A Global Village
Issue 3 » Global Health & Development

Tackling Malnutrition: The First 1000 Days

A Critical Window of Opportunity for Action

Tanya Green, UK Department for International Development (DFID)

The first of the UN Millennium Development Goals is to eradicate extreme hunger and poverty. A third of all children under the age of 5 worldwide (195 million) are chronically malnourished and 80% of these children live in just 24 countries, mostly in South Asia and sub-Saharan Africa.

The effect of chronic malnutrition is stunted growth. The immediate causes of malnutrition are inadequate diet and disease, but the underlying long-term causes are complex and multifaceted: relating to poverty, inequality, health and sanitation, socio-cultural, political and economic factors.

Malnutrition damages cognitive and physical development and weakens the immune system, leading to greater susceptibility to disease. In a series on nutrition, the Lancet undertook a review of the evidence of the impact of malnutrition and found that if not tackled within the first 24 months of a child’s life, the condition leads to irreversible damage – affecting educational achievements, future earnings and overall life chances. Therefore, the time from conception to a child’s second birthday provides a critical window of opportunity to improve the nutritional status of children.

The UK Government focuses on tackling malnutrition in children and pregnant women from conception to a child’s second birthday. Firstly, we recognise the need to tackle the immediate causes of poor diet and disease via direct nutrition interventions; for example vitamin A and mineral supplementation, which, if scaled up, could reduce chronic malnutrition by one-third. Secondly, we also need to tackle the other two-thirds of the problem by programmes in agriculture, social protection (e.g. cash transfers), water, and sanitation to deliver greater nutritional impacts.

We also want to mobilise the international community to work together more effectively to tackle malnutrition. We are currently reviewing all of our aid programmes, and the scale of our plans on nutrition will be announced next year. Crucially, we are also investing in research so that we will have a better understanding about what measures work; particularly about how indirect nutrition interventions work.

Growing International Momentum:
Was 2010 the Tipping Point?
Over the last two years, after the Lancet series and the 2007-2008 food-price crisis, there has been growing momentum for co-ordinated international action. There is now broad international consensus about what needs to be done to accelerate the scaling up of nutrition programmes in countries with high levels of malnutrition. 2010 has seen the launch of a global initiative: Scaling Up Nutrition (SUN) to expand programmes in countries in a coordinated way. A SUN “Framework for Action and Roadmap” was developed by a collection of agencies led by the UN Special Representative on Food Security and Nutrition, and endorsed by more than 100 organisations and institutions from governments, UN agencies, academia, private sector, NGOs and civil society groups.

At the UN Millennium Development Goal Summit in September, major international figures such as Hillary Clinton, the US Secretary of State, Micheál Martin, the Minister for Foreign Affairs of Ireland and Andrew Mitchell, the UK Secretary of State for International Development, along with others gave the issue of nutrition more prominence than it has been given before; all supported the SUN Roadmap launched by the UN Secretary-General Ban Ki-moon. Hillary Clinton launched a campaign called a “1000 days” to focus international attention on this critical window of opportunity in which to have an impact on children’s nutritional health. Seven international donors: Canada, France, Ireland, the Bill and Melinda Gates Foundation, UK, US and the World Bank, committed to work together effectively and to support countries to scale up nutrition. So far Bangladesh, Nepal, Ghana, Malawi and Uganda have come forward to scale up and we hope more countries will follow soon.

The Year Ahead
The next nine months will be crucial to continue to build on the momentum and to start delivering results. What is clear is that tackling malnutrition in the first 1000 days from conception to a child’s second birthday is central to the UK’s approach, and it is shared by a coalition of other organisations working towards achieving the first Millennium Development Goal.

Tanya Green works for the Human Development Department, UK Department for International Development (DFID). 

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