Category: Global

Lifting Up the Powerful Role of Nutrition for Policymakers and Advocates

Good nutrition before, during, and after pregnancy has a profound impact on the health of both a mother and child. This National Nutrition Month (NNM), and as part of our global #March4Nutrition campaign, 1,000 Days is highlighting some of the nutrition-related regulations and legislation that we support to ensure every child can grow, learn, and thrive. Much of this legislation also shapes the future for mothers, pregnant, birthing and postpartum people. This Spring, we are focused on advocating for regulatory updates, legislation that supports nutrition for families here in the U.S. and around the world, and additional funding to support all these programs. This year’s NNM theme of “Fuel for the Future” highlights the importance of ensuring families are well nourished to support healthy futures.

Updated Regulations for Maternal & Child Nutrition

WIC Food Package Updates

The United States Department of Agriculture (USDA) has proposed several regulatory changes to strengthen nutrition programs and improve maternal and child nutrition. The agency is currently updating the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages, that would impact over 6 million WIC participants which include moms, babies, and young children. The updates, which are science-based and align with the most recent Dietary Guidelines for Americans and the 2017 National Academies (NASEM) report, increase fruit and vegetable vouchers, promote greater flexibility to accommodate cultural food preferences and dietary needs, strengthen support for breastfeeding, and increase access to under-consumed, nutritious foods, like seafood with lower levels of methylmercury.

Child Nutrition Program Updates

USDA also proposed updated nutrition standards to school meals that would more closely align the standards recommended in the Dietary Guidelines for Americans to provide children with nutritious and delicious meals. The proposed updates do include some changes to the Child and Adult Care Food Program (CACFP), which serves young children, including those in their 1,000-day window, at childcare. Changes in the CACFP program would support more nutritious meals and snacks by reducing added sugar content and allowing more plant-based meat/meat alternate options.

Dietary Guidelines for Americans

While not specific legislation or regulations, the Dietary Guidelines for Americans (DGA) form the basis of nutrition policy in the U.S. and are a critical component of improving maternal and child nutrition. Co-developed every five years by USDA and the Department of Health & Human Services (HHS), the basis of the guidelines is a science-based report developed by the Dietary Guidelines for Americans Advisory Committee (DGAC) which includes nutrition researchers, physicians, and Registered Dietitians. The DGAs have a broad impact ranging from WIC food packages and child nutrition programs to food labeling and nutrition education programs. The guidelines include dietary recommendations for pregnant and lactating people and birth to age 2, which were included for the first time in the 2020-2025 DGA. The next iteration of the guidelines is currently underway as the DGAC is reviewing evidence and drafting conclusion statements which will ultimately lead to dietary recommendations and guidelines for Americans, including mothers, babies, and young children.

2023 Farm Bill

Every five years, Congress reauthorizes the Farm Bill which is a robust, multiyear law that authorizes food and agricultural programs. Although the name may imply that most of the bill is focused on farming and agriculture, nutrition spending makes up an overwhelming majority of the legislation. In 2018, the nutrition title (Title IV) made up about 76% of total Farm Bill spending, and for the 2023 Farm Bill, it is projected to be as much as 85%. The Supplemental Nutrition Assistance Program (SNAP), formerly known as “food stamps,” is authorized in the Farm Bill which is the reason for the large amount of spending for nutrition in the bill. When children have access to SNAP, from birth through early childhood, their risk of developing high blood pressure, heart disease, diabetes, and other poor health outcomes later in life greatly decreases. Children on SNAP can immediately experience a reduction in food insecurity. As Congress works to reauthorize the 2023 Farm Bill, it is imperative that they ensure families have access to the food and nutrition assistance they need through SNAP benefits as nearly half of all people who participate in SNAP are children.

In addition to domestic nutrition programs, the Farm Bill also reauthorizes international food aid programs in Title III. These programs include Food for Peace Title II, the McGovern-Dole Food for Education Program, Food for Progress, and the Bill Emerson Humanitarian Trust. These programs are primarily focused on improving food security. As Congress works to reauthorize the 2023 Farm Bill, we urge them to further consider how the programs can incorporate nutrition interventions to address both food and nutrition insecurity and prevent malnutrition. Robust funding will be needed to address the current malnutrition crisis and to build resilience in communities globally.

Implementation of the Global Malnutrition Prevention & Treatment Act

In October 2022, the Global Malnutrition Prevention & Treatment Act (GMPTA) was signed into law to bolster the federal government’s efforts to address global malnutrition and build resilience. It authorizes the United States Agency for International Development (USAID) to advance targeted interventions to prevent and treat malnutrition around the world while requiring a robust monitoring of interventions to ensure effective use of funding. As USAID works to draft the implementation plan and coordinate efforts, we look forward to working alongside them to ensure all activities address the nutritional needs of families in their first 1,000 days.

