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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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What We’re Watching – July 2022

July is bringing hot temperatures to the Nation’s Capital and work is also heating up on Child Nutrition Reauthorization and the White House Conference on Hunger, Nutrition and Health. To the delight of child nutrition advocates, House Education and Labor Chairman Bobby Scott (D-VA) and House Civil Rights and Human Services Subcommittee Chair Suzanne Bonamici (D-OR) released the Healthy Meals, Healthy Kids Act, the Committee’s much-anticipated Child Nutrition Reauthorization bill. The legislation addresses critical needs and recommended improvements in the programs that serve children including the National School Lunch Program, Summer Food Service Program, Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Child and Adult Care Food Program (CACFP). Proposals in the bill are designed to increase access to these programs and strengthen the nutritional resources provided to participants. Many of the recommendations are based on learnings from the COVID-19 pandemic about strategies to reach more children and meet the critical needs of program providers to ensure program sustainability.

1,000 Days is particularly excited to see provisions that

  • modernize WIC by improving access to telehealth so that receiving program benefits is not limited due to physical burdens;
  • expand the WIC Breastfeeding Peer Counselor Program to ensure more families have access to breastfeeding support;
  • strengthen CACFP by providing reimbursement for an additional meal or snack per child, allowing young children in care for longer hours to receive the nutrition they need; and
  • permit children in households participating in the Supplemental Nutrition Assistance Program (SNAP) to be automatically eligible for CACFP, ensuring more young children will receive nutritious meals and snacks.

The team at 1,000 Days will monitor the Committee markup on Wednesday, July 27 and work closely with partners and lawmakers to advance this bill and its critical components that improve nutrition security for birthing people, young children, and their families.

1,000 Days also worked across the public health community and in specific coalitions to inform the Administration about our priorities for the White House Conference on Hunger, Nutrition and Health by the July 15 deadline. Examples include working with Council for a Strong America’s CEO Barry Ford to submit this letter to reinforce the need for policies to support maternal and child health, equitable policy implementation and more. Paid Leave for All, where Blythe Thomas, 1,000 Days’ Initiative Director, serves on the steering committee, submitted a letter leveraging 1,000 Day’s report that demonstrates paid leave is a public health imperative and must be considered as an intersectional policy that supports and builds stability for low-income and other marginalized communities. Finally, although it’s not an official part of White House property, the Task Force on Hunger, Nutrition and Health collected policy reports and white papers to help inform their recommendations. That portal includes four papers authored by 1,000 Days and four papers from other organizations with a focus on the 1,000-day window in the title. We’re working hard to ensure the White House hears us!

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: 

1,000 Days Submits Comments to USDA and HHS for Next Edition of the Dietary Guidelines for Americans

The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) are preparing for the next edition of the Dietary Guidelines for Americans. They recently proposed a list of scientific questions to inform the next version, with a focus on diet and health outcomes across the lifespan. In response, 1,000 Days submitted comments emphasizing the critical importance of nutrition in shaping future health and outcomes. Our comments specifically recommend adding developmental milestones as outcomes of study for infant and toddlers, including key questions on maternal and child nutrition and health outcomes from the 2020 Dietary Guidelines Advisory Committee report, and updating research on breastmilk composition and consumption.

See the comments here.

U.S. Breastfeeding Committee’s Statement on the Formula Shortage

The following guidance is also available from the Academy of Breastfeeding Medicine and HealthyChildren.Org.

Dear Members,

It’s been a long week/month/year (already, here in May). We see you. We are you. Much love.

As the United States faces a serious shortage of infant formula, we know that no baby should ever go hungry. Families are scared and stressed, and like every other crisis facing our nation, BIPOC and economically vulnerable communities are pressed even harder. This is a national crisis.

Long standing public health advocates know this was predictable and thus preventable. The USBC-Affiliated COVID-19 Infant & Young Child Feeding in Emergencies Constellation published a Statement at the start of the pandemic outlining actions needed to prevent the formula shortage and care gaps seen at that time from growing to a dangerous level. Being prescient is only valuable in the context of investment, action, and policy change to ensure every family has access to care. Yet here we are.

A robust infrastructure to support infant and young child feeding in emergencies includes both inventories of available commercial milk formula and lactation support and resources in every community. Public officials are currently calling for increased production of formula – which is desperately needed – yet without also investing in lactation support in every community. This exacerbates existing gaps, and as such feels short-sighted. Thank you to all the organizations lifting up resources and information on boosting milk supply, re-lactation, human milk donation, informed consent for safer milk sharing, all while calling out the systems failure that caused this to be necessary.

Long term, this is still a call to action to build systems and infrastructure to ensure that breastfeeding/human milk feeding is the easy and obvious feeding choice for most families. This includes routine skin to skin at birth; continuity of care from trained lactation support providers; family paid leave; workplace accommodations; a regulated commercial milk formula industry that invites formula-feeding parents to the table as valued stakeholders; a national network of milk banks; and IYCF-E infrastructure for disaster relief. Systems, in other words, that hold us all in care. Collectively we can build the resiliency to support a single community during a flood, a region during a power outage, or a nation during a pandemic or supply chain crisis. Dear choir – we know you know this sermon.

