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Author: Chanelle Kacy-Dunlap

Keeping Healthy During Pregnancy & Breastfeeding

During pregnancy and when you’re breastfeeding, nutritious food choices will help fuel your
baby’s growth and keep you healthy.

Watch and learn 6 steps you can take during your 1,000-day window to nourish you and your little
one.

Taking a Prenatal Vitamin

Eating the Rainbow

Limiting Certain Foods

Managing your Weight

Focusing on Good Nutrition

Breastfeeding for the Benefits to You and Baby

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Paid Leave Must Have a Place at the White House Conference on Hunger, Nutrition, and Health

The following is a statement from the Paid Leave for All coalition, of which 1,000 Days is part.


Dear members of WHCHNH Advisory Committee Members,

As parents, caregivers, early childhood and public health experts, race and gender equity advocates, social justice organizations, and on behalf of our tens of millions of members, we strongly urge you to include paid family and medical leave in the White House Conference on Hunger, Nutrition, and Health and its national strategy. We recommend the White House continue to promote its original proposal of at least 12 weeks of inclusive and comprehensive paid family and medical leave for all working people as a public health imperative. 

Paid leave is a proven tool in addressing the United States’ most pressing health issues, whether it be mitigating the ongoing COVID-19 pandemic, addressing breastfeeding needs in light of a national formula shortage, addressing our worsening maternal mortality rates, or improving our overall health outcomes and families’ well-being. It is also a tool for alleviating the systemic racism and sexism in health care, by allowing more people and those with more caregiving responsibilities access and time to care for themselves along with their loved ones. Yet only 23 percent of workers in this country have access to paid family leave through their jobs and we remain one of the only countries in the world without this protection. 

Paid leave is interconnected with a broad number of health indicators and outcomes. Workers without access to paid leave are more likely than workers with paid leave to experience financial and material hardships, including being more than twice as likely to be unable to pay for rent or utilities and twice as likely to experience food insecurity. Implementing paid leave in California, for example, reduced very low household food security by about two percentage points. Workers without access to paid leave are also more likely to be uninsured, have trouble paying for medical bills, and have less access to medical care because of the cost. A quarter are not confident they could come up with $400 for an unexpected emergency.

Paid leave is also a critical tool to support healthier pregnancies, better birth outcomes, more successful breastfeeding, and both physical and mental health in the postpartum period. This is particularly important while the United States faces a formula shortage—and has the worst maternal mortality rate among wealthy countries, disproportionately impacting Black women, and one that is worsening after COVID-19. Paid leave is critical to giving birthing people the opportunity to establish breastfeeding patterns as an option for their family, and we know that for those who are able and choose to breastfeed, it plays a powerful role in women’s health. Research has shown that breastfeeding is associated with a lower risk of heart disease—the leading cause of death among women in the U.S.—as well as breast cancer, ovarian cancer, type-2 diabetes, and hypertension later in life. It also has health benefits for the child, including improving the digestive and immune system. The American Academy of Pediatrics recently increased their recommended duration of breastfeeding to two years or beyond, a near impossibility for working families without access to paid leave. For low-income families in New Jersey, where a statewide paid family leave program has been in effect since 2009, researchers found that new mothers who use the state paid leave program breastfeed, on average, one month longer than new mothers who do not use the program. According to the Department of Health and Human Services, if 90 percent of women in the United States breastfed their babies for the first 6 months of life, it would save 900 babies’ lives and $13 billion in healthcare expenses annually.

We know that paid sick, family, and medical leave are critical to the overall health—including mental and emotional health—and well-being of working people, families, and whole communities. They are key to diagnosis, treatment and recovery, and the containment of disease. 

Every one of us is going to need to give and receive care in our lifetimes, and without a federal guarantee of paid leave, we will all suffer. We urge you to include paid family and medical leave in this conference and its related strategies, and to prioritize it across the administration. 

Additional Resources: 

The importance of food systems and the environment for nutrition

Published: 24 November 2020

Publication: The American Journal of Clinical Nutrition

Authors: Jessica Fanzo, Alexandra L Bellows, Marie L Spiker, Andrew L Thorne-Lyman, and Martin W Bloem

Read the original paper here.