Fiscal Year 2024 Appropriations

Addressing nutrition security in the U.S. remains a critical need. 1,000 Days joins the National WIC Association and the broader maternal and child health community in urging funding of $6.35 billion for WIC in FY 2024. This amount will ensure adequate funding to support WIC’s growing caseload and address rising food costs in WIC food categories. We also support increased funding to strengthen FDA’s food safety and nutrition capacity, especially for infants and young children.

While reductions in global mortality rates for women and children are two of the biggest success stories in international development, progress has slowed over the past 12 years. There remain significant gaps that additional investments can help close. In 2021, 5 million children under age five died from mainly preventable and treatable diseases, with malnutrition as the underlying cause of roughly half of these deaths. Additionally, 300,000 women die annually of preventable causes related to pregnancy and childbirth. 

As Congress determines funding levels for FY2024, it is critical that funding meets the moment to address the malnutrition crisis. 1,000 Days as part of the 1,000 Days Advocacy Working Group (AWG) and the Maternal, Newborn, Child Health Roundtable (MNCH RT), is requesting $300 million for the nutrition account and $1.15 billion for the maternal and child health (MCH) account within USAID. Malnutrition costs the world $3.5 trillion in lost productivity and healthcare costs each year. The current global food crisis, fueled by conflict, climate shocks and the threat of a global recession, continues to threaten the lives of women and children globally. Full funding of the nutrition account is critical for saving lives and reaching USAID’s goal of ending preventable child and maternal deaths.

Our favorite time of year: #March4Nutrition

Our favorite time of year: #March4Nutrition

We’re thrilled to celebrate the 50th anniversary of National Nutrition Month in March 2023. Developed by our friends and colleagues at the Academy of Nutrition and Dietetics, every March we work especially to amplify the importance of nutrition for families in the first 1,000 days: the time between pregnancy and a baby’s second birthday.

Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. Backed by decades of research and most recently the American Journal of Public Health’s special nutrition series, we know nutrition plays a foundational role in a child’s development and her country’s ability to prosper.

We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures.

Week 1 March 1-10: Women’s nutrition – Access to proper nutrition can help women grow their power.

Week 2 March 13-17: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.

Week 3 March 20-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish.

Week 4 March 27-31: Raise your voices – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition.

Join us this month as we #March4Nutrition for moms and babies!

A Much-Needed Win for Moms and Babies: the Global Malnutrition Prevention and Treatment Act

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.

Multiple micronutrient supplements versus iron-folic acid supplements and maternal anemia outcomes: an iron dose analysis

Published: February 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • The World Health Organization currently recommends 30 to 60 mg of iron during pregnancy, with higher doses recommended in areas of high maternal anemia
    • Multiple micronutrient supplement (MMS) and iron folic acid (IFA) are both used to deliver iron during pregnancy
  • Comprehensive analysis was conducted examining 19 studies to address concerns related to 30mg of iron through MMS vs. 60mg of iron through IFA, with regard to maternal anemia outcomes in low- and middle-income countries (LMICs)

Summary

  • Of the 19 studies that were screened for inclusion, 11 were included and were part of the analyses of the three outcomes of interest:
    • Effect of MMS vs. IFA on maternal anemia in the third trimester
    • Effect of MMS vs. IFA on hemoglobin in the third trimester
    • Effect of MMS vs. IFA on iron deficiency anemia in the third trimester
  • When compared to 60 mg of IFA, MMS providing 30 mg of iron did not result in an increased risk of anemia, nor lower levels of hemoglobin, or increased risk of iron deficiency anemia
  • The included studies found that MMS with 30 mg of iron is comparable to IFA with 60 mg of iron with regard to these above-mentioned outcomes
  • MMS is known to have additional benefits in the risk of infant mortality at 6 months, low birthweight, preterm birth, born small-for-gestational age, and reduction of stillbirth. Greater reductions are found among anemic pregnant women so the data suggest that transitioning from IFA with 30 or 60 mg of iron to MMS with 30 mg of iron would not increase the risk of maternal anemia and has additional maternal/child health benefits.

Key Quotes

  • “Because MMS with 30 mg of iron influenced hemoglobin with clinically comparable results to IFA with 60 mg iron, and because MMS significantly improves fetal growth and survival, especially in anemic women, we suggest that policymakers in LMIC proceed with the transition from IFA to MMS.”

