Category: Region

Advocating for Nutrition, Maternal and Child Health Funding

From left to right: Dorothy Monza (RESULTS), Stephanie Hodges (1,000 Days), Andrew McNamee (Food for the Hungry), John Goetz (Legislative Correspondent for Sen. Tim Scott), Daren Caughron (Bread for the World)

Each year, there is an appropriations process that determines the budget for the federal government and the programs that it carries out. The President releases a budget, which provides insight into an administration’s priority, but ultimately, it is up to Congress to draft and pass the budget for the federal government each fiscal year. 1,000 Days, an initiative of FHI Solutions, raises awareness of this process and engages every year to advocate for robust funding to support and promote maternal, newborn, and child health and nutrition.

In partnership with the Maternal, Newborn, and Child Health Roundtable (MNCH RT), and representing the 1,000 Days Advocacy Working Group (AWG), 1,000 Days led and attended Hill meetings in both the House and Senate to advocate for funding increases for the Maternal and Child Health Account and the Nutrition account within the United States Agency for International Development (USAID). We conducted nearly 40 meetings and secured sign-ons to Dear Colleague letters from Democrats and Republicans in the House and Senate supporting these funding increases.

In FY23, the nutrition account was funded at $160 million, and the maternal and child health account (MCH) was funded at $910 million. To address the malnutrition crisis and to meet the moment of increased health and nutrition needs, our International Non-Governmental Organization (INGO) community is requesting $1.15 billion for the MCH account, which includes $340 million for Gavi, the Vaccine Alliance, and $300 million for the nutrition account within USAID. 

These additional investments can help close the food and nutrition insecurity gaps and pick up the pace on progress toward ending malnutrition which has slowed over the past 12 years. 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. 

The Nutrition account within USAID supports nutrition programs for women and children, focusing on the 1,000-day window, the time between pregnancy and a child’s second birthday. It is crucial to reach children and their caregivers early in life with interventions like breastfeeding support and vitamin A supplementation to prevent malnutrition. When children are malnourished, early detection and access to therapeutic foods can save lives. Severely malnourished children are much more likely to have weakened immune systems and are at risk of permanent physical and mental stunting, which prevents them from reaching their full educational, social, and earning potential. 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.

As Congress establishes budget levels for FY24, we urge them to include the increased funding levels for USAID and we will continue to advocate for these funding increases. If investments are not made in preventing and treating malnutrition and improving maternal and child health, we will continue to see backsliding of the progress made and lives lost. Now is the time to act to ensure mothers and children have the health and nutrition supports they need within the first 1,000 days and beyond.

 

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.

President’s FY2024 Budget Meets the Moment for U.S. Families, Misses the Mark for Foreign Investments in Nutrition

The Biden Administration’s FY 2024 budget proposal includes significant funding for several of 1,000 Days’ domestic key policy priorities. The proposal reflects priorities of the 2022 White House Conference on Hunger, Nutrition, and Health and opportunities identified in the American Journal of Public Health series 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. It includes:

  • $6.3 billion to fully fund the 6.5 million individuals expected to participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  • $325 million to establish a national, comprehensive paid family and medical leave program plus $10 million to help states expand access to paid leave benefits, including creation of a Technical Assistance Hub to share best practices among states.
  • $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to strengthen maternal health initiatives. Additionally, the budget requires all states to provide continuous Medicaid coverage for 12 months postpartum, eliminating gaps in health insurance at a critical time.
  • Increased funding for early care and education programs to increase childcare options for more than 16 million young children and lower costs so that parents can afford to send their children to high-quality child care.

