UNICEF: We face a global nutrition crisis

A new UNICEF report, Undernourished and Overlooked, released in advance of International Women’s Day warns that the world faces “a food and nutrition crisis of global proportions – one exacerbated by poverty, conflict and climate change.” The report cautions that adolescent girls, women, and their children are bearing the brunt of this crisis.

The analysis focuses on undernutrition, micronutrient deficiencies, and anemia – three forms of malnutrition that affect the most vulnerable adolescent girls and women in low- and middle-income countries.

It finds that global progress on the nutrition of adolescent girls and women is too slow to meet our global 2030 targets for reducing anemia and low birthweight. In fact, acute malnutrition has risen by 25% since 2020 in 12 crisis-hit countries. A total of one billion adolescent girls and women worldwide suffer from undernutrition. That includes being underweight and short height, having micronutrient deficiencies and anemia. This puts these women and adolescent girls at risk for poor health and for complications and death during pregnancy and makes it more likely that their children are born too small and have poor health.

But the report also highlights potential paths forward illuminated by Exemplar countries that are accelerating progress.

For example, Nepal now has one of the highest rates in the world of iron and folic acid supplementation during pregnancy. In 2001, only 6% of pregnant women in the country took these supplements for at least 90 days.

At the time, these supplements were only available to Nepal’s pregnant women who attended antenatal care at health facilities or health posts. But accessing that antenatal care was a challenge. Such services were more than one hour away for the overwhelming majority of pregnant Nepalis (about 67%). In fact, for 10% of pregnant women such essential health care was at least three hours away. And even when women accessed such care during their pregnancy, they often didn’t ask for the supplementation because they knew little about its benefits.

To address these supply side and demand side barriers, starting in 2003, the government of Nepal tasked the country’s 50,000-strong cohort of female Community Health Volunteers with educating women about the supplements and distributing them. By 2016, 65% of pregnant women in Nepal were consuming the supplements.

The report also highlights social protection programs in Ghana, South Africa, and Ethiopia that have proved effective at improving nutrition for women and girls. Social protection programs generally include a cash transfer to vulnerable individuals or households. In Ghana, South Africa, and Ethiopia, they were designed to provide an added bonus – to boost women’s nutrition.

Ethiopia’s Rural Productive Safety Net Program provides eight million extremely poor households with regular cash or food assistance in exchange for labor on public works projects. The program was designed with women in mind in a few key ways. First, work conditions have been adapted to meet women’s capabilities. Pregnant women are excused from difficult labor until their child’s first birthday, yet they continue to receive benefits during the period. Second, the program includes childcare at worksites staffed by participating mothers. The childcare centers provide attending preschoolers with a daily nutritious meal and early childhood education. Third, the program identifies and trains some participating women as “nutrition champions” – women who assist the government’s Health Extension Workers by providing nutrition advice and support to other women in their community.

Ghana’s cash transfer program, the Livelihood Empowerment Against Poverty Program, was launched in 2008 with the goal of alleviating extreme short-term poverty by providing poor households with orphans, vulnerable children, the elderly, and people with disabilities with unconditional cash every two months. In 2015, the program was expanded to include pregnant women and children less than 12 months. The program was designed to benefit women in a few key ways: it pays cash directly to women; it also provides women and their households with free health insurance and free maternal health services. An evaluation found that benefiting households diversified their diet and ate more meals per day. The program also increases the likelihood of pregnant women receiving antenatal care by 11 percentage points.

Lastly, the UNICEF report highlights South Africa’s innovative program to provide social insurance to informal workers, many of whom are women. Informal workers are often overlooked by social insurance schemes, even though they tend to be among the most economically and socially vulnerable workers.

The report says, “national and subnational governments – together with civil society organizations, development and humanitarian partners, media, research and academia and the private sector – must act now to leverage the policies, programmes, resources and actors of the food, health and social protection systems to deliver nutritious and affordable diets, essential nutrition services and positive nutrition and care practices for adolescent girls and women everywhere.”

The report’s authors call for a several key actions including expanding access to social transfer programs for girls and women, like those launched in Ethiopia, Ghana, and South Africa. UNICEF’s report also calls on leaders to collaborate to improve girls’ and women’s nutrition and for the mobilization of institutions and stakeholders towards this end. To inform this movement, UNICEF says, leaders should harness data and evidence to both determine the best path forward and measure progress towards the goal of improving access to affordable and nutritious food for women and adolescent girls. Governments should implement policies and legal measures to protect adolescent girls and women from unhealthy food and improve access to essential nutrition services for girls and women before and during pregnancy and while breastfeeding, including in the midst of humanitarian crises.