Accelerating Progress to Meet 2030 Goals to Improve Child and Maternal Nutrition

 

The recently launched UNICEF-World Health Organization (WHO) 2017 Countdown to 2030 report shows mixed results for childhood health and nutrition. The 81 Countdown countries have made progress, but remain far from universal coverage for most essential interventions for reproductive, maternal, newborn, child health, and nutrition. The report presents detailed country and equity profiles on women’s, children’s and adolescents’ health for countries that together account for 95 percent of maternal deaths and 90 percent of deaths among children under five.

Countdown to 2030 Report/UNICEF

To galvanize attention and mobilize action around priorities in maternal and child nutrition, various global targets have been set, including the United Nations' 2030 Agenda for Sustainable Development and the WHO’s Every Woman Every Child Global Strategy for Women's, Children's and Adolescent's Health (2016–2030). The Countdown to 2030 report systematically tracks progress towards achieving these. IFPRI is a member of the Countdown to 2030 collaboration.

In the accompanying Countdown to 2030 paper published in The Lancet on tracking progress towards universal coverage for reproductive, maternal, newborn, and child health, Countdown collaborators have underscored the need to accelerate the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children under five, to achieve the Sustainable Development Goals by 2030. Such efforts will require a rapid scale-up of effective interventions to all population groups within affected countries, supported by improvements in underlying socioeconomic conditions, including women’s empowerment.

India is one of the priority Countdown countries, and as the findings of this report reflect, is still a long way from achieving universal coverage for most essential interventions in these key health and nutrition areas. The Countdown work has been an inspiration for POSHAN’s research and data visualization work on coverage of interventions across the continuum of care in Indian states. POSHAN’s state-level Policy Notes, based on updated coverage data now available in NFHS-4 (2016), reveal that the coverage of interventions for mothers and children in the first 1,000 days has improved substantially over time, but challenges remain. There are significant state-level variabilities in the coverage for some interventions. Coverage during pregnancy is generally high, up to 75 percent for some interventions, like pregnancy registration. However, coverage of nutrition interventions integrated into pregnancy care is low at less than 33 percent for women who consumed iron and folic acid supplements. During delivery, coverage is high: Nearly 80 percent for interventions pertaining to institutional delivery, skilled birth attendance, and birth registration. However, coverage of interventions for lactating women remains much lower than 50 percent.

An effective way to track a country’s progress towards any global goals is to apply them at the national level. In India, there is much optimism pegged on the recently launched National Nutrition Mission, which aims to reduce stunting, undernutrition, and low birth weight by 2 percent and anemia by 3 percent annually, covering states and districts in a phased manner over three years (2017-20), benefiting more than 100 million people. Meeting these goals will require that India deploy the interventions already in the policy framework at high coverage, reaching across states and districts. Analyzing coverage levels and trends is an important first step in prioritizing interventions where gaps are large and where efforts need to be scrutinized and accelerated.

As 2017 Countdown to 2030 report points out, to address the targets at the global and national levels, it is important to focus on the strengthening of vital statistics, understanding drivers of coverage change, and obtaining better data on early childhood development and adolescent health. In India, the government think tank NITI Aayog now has a Nutrition Dashboard that provides nutrition charts of India's states and districts and examines coverage of some (but not all) critical interventions. POSHAN’s district-level interactive maps and 640 District Nutrition Profiles also provide disaggregated data and detailed in-depth analyses.

In addition to outcomes and coverage, it is also important to focus on the indirect and underlying determinants, like sanitation and hygiene, access to drinking water, women’s literacy, girls’ age at marriage, etc. Countdown’s national profiles and POSHAN’s state and district profiles provide ready reckoners for an assessment of these underlying drivers and help to identify the gaps that need to be closed to accelerate change in health and nutrition outcomes.

Changes in health outcomes will only become a reality with changes in coverage of interventions and in the drivers of these outcomes. Promising beginnings have been made on the nutrition and health landscape and there is much anticipation on the horizon. However, efforts to address coverage and drivers now need to be strategically navigated to catalyse progress towards 2030, both globally and in India.