Summary 

  • Food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability
  • We’re going to need more research to tell us what food policy changes we should make to ensure everyone has access to nutritious food despite the impacts of climate change.
  • We need to think about this key question: how can both human and planetary health thrive while meeting the demands of a growing human population, and if we can’t have it all, what trade-offs are we willing to live with?

Background

  • Food systems involve the production, processing, packaging, distribution, marketing, purchasing, consumption, and waste of food.
  • By “transforming” (improving) food systems, we could make healthy food more accessible and reduce environmental impact 
  • We need a lot more research to figure out how best to structure this transformation
  • Silos within the field make this research harder

Research Gaps

The impact of climate change on food systems

  • The link between climate and food systems is getting more and more attention, but there are still a lot of gaps in our knowledge. Specifically, we need more research on:
    •  The “missing middle” of the food supply chain (aka anything other than people’s diets and agricultural production) 
    • How climate change will affect non-staple crops (most research to date has only looked at staple crops).
    • How to create context-specific policies (eg. financial incentives, targeted messaging campaigns etc.) that encourage/allow people to eat sustainable diets and how to measure whether these policies are working:

Food systems 

  • Diets. We need more information on:  
    • The best way to measure how sustainable someone’s diet is
    • How people’s diets are changing as incomes rise
    • Healthy, locally appropriate, and sustainable diets are sometimes at odds with one another. How should we prioritize?
      • “One of the shortcomings of the EAT–Lancet Commission report was that it provided a single healthy reference diet for the world, and did not take into account that healthy and sustainable diets may differ in their availability, accessibility, and cost at the global, regional, and individual levels. Even more so, what is considered healthy is not always sustainable, and what is considered a sustainable diet is not always a healthy one.”
  • Food safety. We need more information on:
    • The danger of using pesticides and chemicals, and whether these dangers affect consumer purchases.
    • The danger of plastics (in food packaging, production etc.).
  • Food loss and waste.  We need more information on:
    • How to measure and reduce food waste/loss.

Interesting Stats

  • “Some models suggest that changes in food availability due to climate change, specifically reduced availability of fruit and vegetables, are estimated to result in an additional 529,000 deaths by 2050.”
  • “Globally, agriculture and livestock production utilize ∼40% of arable land account for ∼70% of fresh water withdrawn for human purposes, and are responsible for ∼11% of GHG emissions (although some estimates range from 11% to 24% depending on what is counted).”
  • “​​Food wasted at the retail and consumer levels alone averages 1217 calories, 33 g protein, 6 g fiber, and 286 g Ca per person per day.”

Figure: Link between food systems and the environment

The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries

Published: July 2021

Publication: Nature Food

Authors: Saskia Osendarp, Jonathan Kweku Akuoku , Robert E. Black , Derek Headey, Marie Ruel , Nick Scott , Meera Shekar, Neff Walker, Augustin Flory , Lawrence Haddad, David Laborde , Angela Stegmuller , Milan Thomas  and Rebecca Heidkamp

Read the original paper here.

Summary:

  • COVID-related disruptions to food and health systems mean cases of malnutrition around the world are likely to get worse.
    • People also have less money and therefor are turning to less expensive sources of calories such as starchy staples and eating fewer nutrient-dense foods.
  • The study authors used statistical models to predict what these disruptions would do to malnutrition rates.
  • They calculated “optimistic”, “moderate” and “pessimistic” outcomes.
  • After the paper’s publication, the authors stated the pessimistic outcomes are the most likely.
  • Using the pessimistic model as the authors recommend, they predict that by the end of 2022, COVID-19-related disruptions could result in an additional:
    • 13.6  million wasted children 
    • 3.6 million stunted children 
    • 283,000 additional child deaths
    • 4.8 million maternal anaemia cases
    • 3 million children born to women with a low BMI 
    • US$44.3 billion in future productivity losses due to excess stunting and child mortality.
  • To make up for the demands of the projected undernutrition increases, the authors predict we will need an additional $1.7 billion per year.
  • The report also predicts that ODA for nutrition will be 19% less through 2030 than it would have been without COVID, accompanied by a similar decrease in domestic health budgets.
  • We could save a lot of babies from being born small, preterm or stillbirth by a) switching the prenatal vitamins we give out from iron folic acid (IFA) to multiple micronutrient supplements (MMS) and b) Give balanced energy and protein supplements to malnourished pregnant women.
  • The report argues1 that fewer children would be impacted if we move funding away from providing complementary foods and instead allocate resources toward:
    • Balanced energy protein supplementation
    • Breastfeeding promotion
    • IYCF counseling at 6–23 months of age in food-secure households
    • Wasting treatment
    • Vitamin A supplementation