As the nation grapples with the immediate and present impact of this emergency, we need to do everything we can to support infant nutrition, including ensuring access to lactation support, supplies, and accommodations, donor milk, and infant formula. Organizations and agencies from across the nation are mobilizing in response to the shortage, offering support and messaging response according to the scope, stance, and capacity within their reach.

Throughout its history, the U.S. Breastfeeding Committee has worked to ensure food security for our nation’s infants by addressing gaps in the policy landscape with policy, systems, and environmental change solutions that include building an infrastructure for infant and young child feeding in emergencies. We remain committed to this cause and will continue to curate and amplify resources from the field, for the field, so that you are equipped to support the families you serve.

Thank you for all you are doing, including taking respite as you need.

Focus on Nutrition During National Women’s Health Week

By:  Blythe Thomas, Initiative Director, 1,000 Days of FHI Solutions

Minerva Delgado, Director of Coalitions & Advocacy, Alliance to End Hunger

Not nearly enough time or attention is spent discussing and acting upon when “good nutrition” for an individual should start. The answer? Before the individual is even born. This week is National Women’s Health Week and marks an important time for the nutrition and anti-hunger community, individuals, and policymakers, to reflect on what we can do to promote and improve the health of women, children and families. We must focus on supporting policies that build a healthier and more equitable future for all pregnant, birthing, postpartum, and parenting people and their children.  

The 1,000-day window, which spans from pregnancy to age 2, marks one of the most crucial times to provide vital maternal and infant nutrition interventions. The nutrition community has coalesced around this critical window working to ensure mothers, children and families have access to the nutrition they need for vibrant futures. This goal is unfortunately – but unsurprisingly – difficult to achieve across the board. Factors such as race or where a child is born should not affect health and well-being; however, this is a reality in many communities. In particular, families of color and low-income families are more often overburdened with barriers to accessing nutrition and are under-resourced. As a result, there are glaring disparities in the health and well-being of women and children from these households. 

Adequate nutrition is fundamental to the overall well-being of a community because good nutrition impacts more than just physical health. Good maternal nutrition during pregnancy fuels the development of a baby’s rapidly growing brain so by the time that a baby is born, their brain will contain 100 billion neurons. We also know, for example, that children with access to healthier, more nutritious meals are better able to concentrate in school and enjoy better educational outcomes. Similarly, adults who can easily access and maintain a healthy diet benefit from improved health and economic opportunities. Addressing inequities in access to healthy and nutritious foods cannot be ignored. We must prioritize interventions that give every family the opportunity to be healthy.  

To that end, there are a number of programs that merit continued support and strong expansions, such as the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program (CACFP). For example, WIC has bridged the gap between medicine, food, and nutrition better than almost any federal program, leading to improved nutrition intake, healthier pregnancies and improved birth outcomes. Congress has temporarily increased the overall value of WIC’s fruit and vegetable benefit (or Cash Value Benefit (CVB)) through the end of September 2022. So far, this has led to better access to nutritious foods for over 4.7 million WIC participants. Making the increased benefit permanent will significantly close nutrition gaps for women and their children. 

Improving nutrition also means supporting programs like the recently expired monthly Child Tax Credit (CTC). The revamped CTC monthly payment proved to have an astonishing impact on lifting children and families out of poverty. In 2021, Congress expanded the CTC and made the full credit available to low-income families who previously did not qualify because their earnings were too low. Families were allowed to receive the credit in monthly increments, which was vital in helping families with their everyday expenses like buying nutritious food. It is estimated that 3.7 million children were kept out of poverty in December 2001 when the last child tax credit payments were made. Further, nearly half of families who received the tax credits used the extra funds to purchase food helping to address nutrition insecurity around the country. In January, the first month without the deposits, those gains were lost and 3.7 million children again fell into poverty. 

But we must support the overall health and well-being of women and families with comprehensive approaches to address the root causes of poverty and malnutrition. Employers must implement family-friendly policies and programs in workplaces and communities to support women at home and at work. This includes providing workers with sufficient paid family leave, as well as ensuring equitable access to the lactation services and support women need to meet their breastfeeding goals. These policies help make the workplace and our society a safe and enabling environment. The recent pandemic and subsequent inflation have highlighted not only the critical nature of poverty and nutrition programs, but also the vulnerabilities and gaps in supporting those who need it most. All future policies must prioritize making programs more equitable and effective. While Congress has many competing priorities, we know that voters across all demographics deeply care about ensuring women and their children have access to the nutrition they need to be healthy. For example, a recent bipartisan poll by ALG Research/McLaughlin & Associates, on behalf of the National WIC Association and Alliance to End Hunger, reveals strong support for WIC among likely 2022 voters – 83% total support for the program, and approximately 75% support for expanding the value of the WIC food package, expanding postpartum eligibility, and modernizing WIC services.  