Purnima Menon and Stuart Gillespie are Senior Research Fellows with IFPRI's Poverty, Health and Nutrition Division and members of the Countdown to 2030 Collaboration: Menon participated in the Coverage Technical Working Group; Gillespie in the overall Technical Review Group. Pratima Mathews is an IFPRI Communications Specialist. This post originally appeared on the POSHAN blog.

New Abstract Digest on Maternal and Child Nutrition Research – Issue 7

We are pleased to release Issue 7 of our bi-monthly Abstract Digest on maternal and child nutrition. This issue features interesting publications examining nutrition from both a biological and political lens, in India and beyond. Highlights include:

Abstract Digest-Issue 07
Abstract Digest-Issue 07
Click to download PDF (708 Kb)

Abstract Digest-Issue 07

  • A special open-access issue of Annals of the New York Academy of Sciences on integrating nutrition and early childhood development interventions
  • Two articles from Advances in Nutrition discussing 1) how nutrition research can become more useful in informing global nutrition guidelines (Stoltzfus 2014), and 2) arguing for the need to develop implementation science to enable stronger delivery of adequate nutrition to those in need (Habicht and Pelto 2014).
  • One study in Bio Medical Education identifying gaps in South Asian postgraduate nutrition programs to build capacity to address the current public health nutrition challenges (Khandelwal et al. 2014).
  • Two reviews, one providing an overview of the evidence-base for nutritional deficits in early life and greater risk for non-communicable diseases in later life (Langley-Evans 2014) and the other recommending investments in improving maternal autonomy to improve child nutritional status (Carlson et al. 2014).
  • Several articles focusing specifically on malnutrition in India, including on determinants of anemia (Anand 2013), vitamin A programming in India and its reach (Aguayo 2014), and management of severe acute malnutrition (Singh et al. 2014; Kumar et al. 2013).

 

IFPRI Hosts Policy Seminar on “Social Protection, Food Security and Nutrition” in New Delhi

Written by Suman Chakrabarti, Poverty, Health and Nutrition Division, International Food Policy Research Institute, New Delhi

The International Food Policy Research Institute (IFPRI), organized a policy seminar on “Social Protection & Safety Net

Source: Pallavi Rajkhowa/IFPRI
Source: Pallavi Rajkhowa/IFPRI

Interventions” in the month of February in New Delhi. The seminar touched on the role of food and cash transfers in improving poverty, food security and nutrition, in global and regional contexts. All speakers were well received by the audience and the seminar was lively with an array of wide ranging questions and discussions.

The first speaker, John Hoddinott, Deputy Director at the Poverty, Health and Nutrition Division – IFPRI , Washington,  DC, pooled insights from recent studies in Ecuador, Niger, Uganda and Yemen, on social protection programs and their nutrition outcomes. He highlighted the relative advantages and drawbacks of cash, voucher and food transfers in terms of cost effectiveness, achievement of caloric intake increase and impact sufficiency to reduce chronic under-nutrition in young children. In addition, he shared very recent findings on the impact of combining behavioural change interventions with cash transfers in Bangladesh.

The second speaker, Avinash Kishore, Associate Research Fellow, IFPRI, New Delhi, shared insights from a working paper that investigates the impact of reforms in the Public Distribution System (PDS) of Tamil Nadu, Andhra Pradesh, Odisha and Chhattisgarh, on the offtake of rice from fair price shops as well as on the reallocation of savings towards other food groups.  These findings are central in the context of India’s National Food Security Act (NFSA) which was enacted in 2013.  The NFSA lays out very similar PDS reforms in terms of price reductions for key cereals and increase in the population covered, accompanied with supply side corrections, as were enforced in the aforementioned states.

The third and final speaker, Reetika Khera, Assistant Professor, Economics, Indian Institute of Technology, New Delhi, discussed her research on shifts in India’s PDS. She discussed various facets of interest within the PDS including coverage, leakage, implicit subsidies, exclusion errors, and nutritional impacts, among others.  The findings indicate an overall revival of the PDS in India albeit with high interstate variations. She concluded that there was a long way to go for improvements in the PDS, and emphasized that key reforms should focus on an expansion in the implicit subsidy given to households, incentives, computerization, and decentralization.

