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.

Trends in Nutrition Outcomes and Determinants in India

Source: Rasmi Avula/IFPRI

Cross-posted from India Food Security Portal 

While India has made significant progress in nutrition incomes for women and children over the past ten years, this progress has not been uniform across states, and several regions still lag behind national nutrition and health trends and program implementation.

This is according to the latest research from POSHAN, published in a recent paper covering nutrition trends and determinants in the country from 2006-2016. The report utilizes data from India’s National Family Health Surveys for 2005-2006 and 2015-2016 and the2013-2015 Rapid Survey on Children, as well as a comprehensive review of India’s policies and programs aimed at improving women’s and children’s nutrition outcomes. The paper also examined levels and changes in immediate, underlying, and basic determinants of nutrition and health, based on indicators and formulas taken from UNICEF.

According to the report’s findings, India as a whole has seen substantial progress on a number of nutrition and health incomes over the past decade. Child stunting fell from 48 percent to 38.4 percent, and child underweight rates also declined from 42.5 percent to 37.5 percent. The use of exclusive breastfeeding increased by almost 9 percentage points, and low birthweights in children fell from 21.5 percent to 18.6 percent.

However, national levels of wasting in children increased during the study period, from 19.8 percent to 21 percent. The rates of anemia in women, a major health challenge in India, remained fairly stagnant during the study period; anemia continues to impact almost half of Indian women of reproductive age.

Nationally, the underlying determinants of nutrition improved during the study period. The report finds improvements in women’s education levels and marriage age, both of which impact women’s overall well-being. The number of women with 10 or more years of education grew by 10 –percentage points, while the number of girls getting married before the age of 18 fell by 20 percentage points. The study also reports an increase in access to electricity, safe drinking water, and improved sanitation facilities. However, the authors also emphasize that further efforts and investments are needed in these areas, particularly education and sanitation, in order to ensure continued inclusive improvements in health and nutrition outcomes.

The immediate determinants of nutrition – such as early use of breastfeeding, timely introduction of complementary foods for children, and children’s disease burden – saw mixed results during the study period. Women with low BMI declined from 35.5 percent to 22.9 percent, nationally. The number of women breastfeeding their infants doubled from 23.4 percent to 41.6 percent, but the introduction of appropriate complementary foods for older children declined from 52.6 percent to 42.7 percent. The disease burden for children (including diarrhea and acute respiratory infections) remains low, but did not change much over the study period; thus, further efforts to prevent childhood illnesses are needed to “move the dial” on that indicator.

National coverage of nutrition-specific interventions, such as programs to provide iron-folic acid supplements to pregnant women and immunizations and vitamin A supplements to infants and children, improved throughout the period. However, overall coverage of food supplementation programs (during pregnancy, lactation, and early childhood) remains at only 40-50 percent. In fact, of the 12 nutrition-specific interventions reviewed by the report, only three (institutional delivery, skilled birth attendance, and birth registration) reached 75 percent. Thus, while India’s two national women and child health programs - the National Health Mission (NHM) and the Integrated Child Development Services (ICDS) – attempted to expand coverage from 2006-2016, challenges clearly remain.  The authors identify these challenges as poor policy guidance, lack of financing, poor state-level implementation, and lack of education or positive perceptions that may impact people’s choices to participate in these interventions.

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