Milk
The Access to Donor Milk Act (ADMA)
This bill would help increase life-saving access to donor milk, particularly important in light of the 2022 formula recall and shortage, and as part of a robust infrastructure for infant nutrition security.
Access to Quality, Comprehensive Health Care
Improving Coverage and Care for Mothers Act
This bill would expand eligibility for Medicaid to all who are pregnant or within one year postpartum. It would also authorize Medicaid to extend coverage of services provided to include lactation consultants. As the bill highlights, a lactation consultant is a health professional trained to focus on the needs and concerns of a breastfeeding mother and baby, and to prevent, recognize and solve breastfeeding difficulties.
The Mothers and Offspring Mortality and Morbidity Awareness (MOMMA’s) Act
This bill would expand eligibility for Medicaid up to one year postpartum, and for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) up to two years postpartum.
Health Equity
The Black Maternal Health Momnibus Act
This bill would comprehensively address every dimension of the Black maternal health crisis in America by making critical investments in social determinants that influence health outcomes and confront issues of systemic racism in the medical system. It would also establish grant programs to increase the number of perinatal health workers – including lactation consultants and dietitians – who offer culturally congruent support.
Paid Family and Medical Leave
The Family and Medical Insurance Leave (FAMILY) Act
This bill would provide comprehensive paid family and medical leave of up to 12 weeks to all workers in the United States. Categorically recognizing paid leave as a public health imperative, this bill has the potential to transform the lives of families. As research shows, paid leave supports breastfeeding initiation and duration in a number of ways. For example, a person is more than twice as likely to stop breastfeeding in the month the person returns to work compared to someone who has not yet returned to work.
WIC Food Package Updates – Making a Critical Program Even More Impactful
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a critical program in providing healthy foods and nutrition services for more than 6.3 million pregnant and postpartum women, infants, and children across the country.
Building on the program’s success and strengths, the U.S. Department of Agriculture (USDA) published a proposed rule to update the food packages to further reduce health disparities and ensure that all women and children have a healthy first 1,000 days. The proposed rule would permanently increase the Cash Value Benefit for fruits and vegetables, add seafood across food packages, increase whole grain options to better represent culturally-diversified recipes, include new substitution patterns and flexibility to improve participant access to WIC foods and support breastfeeding.
Why we’re excited
First, the proposed rules are more closely aligned with the latest research and science, such as this series in the American Journal of Public Health, so everyone is given the best, most up-to-date nutrition guidance.
In particular, we applaud USDA for increasing benefits for fruits and vegetables while decreasing juice in the proposed rule. This change better aligns with the recommendations in the Dietary Guidelines for Americans (DGA) to consume whole fruits and vegetables and limit juice intake in young children. (Click here to learn more about serving juice to kids.)
We also commend the proposals to strengthen support for moms and babies across a wider range of breastfeeding options, including those that mostly, but not exclusively, breastfeed. These changes provide partially-breastfeeding people with food packages that align with their higher calorie needs and also adds flexibility to the amount of formula provided for partially-breastfed infants. These changes better support individual breastfeeding goals.
These additional flexibilities in the WIC food packages, along with the WIC breastfeeding peer counselor program, which connects moms with others from their community to provide education, encouragement and support, will help all moms with their infant feeding needs. It takes everyone to support breastfeeding, not just the mother. (To dive a little deeper, listen to this interview by former WIC breastfeeding peer counselor, Chrisonne Henderson.)
1,000 Days joins many of our partners in strongly supporting the proposed WIC food package changes. Nutrition in particular plays a foundational role in a child’s development. The proposed WIC food packages take a critical step in ensuring implementation of the Dietary Guidelines for Americans for families who need the extra support with healthy foods and nutrition education, which is critical to the health and well-being of parents and babies. (Check out these short videos about some of the DGA recommendations.)
What you can do
We invite you to join us in submitting supportive comments to USDA. The National WIC Association has a template and online submission form to make it quick and easy! Comments are due by February 21, 2023.
Today, Congress passed, and President Biden will sign, the fiscal year 2023 Omnibus. This bill not only funds federal government programs and foreign assistance but also includes important provisions to support maternal and child nutrition globally. We applaud the passage of this bipartisan bill while recognizing there is still work to be done when the new Congress begins in January.
We are thankful for Congress’ support and inclusion of the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act and the Pregnant Workers Fairness Act in the Omnibus. These bipartisan and broadly supported pieces of legislation provide protections for birthing and lactating people to maintain healthy pregnancies, recover safely from childbirth, and return to the workplace while supporting their breastfeeding goals. Their inclusion is a win for families across the country.