This week, let’s reflect once again on the fundamental importance of nutrition for women and girls across the country, and urge Congress to make access to healthy foods and investment in nutrition programs a priority. Ensuring the health and well-being of those who are pregnant and their children is critically important to our nation’s future and requires both focus and determination of policymakers and advocates. 

1,000 Days, an initiative of FHI Solutions, fights to win support for policies and investments in the wellbeing of mothers, babies and toddlers in the U.S. and around the world. 

Alliance to End Hunger unites diverse sectors to address today’s hunger and malnutrition needs and to solve the root causes of hunger at home and abroad. 

Paid Family Medical Leave Remains Critical for Low-Income Pregnant and Postpartum Women

By: Daphna Dror, PHD, RD

The lack of national, comprehensive, and paid family medical leave in the United States has significant consequences for low-income women, especially those who are pregnant or have recently given birth. Many women risk their own or their child’s health to continue working throughout pregnancy and the early postpartum period in order to pay bills and provide for dependents. Only seven states and the District of Columbia have passed their own paid leave programs, meaning far too many new mothers must choose between caring for themselves and bonding with their newborn or making ends meet. 

Paid leave:

  • Supports healthier pregnancies. Financial concerns due to lost wages may prevent low-income women from seeking regular prenatal care, which itself is associated with better pregnancy and birth outcomes. Paid leave reduces the risk of preterm birth, low birthweight, and infant mortality (1)
  • Increases breastfeeding initiation and duration. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months followed by a combination of complementary foods and breastmilk for at least 12 months (2), yet new mothers who plan to return to work before 12 weeks or to work full time are less likely to opt for exclusive breastfeeding (3). A recently published study of participants in the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) found that amongst women who had worked prenatally, returning to work within 3 months postpartum significantly decreased the odds of breastfeeding for the first year (4). Paid time off can alleviate the financial stress of combining work and breastfeeding (5,6).
  • Improves the physical and mental health of mother and baby postpartum. While postpartum depression (PPD) occurs in approximately 11% of all US mothers, a qualitative study in low-income women found that 35% experienced PPD or sadness (1). Nearly one third of low-income mothers who returned to work reported that employers were not understanding of postpartum needs, most commonly requiring more time off (1). Mothers who have access to paid leave and other work accommodations can minimize financial strain and career disruptions while improving their own health, their baby’s health and their bond with their baby.
  • Reduces maternal and infant racial and ethnic disparities. Women of color are disproportionately affected by lack of access to paid leave, exacerbating perinatal health disparities (7). Compared with Caucasians, African-American mothers in the United States are more than three times as likely to die of pregnancy-related causes (8); infants born to African-American mothers have more than twice the mortality rate of infants born to Caucasian mothers (9). Women of color are overrepresented in part-time, seasonal, and low-wage jobs, employment categories least likely to offer paid leave (7).

Of 41 high- and middle-income countries, the U.S. is unique in lacking nationwide paid maternity leave, paternity leave, or parental leave (10). Only 19% of U.S. workers have access to paid family medical leave, with even lower access amongst those who work part-time, in low-wage industries, at small firms, or who are not unionized (11). Universal access to paid family leave is imperative to ensure that all families in the United States have a healthy first 1,000 days and a strong foundation to thrive.


References

1.     McClanahan Associates, Inc., 1,000 Days. Qualitative Paid Leave Report: Furthering our Case for Paid Leave in the United States.

2.     Eidelman AI, Schanler RJ. Breastfeeding and the Use of Human Milk. Pediatrics. 2012 Mar;129(3):e827-41.

3.     Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. In the United States, a Mother’s Plans for Infant Feeding Are Associated with Her Plans for Employment. J Hum Lact. 2014 Aug;30(3):292–7.

4.     Hamner HC, Chiang KV, Li R. Returning to Work and Breastfeeding Duration at 12 Months, WIC Infant and Toddler Feeding Practices Study-2. Breastfeed Med. 2021 Dec;16(12):956–64.

5.     Rojjanasrirat W, Sousa VD. Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010 Jul;19(13–14):2014–22.

6.     Johnson AM, Kirk R, Muzik M. Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers’ Needs for Workplace Breastfeeding Support. J Hum Lact. 2015 Aug;31(3):425–33.

7.     Goodman JM, Williams C, Dow WH. Racial/ethnic inequities in paid parental leave access. Health Equity. 2021 Oct 13;5(1):738–49.

8.     Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018 Jun;61(2):387–99.

9.     Ely DM. Infant Mortality in the United States, 2018: DataFrom the Period Linked Birth/Infant Death File. National Center for Health Statistics; 2020 Jul.

10.     Chzhen Y, Gromada A, Rees G. Are the World’s Richest Countries Family Friendly? Policy in the OECD and EU. Florence, Italy: UNICEF Office of Research; 2019.

11.     National Compensation Survey: Employee Benefits in the United States. U.S. Department of Labor, U.S. Bureau of Labor Statistics; 2019 Mar.

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.