  • These numbers should make it clear to decision makers that the pandemic is causing levels of undernutrition to rise in LMICs and that we need to urgently increase ODA and domestic funding to address this crisis.

Key Quotes:

  • “The COVID-19 pandemic has created a nutritional crisis in LMICs. Without swift and strategic responses by subnational, national, regional and international actors, COVID-19 will not only reverse years of progress and exacerbate disparities in disease, malnutrition and mortality, but will also jeopardize human capital development and economic growth for the next generation.”
  • “While women of reproductive age and young children are largely spared COVID-19’s direct effects (that is, serious disease and death), our projections demonstrate that, regardless of the scenario, the COVID-19 crisis is expected to have dramatic indirect effects on maternal and child undernutrition and child mortality in the current generation.”
  • “The nutritional impacts of the COVID-19 crisis could have massive, long-term productivity consequences that could extend to future generations. Poor nutrition during early life stunts both physical and cognitive development, affects schooling performance and adult productivity, increases the risks of overweight/obesity and diet-related non-communicable diseases later in life, and triggers the intergenerational transmission of malnutrition.”

1 The article notes that “The optimal results and allocative efficiency gains will vary across countries, depending on demographics, epidemiological factors and baseline intervention coverages, as well as context-specific costs, priority targets, delivery platforms and other constraints.”

Scaling Up Impact on Nutrition: What Will It Take?

Published: 07 July 2015

Publication: Advances in Nutrition

Authors: Stuart Gillespie, Purnima Menon, and Andrew L Kennedy

Read the original paper here.

Summary:

  • Even though scaling is important to the nutrition community, people have different ideas about what the term means. 
  • If we’re going to successfully scale nutrition interventions, we need a clear and consistent definition of what the word means.
  • This paper analyses 36 scaling frameworks (from multiple sectors), and distills these frameworks into nine “critical elements” for successfully scaling nutrition projects:
  1. Have a vision/goal:  From the beginning, it is important that everyone agrees on what the project is trying to achieve and how you will measure success. 
  2. Focus on evidence-based interventions: only scale interventions that have already been tested and that are effective at a smaller scale.  
  3. Context matters.  Make sure that any programs you try to scale take into account all the challenges and opportunities of the surrounding environment (policies, institutions, culture etc.). If there are big barriers, make sure your intervention can work around them or don’t scale it there. 
  4. Drivers for scale up include high-level political support, an engaged nutrition champion to spark support, national and local ownership of the intervention, and performance incentives for individual frontline workers or  whole organizations.
  5. Identify scaling-up strategy, processes, and pathways: Be clear about exactly what you’re trying to scale and how you’re going to do it. These measures can be quantitative (expansion in geographical coverage, budget, or size), functional (increase in types of activities and integration with other programs), political (increases in political power and engagement), and organizational (strengthened organization capacity)
  6. Make sure there is strategic and operational capacity to scale up.  Capacity can be improved through nutrition leadership and training.
  7. Governance:  Recognize that successful scaling means managing trade-offs (for example between demonstrating short-term success and building sustainable systems) and make sure governments at different levels have a coherent way of working together.
  8. Financing:  Not only do you need to have enough money, but that money needs to be reliable and flexible. Interventions also cost different amounts depending where you are, so wherever possible make sure your budget is based on local data and prices.
  9. Monitoring, evaluation, learning, and accountability:  We need a lot more evidence on the impact of and lessons learned from scaling. Make sure to collect and disseminate data as you go.