While we celebrate increases across domestic nutrition programs, the proposals for global programs missed the mark. We welcome the topline increases for the State Department and USAID, but the Administration’s proposal to provide no increases to current investments in global nutrition and maternal & child health fall short in addressing growing the need. This past week, a report released from UNICEF shed light on how dire the malnutrition crisis is, particularly among adolescent girls and women. The number of pregnant and breastfeeding mothers suffering from acute malnutrition has soared from 5.5 million to 6.9 million – or 25 percent – since 2020 in 12 countries hardest hit by the global food and nutrition crisis. Ensuring children have access to good nutrition when it matters most is one of the most powerful and cost-effective ways to create brighter, healthier futures.

As rates of hunger and malnutrition continue to climb around the globe, it was disappointing to see that Global Health accounts within the United States Agency for International Development’s (USAID) budget for the Nutrition and Maternal & Child Health (MCH) did not receive funding increases in the President’s Fiscal Year 2024 budget. Within the proposal, the nutrition account is flat funded at $160 million and the MCH account is flat funded at $910 million. The NGO community has called for no less than $300 million for the nutrition account and $1.15 billion for the MCH account. The released budget is world’s apart from these needs-based community asks to address the ongoing health and nutrition crisis.

Ultimately, these funding levels will be decided by Congress and we urge Congress to fund State and Foreign Operations accounts at a level that meets the moment, including $300 million for the Global Health Nutrition account, $1.15 billion for the Maternal and Child Health account.

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!

New Research Highlights Critical Need for Strong Policies to Leverage the Value of Breastfeeding

February 9, 2023

Dear Members of the 118th Congress,

As leaders advocating for healthy families and children, 1,000 Days and the U.S. Breastfeeding Committee invite you to join us in creating a landscape of breastfeeding support across the United States.

Breast milk is recognized as the optimal food for babies and plays a critical role in their growth and development.[i] Numerous studies have shown that breastfeeding promotes healthy cognitive and social-emotional development.[ii] It also saves lives by helping to protect babies from infections and conditions such as sudden infant death syndrome (SIDS).[iii] Breastfeeding even lowers a child’s risk of obesity and type 2 diabetes later in life. In addition, women who breastfed reduce their risk of specific chronic diseases, including type 2 diabetes, cardiovascular disease, and breast and ovarian cancers.[iv]

Unfortunately, the U.S. has many barriers to establishing and maintaining breastfeeding. While four out of five babies born in the United States start out being breastfed, about half are still doing so at six months.[v] This is not due to capacity or wishes of the parent, but rather because environments in the U.S. do not support breastfeeding.

Our country’s policies, systems, and environments must be improved to make breastfeeding a realistic option for all families. New research released this week highlights the critical need for strong policies to fully leverage the value of breastfeeding.

  • Breastfeeding rates can be rapidly improved by scaling up known interventions, policies, and programs in the workplace and health system.
  • Infant formula companies utilize intrusive marketing strategies to families, health care providers, and policy makers to portray these products as solutions to common infant health issues in ways that systematically undermine breastfeeding and prey on parental concerns.
  • Policy changes are needed to address the power imbalances and political and economic structures that influence feeding practices and health outcomes.

As we approach the one-year anniversary of the infant formula crisis, it is critical that you and your colleagues in the House and Senate take action to address infant nutrition security, including through support for breastfeeding.

As you know, changing environments and systems requires everyone do their part – parents, policymakers, health facilities, communities, and employers. As a Member of Congress, you have an incredible opportunity to create the policy changes families need. Together, we can build on the momentum from recent advancements like the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act to build a robust infrastructure for infant nutrition security.

Breastfeeding has such a profound impact on population health outcomes that increasing breastfeeding rates and creating lactation-friendly environments have been identified as critical public health priorities in the U.S. as well as across the world. Breastfeeding is included in a variety of national initiatives, including the Dietary Guidelines for Americans, Healthy People 2030, The Surgeon General’s Call to Action to Support Breastfeeding, and more.

It is time to move from reports and vision statements, to taking action on the policy priorities that families deserve. We hope you will take the time to explore the new Lancet series on breastfeeding and join us as we work to build a country where infant nutrition security and breastfeeding is valued, protected, promoted, and supported.