Read the original article here

Effect of multiple micronutrient supplements vs iron and folic acid supplements on neonatal mortality: a reanalysis by iron dose

Published: April 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • Multiple micronutrient supplements (MMS) are a cost-effective method of delivering iron to a mother and fetus, as well as reducing adverse pregnancy and birth outcomes, including anemia
  • However, there are concerns that MMS may increase the risk of neonatal mortality as compared to the use of iron and folic acid supplements (IFA), a similar prenatal vitamin

Summary

  • The study aimed to assess the effect of MMS vs. IFA on neonatal mortality stratified by iron dose in each supplement
  • The study authors updated the neonatal mortality analysis of the 2020 WHO guidelines to calculate the effects of MMS vs. IFA on neonatal mortality in subgroups that provided the same or different amounts of iron – varying amounts of MMS and IFA
  • The study found that there were no significant differences in neonatal mortality between MMS and IFA within any of the subgroups therefore, neonatal mortality did not differ between MMS and IFA regardless of iron dose in either supplement.

Read the original article here

Maternal and child undernutrition: consequences for adult health and human capital

Published: January 2008 

Publication: The Lancet 

Authors: Prof. Cesar G. Victora, M.D., Prof. Linda Adair, Ph.D., Prof. Caroline Fall, D.M., Pedro C Hallal, Ph.D., Prof. Reynaldo Martorell Ph.D., Prof. Linda Richter Ph.D., Prof. Harshpal Singh Sachdev, M.D., for the Maternal and Child Undernutrition Study Group 

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
    • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
    • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
    • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
    • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • Malnutrition in pregnancy and childhood can cause generational health problems 
  • Undernutrition in pregnant mothers and children was strongly associated with… 
    • Shorter adult height 
    • Less schooling 
    • Reduced economic productivity  
    • Lower offspring birthweight in women (birthweight is positively associated with lung function, the incidence of some cancers; undernutrition could be associated with mental illness) 
  • Lower weight and malnutrition in childhood followed by weight gain after two years of age was found to be risk factors for high glucose concentrations, elevated blood pressure and harmful lipid profiles once adult BMI and height were adjusted for, suggesting that rapid postnatal weight gain, after infancy, is linked to these conditions 

Key Quotes: 

  • “Poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birthweight.” 
  • “Children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.” 
  • “We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations.” 

Read the original article here

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a forty-year study

Published: Nov. 26, 2013

Publication: National Library of Medicine

Authors: Deborah P. Waber, Ph.D., Cyralene P. Bryce, M.D., Jonathan M. Girard, B.A., Miriam Zichlin, B.S., Garrett M. Fitzmaurice, Sc.D., and Janina R. Galler, M.D.

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
  • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
  • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
  • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
  • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • While previously malnourished individuals were able to catch up physically to their healthy peers, their cognitive and behavioral development lagged behind 
  • IQ scores in the intellectual disability range were 9 times more prevalent in the previously malnourished group 
  • Previously malnourished individuals had lower IQs, lower grades in school, and higher rates of attention problems. They also suffered from intellectual disabilities at a higher rate than their healthy peers. 
  • Malnutrition during the first year of life carries risk for significant lifelong functional morbidity.  

Key Facts: 

  • The estimated difference in IQ between the two groups was 15 points when tested as adolescents and 18 points when tested as adults 
  • 26.3 percent of individuals in the previously malnourished group had IQs indicating intellectual disabilities compared to only 3 percent in the control group 

Read the original article here

Long term consequences of early childhood malnutrition

Published: December 2003 

Publication: International Food Policy Research Institution 

Authors: Harold Alderman, John Hoddinott, Bill Kinsey 

Background

  • Researchers studied the preschool nutritional status (measured by height, given age) of children in Zimbabwe who experienced civil unrest and/or a drought before the age of three
  • Civil war and droughts were used as an indicator of malnourishment
  • Nutritional status was then compared to subsequent health and education achievements of these children to show the effects of early-childhood malnutrition on adult outcomes

Summary

  • The study indicates that early childhood malnutrition can lead to continued stunting and lower school achievement in adolescence as compared to peers who experienced no malnutrition or a lesser degree of malnutrition in childhood
  • Children who measured at median height in preschool were more likely to measure at median height by adolescence and have completed an additional 0.7 grades of schooling than students who measured below median height in preschool
  • This study also indicates that improving preschool nutrition can facilitate growth and higher educational achievement in adolescence
  • Because of the negative impact of “shocks” (i.e. war and drought), interventions should focus on mitigating the impact of these shocks.

Read the original article here

A Conversation with Action Against Hunger

Blythe Thomas, Initiative Director at 1,000 Days, an initiative of FHI Solutions, recently spoke with Dr. Charles Owubah, CEO of Action Against Hunger, to discuss the vital work of his organization to detect, treat and prevent malnutrition. The two discussed the effects of COVID and climate change on food and nutrition, the role of women farmers in ending malnutrition, and LifePack, an innovative tool to raise money for malnutrition treatment.

Watch the video to learn more. 

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