Issues and questions raised in the discussion period included:
- What is better in India’s context, cash or food? A balanced approach would be a contextualized response, where cash could be better for some regions and food for others.
- What might be the possible measures to control leakages in the PDS? Mechanisms to check leakages might be easier to enforce under a cash transfer paradigm with the use of IT.
-Targeting versus universalization of the PDS: Given the large targeting errors for AAYs, BPLs, and APLs, would a universalized PDS prove to be more effective?
- What is the role of the private sector in grain management? Can the private sector distribute grains more efficiently and cost effectively?
- What are the effects of transfers on households? How do they re-allocate savings from subsidies? What are the effects on women’s empowerment?

Presentation 1-Social safety nets, food security and nutrition

Presenation 2-Revival of the PDS Evidence and Explanations

POSHAN New Policy Note Explores Lessons Learned in Working Multisectorally to Improve Nutrition Globally and India

Photo Credit Aishwarya Pillai
Photo Credit Aishwarya Pillai

It is recognized that eliminating undernutrition requires actions across multiple sectors.  A child must receive food with adequate energy, protein, and micronutrients while at the same time having access to safe water, good sanitation, and quality health care.  However, services that need to be delivered are typically not led by the same sector, agency, or actor.  The agricultural sector, for example, focuses mostly on food production. The health sector usually focuses on clinical care, rather than on care and feeding in the home.

Though it is recognized that working multisectorally is critical to ensuring that adequate food, health, and care reach children, it isn’t always clear how to do so and it is rarely easy. With an aim of garnering lessons learned that could inform India’s policymakers and program implementers, POSHAN commissioned a review of global and Indian experience in improving nutrition through multiple sectors. The new Policy Note Working Multisectorally to Improve Nutrition: Global Lessons and Current Status (Please see below the paper)  in India examines best practices from other countries, including Bolivia, Colombia, Peru, Senegal, and Thailand, as well as the status of current multisectoral initiatives in India in nutrition, which include the Multisectoral Nutrition Programme to Address Maternal and Child Undernutrition, which was conceived in 2008 by the Prime Minister’s National Council on India’s Nutrition Challenges and launched in 2014. The paper features recommendations to ensure better implementation and sustainability of multisectoral approaches in India.

Last year in May 2013, POSHAN had organized a consultation on multisectoral approaches to improve maternal and child nutrition in India and had brought together key policymakers and policy advisers from a variety of ministries at the national level and from the Indian states of Odisha, Andhra Pradesh, Karnataka and Madhya Pradesh. This event highlighted lessons and experiences from other countries and from India.

Download the POSHAN Policy Note Working Multisectorally to Improve Nutrition Globally and India.pdf (661 Kb)

POSHAN’s Abstract Digest on Maternal and Child Nutrition Research – Issue 6

Aaganwadi centre (Photographer Aishwarya Pillai)
Aaganwadi centre (Photographer Aishwarya Pillai)

As we wrap up 2013, we are pleased to release the sixth issue of our bi-monthly Abstract Digest on maternal and child nutrition, the last issue for this year. This issue features interesting publications examining nutrition from both a biological and political lens, in India and beyond.

An India-based study in The Lancet highlights regional differences in neonatal and under-five mortality; the study highlights how several districts are on track to achieve Millennium Development Goal 4 as early as 2015, while several others may not achieve it until 2023.

A BioMed Central Public Health study examines whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. The study identifies a significant relationship between coverage of maternal and child health services and birth order, offering a potential explanation for the association between higher parity and child mortality.

Using birth cohorts from 5 countries, a study from the Journal of Pediatrics examines the relationship between maternal height and child growth, concluding the strongest associations with conditional heights for adulthood and 2 years of age. The study confirms that maternal height influences linear growth of children over the growing period.

Of two studies focusing on the political context of maternal health in India, one, featured in Science Direct, uses evidence from two South Indian states to identify three key factors that shape health policy and its implementation: consistent political priorities, policy entrepreneurship, and strong public health system administration.

Thank you for your interest in the POSHAN Abstract Digest. Please feel free to share this digest with others, and engage in discussions with us on our Facebook page! We wish you and your families a very happy new year and we look forward to sharing highlights of maternal and child nutrition publications in 2014.

Click here to download the latest issue:

POSHAN Abstract Digest Issue#6DEC2013

For earlier issues, please visit our blog.

 

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