Sincerely,

Amelia Psmythe Seger,
U.S. Breastfeeding Committee		 Blythe Thomas,
1,000 Days

 

About 1,000 Days

An Initiative of FHI Solutions, 1,000 Days is the leading non-profit organization working in the U.S. and around the world to ensure women and children have the healthiest first 1,000 days. Our mission is to make the well-being of women and children in the first 1,000 days a policy and funding priority. We are passionate about turning evidence into action and use our deep understanding of the science and the issues to help shape policies that improve the lives of moms and babies in the U.S. and throughout the world.

About the U.S. Breastfeeding Committee

The mission of the U.S. Breastfeeding Committee (USBC) is to drive collaborative efforts for policy and practices that create a landscape of breastfeeding support across the United States. USBC functions as a national coalition of 100+ organizational members representing nonprofits, breastfeeding coalitions, federal agencies, and businesses working at national, state/territorial, tribal, local, and community levels to protect, promote, and support human milk feeding. The USBC uses an equity-centered collective impact approach to facilitate multisectoral collaborations.

 

[i] Breastfeeding. World Health Organization. https://apps.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html.  Published Aug. 2018. Accessed February 6, 2023.

[ii] Nutrition in the First 1,000 Days: A Foundation for Brain Development and Learning, 1,000 Days and Think Babies. https://thousanddays.org/wp-content/uploads/1000Days-Nutrition_Brief_Brain-Think_Babies_FINAL.pdf. Accessed February 4, 2023.

[iii] Breastfeeding Benefits Both Baby and Mom. Centers for Disease Control and Prevention, https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html. Published July 27, 2021. Accessed February 6, 2023.

[iv] Making the decision to breastfeed | womenshealth.gov. womenshealth.gov. https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed/#1. Published 2020. Accessed December 20, 2022.

[v] Breastfeeding Report Card, United States 2022. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Published August 31, 2022. Accessed February 8, 2023.

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.

New Peer-Reviewed Series Reinforces Powerful 1,000-Day Window in U.S.

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.

Q&A with Dr. Kofi Essel: AJPH Special Series on Nutrition in the 1,000-Day Window

An interview with Dr. Kofi Essel, Community Pediatrician, Children’s National Hospital

What inspired you to become a pediatrician?

I always found the field of pediatrics to be a very fertile ground.  Families are interested in the wellbeing of their children, doing whatever it takes to improve the health of the next generation.  This made my clinical experiences very positively reinforcing as we engaged in effective, shared decision-making.  In addition, my mentors in my early training were all pediatricians and huge community advocates.  I knew I wanted my career to expand beyond the clinical examination room, and I found the opportunity to advocate for marginalized young children and families to be meaningful and necessary.

Your recently published a paper entitled, “The first 1,000 days: A Missed Opportunity for Pediatricians.” Why are the first 1,000 days important?

The first 1,000 days are a critical stage for young children.  Unfortunately, healthcare is often very reactionary and prioritizes management and treatment of disease.  However, the opportunity to engage young children and families in prevention and take advantage of these early years to optimize brain development and maturation, eating patterns, and healthy family relationships is critical.  We know that children are incredibly vulnerable during these first 1,000 days and small insults to their brain and environment can cause permanent challenges down the line.  Helping families and creating systems that protect and support the most vulnerable is essential for our nation.

Why is this a missed opportunity for pediatricians?

This article gave me a chance to highlight the gaps in nutrition education for future and practicing providers, but also magnify the importance of pediatricians like myself to take the mantle to support our young children and families.  Systemic change is crucial and necessary, but the need for strong counseling and advocacy is always going to be an important piece of the puzzle.  The gap in nutrition education is a disservice to our patients, so I call on our training programs to recognize the essential nature of equipping our current and future pediatricians with the knowledge, tools, and skill to work alongside our patients and through shared decision-making support their desire to optimize the health of their children.  We also must remember that the 21st century clinician must engage using modern tools of integration.  We must seamlessly integrate our clinical work with population health to provide more voices to advocate for the changes needed that our families share with us each and every day.