While we celebrate the new protections for families, we also are compelled to keep raising our voices for all the provisions that will create the best possible first 1,000 days for pregnant and birthing people, babies and toddlers. While the Omnibus maintains the enhanced WIC fruit and vegetable benefits and establishes a permanent summer EBT program, we believe Congress missed a chance to streamline and modernize access to WIC services and strengthen the Child and Adult Care Food Program by not comprehensively reauthorizing these child nutrition programs.
We are also grateful for the United States commitment to combatting malnutrition globally. While the global nutrition subaccount received a modest increase of $5 million – a step in the right direction. However, we stand by the compelling case that $300 million is needed to meet the moment during the food and nutrition crises too many are experiencing today. We encourage Congress to continue to expand U.S. leadership on global nutrition and supply programs with the necessary funding to meet dire circumstances.
1,000 Days looks forward to a continued partnership with both Congress and the Administration to ensure families all over the globe have a healthy first 1,000 Days.
Good nutrition is essential to combatting food insecurity and is one of the best investments to build resilience in communities and promote health.
On December 23, 2022, President Biden signed into law the Global Food Security Reauthorization Act of 2022 (H.R. 8446), a critical bill that helps address the global food and nutrition insecurity crisis we are currently facing. The bill reauthorizes Feed the Future, the United States government interagency initiative that brings together partners to address root causes of poverty and hunger by boosting agriculture-led growth, resilience, and nutrition in countries with the most need and opportunity for improvement. This legislation highlights the importance of nutrition in the 1,000-day window, the time between pregnancy and a baby’s second birthday, by reducing hunger and improving nutrition for mothers and children. When children are well nourished, they can achieve more, a win-win for individuals and communities.
About the Bill
The Global Food Security Reauthorization Act (GFSA) of 2022 comes at a time when we are experiencing serious climate shocks and stressors, global conflict, and the impacts of the COVID-19 pandemic. The World Food Programme states that in only two years, the number of people experiencing, or at risk of, acute food insecurity increased from 135 million in 53 countries prior to the pandemic to 345 million in 82 countries today. Additionally, nearly half of all deaths in children under 5 are attributable to malnutrition. Given this food and nutrition security crisis, particularly amongst women and children, GFSA meets the moment in responding to the alarming rates of food insecurity and malnutrition.
In addition to reauthorizing Feed the Future through 2028, the bill also requires a whole-of-government strategy be developed to better address food insecurity and includes improving maternal and child nutrition through this strategy. It also requires assessing and reporting on the strategy on an annual basis and improves monitoring and evaluation practices. GFSA also works to build resilience in countries and communities through agricultural productivity, food and nutrition security efforts, and local economies.
Making Progress on the Global Food & Nutrition Crisis
GFSA not only addresses the acute crises we are seeing today but can help to prevent future food and nutrition insecurity crises. The investments and actions outlined in this legislation will better address malnutrition and put a stronger focus on the importance of nutrition, particularly in the 1,000-day window for families around the world.
“With the passing of GFSA, nutrition will be front and center in responding to food insecurity and hunger crises while also being recognized as a key component in preventing malnutrition and strengthening economies,” said Blythe Thomas, 1,000 Days of FHI Solutions Initiative Director.
1,000 Days is proud to have supported this critical legislation and will continually engage with USAID and other relevant agencies as the act is implemented.
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:
“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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Low and middle-income countries are still grappling with the ongoing COVID-19 pandemic, conflict, and weather shocks which continue to impact global food and nutrition security. The World Food Programme estimates that 50 million people in 45 countries are on the edge of famine. On World Food Day 2022, we take stock of the hard-fought progress that has been made to strengthen nutrition during the first 1,000 days, and we renew our commitment to continue the fight. Though work still needs to be done to truly leave no one behind, we applaud the following actions that have been taken by the US government to address food and nutrition insecurity in low and middle-income countries.
United Nations General Assembly Food Security Announcements
US Government Global Food Security Commitments
Multiple events were held at the United Nations General Assembly (UNGA) in New York related to food and nutrition security efforts. President Biden announced $2.9 billion in additional funding to strengthen food security, which included funding for humanitarian assistance and global development assistance. As part of UNGA, the Global Food Security Summit, which was held one year after the UN Food Systems Summit, took place on September 20th and included remarks from Secretary of State Antony Blinken. Secretary Blinken highlighted current actions to address food insecurity, including progress made on the Roadmap for Global Food Security, and called for more countries to respond to the food insecurity crisis. He mentioned commitments made by the US government, which include $6.1 billion in humanitarian assistance and $2.3 billion in development assistance, and the expansion of Feed the Future. Much of the funding provided by the US government addresses the negative impact on food insecurity throughout the world due to the war in Ukraine.
