Category: Infant Health

1,000 Days Statement on Increased U.S. Infant Mortality Rates

At 1,000 Days, we are deeply concerned by the recent CDC data revealing an increase in infant mortality in the United States for the first time in two decades. Our nation has one of the highest infant and maternal mortality rates of any wealthy country. This disheartening increase is a stark reminder of the urgent need for collective action to address the critical challenges facing maternal and child health in the United States.

The CDC found that the overall infant mortality rate increased by 3% with significant increases for mothers aged 25-29. Mortality rates also climbed for preterm babies, male infants, and for infants born in Georgia, Iowa, Missouri and Texas. The data also shows a deepening divide along racial and ethnic lines with infant mortality rates for American Indian or Alaska Native women increasing by over 20%, from 7.4 deaths to over 9 deaths per 1,000 births, while rates for White women increased by about 3% from 4.36 deaths to 4.52 deaths per 1,000 births. Infant mortality rates for infants of Black women did not drastically increase but they continue to experience the highest overall rates of mortality with nearly 11 deaths per 1,000 births, or over double the mortality rate of White infants. The significant disparities in infant mortality rates among different racial groups highlight the pervasive impact of systemic inequities on health outcomes.

1,000 Days remains dedicated to our mission of making the health and well-being of women and children in the first 1,000 days, from pregnancy to two years of age, a policy and funding priority. We call on Congress to continue investing in maternal and child health and services, recognizing that it is critical during the 1,000-day window to deliver nutrition and support for women and infants. Access to proper nutrition and comprehensive maternal health services is a right for all women and families, and it is imperative to ensure that no one is left behind. Strong policies and investments in this critical window are not only about saving lives today but also about nurturing healthier generations.

A strong start in life is every child’s right, and we are committed to working alongside partners, communities, and policymakers to create a world where all children can thrive. The CDC’s findings reinforce the urgency of our mission, and we stand ready to collaborate and advocate for the changes needed to ensure better outcomes for everyone.

Together, we can strive for a future where infant mortality is a rare and unacceptable tragedy. Join us in making a difference and securing a brighter future for the next generation.

For more insights and information, please visit the CDC report here.

Bills We are Watching this Children’s Week

As we kick off the 2023 Children’s Week, we feel a mixture of excitement for the opportunities to improve children’s nutrition and concern about policy and funding proposals that undo progress to protect the health and wellbeing of children and their families in their 1,000-day window.

The nutrition that people receive leading up to and throughout their pregnancy, as well as the nutrition their babies receive in the earliest years of life, has a profound impact on a child’s ability to grow, learn, and thrive. In honor of Children’s Week, 1,000 Days is highlighting some legislation that we support focused on children, mothers, and birthing people. It is our hope that with these bills enacted, moms, babies, and their families will receive the support and resources they need to begin to build a healthier future.

The Wise Investment in Children Act of 2023 (WIC Act of 2023) (H.R.3364/S.1604) expands eligibility to receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This would extend the certification period for infants to up to two years and increases the certification time under the program for postpartum women to a period of up to two years.

Modern WIC Act of 2023 (H.R.2424/S.984) would build on lessons learned during the pandemic and modernize WIC to allow remote access. The remote flexibility implemented during the public emergency contributed to a 12% increase in child participation since 2020.

WIC Healthy Beginnings Act (H.R.3151/S.974) requires USDA to make information on infant formula procurement under WIC publicly available. This increases transparency and promotes competition within the sole-supplier model.

Black Maternal Health Momnibus Act (H.R.3305/S.1606) will address the maternal mortality crisis in the U.S. through historic investments that comprehensively address every driver of maternal mortality, morbidity, and disparities in the United States. The Momnibus Act includes twelve individual bills that among other actions will make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition and extend WIC eligibility in the postpartum and breastfeeding periods.

The Family Act (H.R.3481) would provide employees a family and medical leave insurance monthly benefit payment of two-thirds of the employee’s regular pay, limited to a maximum of $4,000, for no more than 60 days of qualified caregiving. The bill also established the Office of Paid Family and Medical Leave within the Social Security Administration.

No Surprise Bills for New Moms Act (H.R.3387) would automatically cover newborns with health insurance for the first 30 days and create a standard for enrollment after that period. It eliminates confusion for new parents by establishing a uniform 60-day enrollment period after that first month. The bill would also have all health plans and insurers notify parents if they receive a bill for an uncovered newborn.

We also continue to remain focused and engaged in the appropriations process for FY2024. Non-defense discretionary programs, which disproportionately serve young children, families, and those most in need across the country, will face the brunt of spending caps and cuts. We must protect programs that support children and families and build off the recent successful increased investments in the first 1,000 days. In doing so, we are letting our children and our nation’s future the opportunity to thrive. How well or how poorly mothers and children are nourished and cared for during the 1,000-day window has a profound impact on a child’s ability to grow, learn and thrive.

Building Momentum for Nutrition

Nutrition affects every aspect of human development: from children’s performance in school, to our ability to fight off diseases, to a nation’s health, and economic advancement.

The 2021 Lancet Series on Maternal and Child Undernutrition Progress builds on previous research and provides an evidence-based agenda for how the global health and development community can improve the health and nutrition of today’s generation and all the generations ahead. The 2021 Lancet Series on nutrition presents updated information and builds on the 2008 and 2013 Lancet Series to set forth an evidence-based, global agenda for tackling undernutrition.

These critical 1,000 days lay the foundation for all the days that follow. How mothers and children are nourished and cared for during this time profoundly impacts a child’s physical growth, cognitive development, and lifelong health. Improving women’s and girls’ diets, access to nutrition services, and nutrition counseling – before and during pregnancy and while breastfeeding – are critical to preventing malnutrition among families and communities everywhere.

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 FacebookInstagram, 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!

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