How does your awareness of nutrition in the 1,000-day window influence who you are as a pediatrician and what you prioritize?

I truly believe nutrition is a powerful tool that I use in my clinical arsenal, and it deserves more attention.  Food is medicine, and I use this medicine with confidence in the same way I have developed confidence in the tried-and-true inhalers, pills, and liquid solutions that my prescriptions help my families acquire.  Unfortunately, as a pediatrician I realize that the access to the medicine of food is often limited for many populations and this inequity leads to worsening disease with its origins beginning in the womb.  As a pediatrician with an awareness of the power of nutrition I am compelled to advocate for programs, tools, and interventions that support equitable access to nutritious foods so that all my families can have a chance from the start.

What needs to happen to support pediatricians with this opportunity?

In order to support pediatricians to use food and nutrition as medicine to impact the first 1,000 days of young children, it is important to keep a few things in mind: 

  1. Incorporate required, high-quality, substantial and practical nutrition education in medical schools and residency training, so that future providers become aware of its necessity.
  2. Ensure curricula that inform current and future providers engage with the tangible social needs that are ubiquitous throughout the country, such as food and nutrition security.  If not integrated into training, we set the stage for worsening inequities by only promoting a message that appears unreachable for many. 
  3. We often focus on the challenges within communities, but we need to recognize their strengths and assets. Pediatricians need support to screen families for food insecurity and must have in place strong, community, clinical-collaborative referral programs to seamlessly connect families from clinics and health systems to meaningful, nutrition-based, local and federal programs as needed and beneficial (i.e. food as medicine, local pantries, community cooking classes, WIC, SNAP, etc).
  4. Systems change requires systemic solutions.  To redirect the health system will require more than a few pediatric advocates on the ground, but rather larger licensing bodies and federal policy to turn the tide, such as the recent bipartisan resolution authored by Congressman McGovern & Burgess in May of 2022 calling for “substantial training in nutrition” for physicians.

Nutrition During the First 1,000 Days in the United States: Current Status and Recommendations for Improvement

Research question: What is the state of nutrition during the 1,000-day window for families in the United States, and what are the opportunities to strengthen federal research and surveillance, programs, and communication and dissemination efforts aimed at improving nutrition and influencing the health and well-being of pregnant people and children?

Why this research was needed: An analytical essay published in The American Journal of Public Health summarizes the current state of nutrition for families in the 1,000-day window in the United States. It further proposes a framework by which nutrition during this period can be improved. These recommendations could inform policymakers, public health and health care communities, and program leaders.

The 1,000-day window is the period between pregnancy and a child’s 2nd birthday and is a critical time in the development of a child. Good nutrition during the first 1,000 days can have a profound impact on the health and well-being of pregnant people and children.

How the research was conducted: The researchers carefully reviewed dietary intake compared with the US Department of Agriculture and US Department of Health and Human Services Dietary Guidelines for Americans 2020–2025, as well as the primary literature covering health, nutrition, and clinical outcomes for pregnant people and children during the 1,000-day window. They then created a high-level summary on the status of nutrition in the United States with focuses on dietary status, health, and outcomes of pregnant people, infants, and toddlers during the 1,000-day window. They also provided a framework for future improvements to research and public health surveillance, programmatic approaches, and communication and dissemination initiatives.

What the research found: The current state of nutrition during the 1,000-day window shows numerous gaps between dietary intake and recommendations, with race and ethnicity disparities across the spectrum. The average intake of total vegetables, fruits, and dairy are below federal recommendations during pregnancy and lactation. At the same time most pregnant and lactating people exceed the thresholds for sugars (70% and 51%), saturated fat (75% and 77%), and sodium (88% and 97%) respectively. In addition, nearly 50% of pregnant persons gain more than the recommended amount of weight during pregnancy and 20% gain less.

