Undernutrition: An unfinished agenda

“Nutrition is crucial to both individual and national development. The evidence in the Lancet Series on Maternal and Child Nutrition furthers the evidence base that good nutrition is a fundamental driver of a wide range of developmental goals. “The post 2015 sustainable development agenda must put addressing all forms of malnutrition at the top of its goal” was a unanimous agreement at the launch of the Lancet Series in Pakistan. Lancet is a pioneer medical research journal which focuses on health issues. The launch ceremony was well attended by representatives of the federal and provincial governments, UN agencies, donors, academia, media and civil society.

While there has been a tremendous increase in a global political commitment to improve nutrition; yet this has translated into a modest impact. This presents a substantial unfinished agenda i.e. to address the cause of 45% (3.1 million) of all under 5 child deaths due to malnutrition said the President and CEO of Save the Children US, Carolyn S. Miles observed in her opening remarks at the launching ceremony in Islamabad. In Pakistan alone, 35% of all under five deaths can be attributed to the menace of malnutrition observed Ms. Miles. 

She further noted that the national and international momentum to address human nutrition and related food security and health needs has never been higher but we have to seize this opportunity and take concrete actions. Carolyn Miles reaffirmed Save the Children’s commitment to the cause of addressing malnutrition and assured that Save the Children will remain a frontline ally for responding to nutrition issues in Pakistan.

One of the leading global experts on nutrition and a lead author of the Lancet Series Dr. Zulfiqar A.  Bhutta from the Agha Khan University presented the key finding of the four papers. Breastfeeding practices are far from optimum, despite improvements in some countries said Dr. Bhutta. Sub optimum breastfeeding results in an increased risk for mortality in the first 2 years of life and results in 800,000 deaths annually. Furthermore, nearly 15% of deaths of children younger than 5 years can be reduced (i.e. 1 million lives saved), if the ten core nutrition interventions identified in the Lancet Series are scaled up.

“If we want to address issues of malnutrition we would need long term sustained initiatives. This includes food security, child protection, gender dynamics which calls for nutrition sensitive interventions such as programs aimed at poverty alleviation, empowering women, targeted agriculture safety nets and early childhood development programs” recommended Dr. Bhutta.

“Pakistan has made insufficient investments in nutrition sensitive interventions that are critical to produce policy change and impact” lamented Dr. Bhutta and called for a collective societal approach, whereby all segments of society such as media, government, civil society and public work in collaboration to provide an enabling environment which puts the issue of malnutrition at the center stage.

“The Lancet Series in 2008 identified the need to focus on the crucial period from conception to a child’s second birthday-the 1000 days in which good nutrition has lasting benefits throughout life”.

“In Pakistan, about one quarter of the new borns are born at a low birth weight. Whereas, one half of the children suffer from chronic malnutrition. This seriously undermines the prosperous development of Pakistan as consequences of malnutrition cut the nations GDP by up to 4%” said Mr. Dan Rohrmann, Country Representative UNICEF Pakistan. “Despite the economic development of the nation, we are facing a silent crisis of malnutrition with indicators amongst the worst in the world and no improvements in recent four decades regretted Mr. Rohrmann and emphasized that if this issue is prioritized, malnutrition can be ended in a life time of a generation.

The Development Partners for Nutrition (DPN) group is involved in advocacy for considering nutrition as a priority at the national development agenda, policy and strategy support and strengthen nutrition in implementation shared Ms. Silvia Kaufmann, Chief Nutrition, UNICEF Pakistan. The DPN is supporting the development of provincial nutrition guidance notes and provincial inter-sectoral nutrition strategies she informed.

Mr. Aslam Shaheen, Chief Nutrition, Planning Commission of Pakistan lauded the efforts of Save the Children in launching the Lancet Series in Pakistan and observed that recommendations highlighted in the lancet paper will build into the Vision 2025 and government’s 5 year development plan. He also informed the participants that the Government of Pakistan will formally launch the National Nutrition Survey 2011 in the coming few weeks.

The launch of the Lancet Series on Nutrition  is timely and relevant for Pakistan as recommendations could be used in the Integrated Provincial Nutrition Strategies being prepared in all the four provinces through a consultative process. Save the Children together with the DPN is committed to providing support to the federal and provincial governments to have the strategies in place and implemented. There is also a commitment for full support and cooperation to the government for implementing the Scaling up Nutrition (SUN) initiatives commitments in Pakistan. Together with the Development Partners for Nutrition and the civil society of Pakistan we are committed to work for improving the nutrition situation in Pakistan. However, for these initiatives to materialize political will and leadership is needed by the government both at the federal and provincial level.

The launch got excellent coverage from Pakistan’s leading newspapers and on social media including facebook and twitter. There was great resolve and commitment among the stakeholders to use the findings of the series in the ongoing efforts to improve the nutrition situation in the country and put nutrition on the agenda of decision makers, civil society and media and the national and provincial levels.