Commitments to Prevent and Treat Severe Malnutrition
On September 21st, USAID, UNICEF, the Government of Senegal, and the Children’s Investment Fund Foundation co-hosted “The Child Malnutrition Crisis: Pledging to Save Lives.” The event followed the call to action and announcement from United States Agency for International Development (USAID) Administrator Samantha Power in July when the US committed $200 million to scale up access to wasting treatment, including Ready-to-Use-Therapeutic Food (RUTF). During the September event at UNGA, $280 million was announced which included new funding from donors around the world to address severe malnutrition and wasting. Between these events, over $530 million has been committed through public and private sector funds which has the potential to reach the majority of children suffering from wasting with treatment.
Passing the Global Malnutrition Prevention and Treatment Act
In September, the Senate passed the Global Malnutrition Prevention and Treatment Act and it is awaiting President Biden’s signature. The legislation was led by USAID and non-governmental organizations (NGOs) like 1,000 Days of FHI Solutions dedicated to preventing and treating malnutrition. It makes nutrition an even higher priority within the US government by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs and allows USAID administrators to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. 1,000 days is proud to have supported this lifesaving bill!
Advancing the Global Food Security Reauthorization Act of 2022
The House of Representatives passed the Global Food Security Reauthorization Act of 2022 on September 29, 2022. This legislation reauthorizes the Global Food Security Act (GFSA) through 2028 and continues to build upon and strengthen the Feed the Future initiative. It supports agriculture-led economic growth, bolsters small-holder and women-owned farms, and improves maternal and child nutrition, including during the 1,000-day window. GFSA will strengthen local and regional economies and promote resiliency in some of the world’s lowest income countries. This legislation aims to not only improve food and nutrition security, but also national security, and meets the moment to address rates of increased hunger and malnutrition globally.
Moving Progress Forward
Further progress on a global scale is still needed to address the food and nutrition insecurity crises. While we recognize and celebrate the commitments made by donors, the US government, other country governments, and the NGO community, we will continue to advocate for efforts to improve nutrition, particularly during the 1,000-day window. We know the critical role that nutrition plays in a child’s development, and the investments during this time allow communities to prosper. 1,000 Days looks forward to continuing to be a part of efforts to advocate for strong food and nutrition security programs and investments, including evidence-based nutrition interventions.
Photo Credit: USAID
Nutrition plays a foundational role in a child’s development and her country’s ability to prosper. It is why several of the world’s leading economists have called for greater investments in the nutrition and well-being of mothers, babies, and toddlers as a way to create brighter and more prosperous futures for us all.
On September 20, 2022, the Senate passed the Global Malnutrition Prevention and Treatment Act (H.R. 4693) a lifesaving bill that will positively impact tens of millions of women and young children especially in their 1,000-day window, the time between pregnancy and the baby’s second birthday. This is the precious window of opportunity that enables all children to reach their full potential. When children are well nourished, cared for, and protected from disease, violence and toxic stress, they have the best chance at a thriving future. And when children get a strong start, we all benefit.
About the bill
The legislation will support countries in their efforts to prevent the current 2.6 million childhood malnutrition-related deaths worldwide, approximately 150 million children with stunted development, and the 13.6 million children globally under the age of 5 experiencing wasting because they do not have adequate nutrition.
The Global Malnutrition Prevention and Treatment Act, led by the U.S. Agency for International Development (USAID) and non-governmental organizations (NGOs) like 1,000 Days dedicated to preventing and treating malnutrition, makes nutrition an even higher priority by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs, such as prenatal vitamins, fortifying foods with essential nutrients (like Vitamin D, iron, and iodine), providing young children with vitamin A supplementation, supporting new mothers to breastfeed, and lifesaving treatment for severely malnourished children.
With this bill, the USAID administrators will be able to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. The USAID administrators will select priority countries to receive prioritized nutrition assistance and develop clear goals for increasing coverage of high-impact, evidence-based nutrition programs. USAID will be required to submit an annual report to Congress on the progress made toward preventing and treating global malnutrition.
“With the passing of this legislation, we believe the effectiveness of these nutrition programs can be significantly increased with greater strategic vision, accountability, integration, and coordination,” said Blythe Thomas, 1,000 Days of FHI Solutions Initiative Director.
The power to change lives
For example, large-scale vitamin A supplementation has played a major role in decreasing Senegal’s under-five mortality rate from 59 to 37 per 1,000 live births in 5 years. In Nepal through the Suaahara II program, USAID increased the rate of exclusive breastfeeding in supported communities from 45% to 71% in 5 years.