While it is recommended for infants to be exclusively fed human milk for the first 6 months, data from 2019 revealed that only 24.9% of infants exclusively received human milk through 6 months. Race- and ethnicity-based disparities in human milk feeding remain. Moreover, while it is recommended that complementary foods—those other than human milk or formula—should not be introduced before 4 months, this is the case with about 31.9% of infants.

Children between 12–23 months had total vegetable intake below recommendations while total intake of fruits, grains, and dairy were above recommendations. The average intake of added sugars and sodium were above recommendations.

What the research proposed: The proposed framework to improve nutrition encompassed three aspects—strengthening federal research and surveillance, optimizing programs, and improving communication and dissemination.

Historically, surveys have not included, or have had insufficient samples of pregnant and lactating women, infants and toddlers, and different racial and ethnic groups, leading to gaps in the data. Improving research and surveillance can start with modifying existing systems to improve coverage and data gathering for underrepresented subpopulations.

Programs can be optimized by reducing barriers to participation and reducing inequity among participants to alleviate disparity. Improving participation and engagement in these programs, as well as implementing standards, recommendations, and interventions that affect these programs could improve health and nutrition outcomes.

Scientific nutritional recommendations can be communicated through tailored and specific messages that target key audiences and are consistent with the Dietary Guidelines for Americans and supplemental recommendations. With the rapidly changing landscape of reaching audiences, implementing agencies and organizations need to collaborate effectively to provide tools and messaging that are culturally and linguistically relevant.

What this research means for key stakeholders: The framework proposed in this paper could inform key stakeholders in the following ways.

For policymakers: Data-gathering objectives to fill the current information gaps can be met by early care and education programs (ECE), clinics implementing the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and federally qualified health care centers that act as sentinel surveillance sites. Implementing standards that affect programs (e.g., licensing standards in ECEs) could improve health and nutrition outcomes. Updating clinical guidelines could also help improve how care is provided. Targeted, audience-specific messaging can help disseminate information to vulnerable groups.

For the public health and health care communities: The electronic health records of underrepresented populations can be used to bolster technological advances in supplementing existing data like feeding decisions, health outcomes, and biologic data. Clinical guidelines and recommendations for programs can be improved by healthcare delivery through tele-health visits, engaging health care support teams, and updating guidelines to improve how and when care is provided. Interventions should be prioritized that have significantly affected health outcomes, can be scaled, reach high-risk populations, reduce inequities, and complement existing federal or state programs. Linguistically and culturally sensitive communication could improve nutrition status in vulnerable populations.

For program leaders: Improving participation and engagement in programs such as WIC, the Child and Adult Care Food Program, and the Maternal, Infant, and Early Childhood Home Visiting Program could contribute to improving health and nutrition outcomes. The following interventions should be prioritized—those that have significantly affected health outcomes, can be scaled, reach high-risk populations, reduce inequities, and complement existing federal or state programs. Tailored, audience-specific messaging will help communicate and disseminate information on early childhood care and education more effectively.

Key takeaway: Optimal nutrition in the first 1,000 days can have lifelong effects on the health and well-being of pregnant people and children. Working collectively through a framework focused on advancing research and surveillance, programs, and communication and disseminationcould improve health equity, reduce maternal mortality and morbidity, and improve child health outcomes for current and future generations.

*DISCLAIMER: This write-up is derived from a published article and does not reflect the views of the author of the article, their affiliation, or the journal in which this content is published.

Authors/Reference/DOI: 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, PhD. Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective. American Journal of Public Health. doi: 10.2105/AJPH.2022.307028. 2022

Corresponding author contact information: To speak with the author, please contact CDC press office: (404) 639-3286 or media@cdc.gov. To speak with the media team at 1,000 Days, contact Blythe Thomas

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