 

The was blog also published at:

http://www.healthynewbornnetwork.org/blog/undernutrition-unfinished-agenda

http://www.trust.org/item/20130827063530-lq9ek/

http://everyone.savethechildren.net/articles/undernutrition-pakistan-unfinished-agenda

 

 

 

 

The superfood with the potential to save hundreds and thousands of children’s lives

Imagine a food that is free, nutritious and has the potential to save thousands of children’s lives. Well there’s no need to imagine it, it already exists- a mother’s milk; breastfeeding is one of the most powerful weapons we have to fight child mortality. The teachings of Islam also strongly endorse that mothers should breastfeed their children for two years.

The Global Breastfeeding Week concluded with a number of advocacy and awareness raising events across the country and globally. The World Breastfeeding Week which, each year, presents an important opportunity to put the spotlight on the importance of breastfeeding for saving children’s lives. But this can’t just be a one week effort; we need strong leadership and political action all year round to promote it.

According to the medical journal, the Lancet, suboptimum breastfeeding results in more than 800,000 child deaths annually. If we can ensure that every newborn is given breast milk immediately after birth and is fed only breast milk for the first six months, we can greatly increase the chance that they will survive and go on to fulfil their potential. Around one in eight of the young lives lost each year could be prevented through breastfeeding, making it one of the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths.

It is estimated that 3.1 million children die from malnutrition each year. Breastfeeding is not only crucial for tackling malnutrition and saving children’s lives, it also has the potential to have tangible impacts on the economic and social development of countries likes Pakistan. Malnutrition can undermine future earning potential by as much as 20% and can inhibit growth of GDP by as much as 2-3%.  Today’s malnutrition will knock $125bn off the global economy by 2030, when these children reach working age. 

But breastfeeding is undervalued. Global rates of breastfeeding have remained below 40% for the past 20 years as breastfeeding has slipped down the list of political priorities. In some countries, particularly in East Asia and the Pacific, the number of breastfed children is starting to fall.

In Pakistan only 37 per cent of children are exclusively breastfed for the first six months meaning that too many children are missing out on the vital nutrients they need in the first months of life. Similarly, the early initiation of breastfeeding is only 29 per cent in the country. That needs to change.

If babies receive colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhoea.

So what needs to happen? We need to ensure that women have the support they need to breastfeed and overcome the main barriers preventing them from doing so. Those barriers include community and cultural practices which discourage women from breastfeeding, severe shortages of midwives and health workers meaning that too often the opportunity for new mothers to be supported to breastfeed in the first few hours is lost, lack of adequate maternity legislation and marketing practices by some breast milk substitute companies leading to infant formula being used unnecessarily and improperly, ultimately putting children at risk.

Tackling these barriers demands a new and concerted effort from many different groups of people; governments, local communities and business. For example, governments and local communities need to take action to empower women to make their own decisions about breastfeeding, governments need to invest in strengthening health systems to protect, promote and support breastfeeding and introduce nationwide breastfeeding-friendly policies and legislation. Finally, businesses need to act responsibly in their marketing on Breast Milk Substitutes and governments need to ensure that national regulation of Breast Milk Substitutes is strengthened and enforced. This issue is increasingly important in emerging economies, where some companies are aggressively marketing their products, despite the threat that this undermines support for breastfeeding.

In the last two decades there has been huge global progress in reducing child mortality with five million fewer children dying in 2011 than in 1990. The world is nearing a tipping point, the time at which the eradication of preventable child deaths becomes a real possibility.  But there is still a lot to do to reach that point - breastfeeding is key to unlocking further progress and saving hundreds and thousands of children’s lives.

Pakistan, voted in favour of adopting the International Code of Marketing of Breast-milk Substitutes during the World Health Assembly in May 1981, and promulgated “The Protection of Breastfeeding and Young Child Nutrition Ordinance 2002” to enforce the code. The ordinance prohibits the promotion of any milk produced as partial or total replacement for mother’s milk or represented as a complement to mother’s milk to meet the growing nutritional needs of an infant. The ordinance requires from health workers to encourage, support and protect breastfeeding. Following the devolution, earlier this year, the Sindh Assembly enacted the local legislation by Sindh “The Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013”. Similarly, last year the Punjab Assembly also adopted the law as the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment) Act 2012.

“It’s heartening to know that Sindh and Punjab have enacted laws for the Protection and Promotion of Breastfeeding. However, the real test is its implementation in letter and spirit”. “Despite the Protection of Breastfeeding and Child Nutrition Ordinance on statute books since 2002, its implementation has always remained a distant desire.” Similarly, Punjab and Sindh have not been able to notify the rules and Infant Feeding Boards to monitor implementation of the law.

Keeping in view, the importance of breastfeeding in preventing fatal childhood diseases and neonatal mortality it is important that Balochistan and Khyber Pakhtunkhwa also enact laws on the pattern of Sindh and steps are taken for the effective implementation of these laws in all provinces. This will ensure safe nutrition for infants by promoting and protecting breastfeeding.

Similarly, the federal government should also take practical steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 for the Islamabad Capital Territory and Federally Administered Areas. Infant Feeding Boards require to be notified immediately in Islamabad, Sindh and Punjab to monitor the implementation of the respective laws.

There is also a need to put promotion of breastfeeding on the agenda of civil society including NGOs, print and electronic media and academia to play their role in its promotion at all levels and create widespread awareness in the society which will ultimately lead to reduction in preventable infant and under 5 mortality in Pakistan.

The writer is a child rights activist and tweets at @amahmood72