This Global Malnutrition Prevention and Treatment Act is an investment in the future of many lives and aims to address malnutrition at the core so that our most vulnerable populations have access to proper nutrition for continued health throughout the lifespan. As Congresswoman Chrissy Houlahan (D-PA) stated “investing in global nutrition translates to lives saved.”
With both the House and Senate passage, we enthusiastically await the legislation being signed into law by President Biden.
1,000 days is proud to have supported this lifesaving bill and will continually engage with USAID and our partners as the act is implemented.
The “1,000-day window” as an organizing agenda is a new and relatively unknown concept in the United States despite its established role in global health. But, there is opportunity to unite public health communities through the relevant, compelling framework.
We believe further focus on creating the best conditions for families in their 1,000-day window can change the trajectory of the path we’re on. We seek to present a comprehensive picture of the state of the science, research needs, and a policy agenda for optimal maternal and child health in the United States through a dedicated series in the American Journal of Public Health (AJPH).
Three papers were released at 4 p.m. ET September 19, 2022 (and can be found below once published). The full series will be released October 26, 2022 on the AJPH website.
September 20, 2022
The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children
Optimizing federal programs and policies can significantly improve nutritional outcomes in the 1,000-day window—a vital period of development for children
Optimal nutrition between pregnancy and a child’s 2nd birthday (i.e., the first 1,000 days) is critical for the development and long-term health of the child. The 1,000 Days initiative of FHI Solutions aims to improve the health of pregnant people and babies by giving them a healthy start. The 1,000 Days initiative sponsored a new series in the American Journal of Public Health, to publish October 26, 2022, with a pre-release of three papers today.
How can we help create a healthier and more equitable future for all pregnant people and their children? The infant and maternal mortality rates in the US are among the highest of any wealthy country, with glaring racial and ethnic disparities. There is significant room to develop a unifying plan for the right policies and systems to improve nutritional security and well-being for vulnerable families.
A new essay published in the American Journal of Public Health by Dr. Heather Hamner—a health scientist at the Centers for Disease Control and Prevention—reveals numerous gaps between the dietary intake of pregnant people, infants, and toddlers and the US Department of Agriculture and the Department of Health and Human Services’ Dietary Guidelines for Americans, 2020–2025, with race and ethnicity disparities persisting across the spectrum. The average consumption of sugars, saturated fat, and sodium are higher than the recommendations of the Dietary Guidelines. The article also reveals that nearly 75% of infants are not exclusively fed human milk for the first 6 months of their lives and 1 in 3 of them are started on complementary foods (other than human milk or infant formula) before the recommended age. Most children between 12 and 23 months do not consume the recommended amounts of vegetables, dairy, and fruits.
How do we set about addressing these nutritional deficits? The essay states “Advancing efforts related to research and surveillance, programs and communication, and dissemination could help positively, and equitably, influence the health and well-being of mothers and children.” It also outlines a framework by which current federal policies and programs can be strengthened and how access to and participation in programs can be improved.
Another paper in the collection, authored by Blythe Thomas, Initiative Director of 1,000 Days, an initiative of FHI Solutions, points out that a clear plan that unifies maternal and early childhood nutrition policy and systems has eluded implementation in the US. The paper emphasized four sectors where immediate actions can be taken, and where long-term investment can make a significant impact on maternal and child health: early childhood development, health care, philanthropy, and US government relations. “Achieving nutrition security during the first 1000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather,” says Thomas, in her editorial.
A third paper in the collection—authored by Dr. Kofi Essel, community pediatrician, Children’s’ National Hospital, discusses the limited focus on nutrition-related medical education as a significant constraint on the ability of pediatricians to deliver sound feeding and nutritional guidance during the first 1,000 days. Using examples from the author’s own experience during his pediatric residency, the editorial explains that a paradigm shift on the importance of nutrition and nutrition guidance is important to enhance clinical care. According to Dr. Essel, “This shift requires a collective effort that activates pediatricians to work in cross-sector collaboratives to influence change alongside industry, researchers, and even early childhood educators. It requires pediatricians to use their voices to support local policy that shifts the food landscape, supports national policy that enhances nutrition security for our families, and transforms medical education for current and future providers.”
These three papers are part of a special series, sponsored by 1,000 Days of FHI Solutions, that will appear in AJPH on October 26, 2022. The full series will present the state of science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood for the US population.
Reference
| Authors Titles of original papers Journal | Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhDKofi Essel, MD, MPHBlythe Thomas, BS Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective The First 1000 Days—A Missed Opportunity for Pediatricians From Evidence to Action: Uniting Around Nutrition in the 1000-Day Window American Journal of Public Health |
| DOI | 10.2105/AJPH.2022.30706310.2105/AJPH.2022.307028NA 10.2105/AJPH.2022.307028 NA |
