Background
The World Health Organization (WHO) has long advocated for and worked toward substantial and sustained improvements in maternal, infant, and child nutrition around the globe. This is in large part because of the many acute and long-lasting negative impacts that poor maternal/infant nutrition has on not only individuals but entire communities and nations. Together, maternal and child undernutrition are estimated to account for 11% of the global burden of disease, and childhood malnutrition is considered the root cause of mortality in ∼35% of all deaths among children younger than the age of 5 y. Malnutrition can also lead to lifelong deficits in cognitive abilities, academic achievement, and work productivity. As such, improving nutrition in early life and during a woman’s reproductive years has far-reaching implications on many levels both directly and indirectly related to basic health outcomes.
Overarching Goals
From results of a previously conducted review and policy analysis of its member states, the WHO concluded that, although effective nutrition actions exist worldwide, they are often not implemented on a sufficiently large scale to be effective. In addition, policies and actions are often inadequate, given the complexity and challenges at hand. In response, the WHO recently issued a guide for action in this regard.
This 2014 publication, summarized here and titled “Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition,” was endorsed by the WHO’s 65th World Health Assembly that convened in Geneva, Switzerland, in 2012. The objective of this plan was to provide detailed and dove-tailed implementation strategies to address key global targets for reducing maternal, infant, and young child malnutrition. These goals are to be attained by 2025 and are listed here.
40% reduction in children younger than 5 y who are stunted
50% reduction in prevalence of anemia in reproductive-age women
30% reduction in annual incidence of low-birth weight
No increase in childhood overweight
Increase rate of exclusive breastfeeding until 6 mo postpartum to at least 50%
Reduce and maintain childhood wasting to <5%
Action Plan and Proposed Activities
To help communities and nations meet these goals, the WHO put forth 5 priority actions and concomitant proposed activities that they propose be jointly implemented by the WHO, its member states, and international partners. These actions are briefly described here.
Action 1: Create a supportive environment for the implementation of comprehensive food and nutrition policies
Included in this action item are revision of nutrition policies to comprehensively address the double burden of undernutrition and overweight with a human right-based approach, inclusion of nutrition in each country’s overall development policy, and establishing effective intersectoral governance mechanisms for implementation of nutrition policies at both national and local levels. The WHO plans to support these efforts by improving access to normative and policy guidelines, knowledge products, tools, and expert networks. The WHO also urges international partners to engage in international coordination of mechanisms or partnership, strengthen international cooperation to harmonize standards and policies, and implement global advocacy initiatives that increase public awareness of the need to expand nutrition-related programs.
Action 2: Include all required effective health interventions with an impact on nutrition in national nutrition plans
On the basis of the notion that there are myriad, proven interventions that can improve maternal, infant, and young child nutrition (see link below), these types of intervention approaches should be considered for implementation when feasible. Development or strengthening of legislative, regulatory, and/or other measures to control the marketing of human milk substitutes to ensure implementation for the International Code of Marketing of Breast-Milk Substitutes is specifically recommended within this action item. Other proposed activities include strengthening health systems, promoting universal coverage and principles of primary health care, and engaging in vigorous campaigns to promote breastfeeding at the local level.
Action 3: Stimulate development policies and programs outside the health sector that recognize and include nutrition
To reduce the double burden of undernutrition and overweight, the WHO recognizes the importance of simultaneously engaging multiple sectors, including agriculture, food processing, trade, social protection, education, labor, and public information, in the quest to improve worldwide nutrition. The ultimate goals of this action item are to promote the demand for and supply of healthier food and to eliminate constraints to its access. Implementation is envisioned to involve establishment of a dialogue between health and other government sectors to consider policy measures that could improve the nutritional status of the population and reduce conflict between current sectoral policies and health policies. The WHO also urges international partners to involve themselves in analyzing evidence of effectiveness of interventions aimed at improving food security, social welfare, and education in low-income countries.
Action 4: Provide sufficient human and financial resources for the implementation of nutrition interventions
This action item recognizes the enduring and undeniable fact that these action plans and associated implementation strategies will require substantial financial, technical, managerial, and human resources for them to be successful. In addition, greater efficiencies will be needed in funding programs, including better alignment of donor investment with national priorities, and measures to reduce costs of interventions such as micronutrient supplements and ready-to-use foods. The plan recommends that member states implement a comprehensive approach to capacity building, including workforce development and leadership development; provide support to local communities; and establish a budget line and national financial targets for nutrition. It also recommends exploration of innovative financing tools for funding the expansion of nutrition programs worldwide.
Action 5: Monitor and evaluate the implementation of policies and programs
Finally, as with most well-delineated plans related to improving public health, this one recommends the development and use of a well-defined monitoring framework to provide accountability for the actions implemented. This framework should follow a proposed set of indicators as developed by the WHO (see link below). Proposed activities include the implementation of the WHO child growth standards to monitor individual growth patterns and population levels of stunting, wasting, and overweight and the collection and exchange of information between organizations with the aim of ensuring global coverage of the databases.
For More Information
A free on-line version of this report can be found at http://www.who.int/nutrition/publications/CIP_document/en/. The WHO review of food and nutrition policies of member states can be accessed at http://www.who.int/nutrition/publications/policies/global_nut_policyreview/en/. To read the aforementioned document outlining effective nutrition intervention programs, go to http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/. For more information about the WHO monitoring and evaluation indicators, see http://www.who.int/nutrition/EB128_18_backgroundpaper4_nutrition_indicators.pdf?ua=1. The International Code of Marketing of Breast-Milk Substitutes is available at http://www.who.int/nutrition/publications/infantfeeding/9241541601/en/.