Nutrition in the First 1,000 Days - Save the Children

28 SaviNg liveS aND BUilDiNg a Better FUtUre: loW-coSt SolUtioNS that WorK
national laws that are properly enforced can stop baby food companies from
competing with breastfeeding. In fact, a recent WHO review of global nutrition
policies found that only a third of the 96 countries reported to have enacted
Code legislation also had effective monitoring mechanisms in place.85
The Top 4 countries on the Scorecard – Malawi, Madagascar, Peru and the
Solomon Islands – are also regional leaders in terms of child survival. Malawi
and Madagascar have made more progress in reducing under-5 mortality than
any other countries in sub-Saharan Africa. Peru has made the most progress
of any country in Latin America. And Solomon Islands has one of the lowest
rates of child mortality in the East Asia and Pacific region. These countries have
also made improvements in early initiation of breastfeeding and other feeding
practices in recent years.
The Bottom 4 countries – Somalia, Côte d’Ivoire, Botswana and Equatorial
Guinea – have made little to no progress in early feeding or in saving children’s
lives. Somalia, the lowest-ranked country on the Scorecard, has made no progress
since 1990 in reducing under-5 mortality, and in recent years the prevalence of
underweight and stunted children in Somalia has risen by at least 10 percentage
points.86
Top 4 Countries
Malawi tops the Infant and Toddler Feeding Scorecard ranking, demonstrating
impressive achievements in child nutrition. Overall, Malawi is doing a
very good job of feeding young children according to recommended standards,
and this is saving many lives. Within an hour after birth, 95 percent of
babies in Malawi are put to the breast. At 6 months, 71 percent are still being
exclusively breastfed, and between 6-9 months, 87 percent are breastfed with
complementary foods. At age 2, 77 percent of children are still getting some of
their nutrition from breast milk. Malawi has enacted many provisions of the
International Code of Marketing of Breast-milk Substitutes into law and has put
significant energy and resources into improving health services for its people.
Many improvements can be attributed in part to the work of 10,000 health
surveillance assistants who are deployed in rural areas. These trained, salaried
frontline workers deliver preventative health care and counsel families about
healthy behaviors such as hygiene, nutrition and breastfeeding (see the story of
one health worker on page 35). Malawi is an African success story, having reduced
its under-5 mortality rate by 59 percent since 1990. It is one of a handful of sub-
Saharan African countries that are on track to achieve MDG 4. While Malawi
is to be applauded for its results in promoting breastfeeding and saving lives,
the country still has one of the highest percentages of stunted children in the
world (48 percent). This paradox indicates that additional efforts are needed to
ensure children get good nutrition as they are weaned off breast milk.
Madagascar is another African success story, on track to achieve MDG 4,
with a 61 percent reduction in child mortality since 1990. Strong performance
on infant and young child feeding indicators has contributed to Madagascar’s
success in saving hundreds of thousands of lives.87 Madagascar’s Ministry of
Health, in partnership with the AED/Linkages Project (funded by USAID),
launched a major effort in 1999 to raise public awareness of the benefits of
breastfeeding. The campaign used interpersonal communications, community
mobilization events and local mass media to reach 6.3 million people
with positive messages about breastfeeding. Since the launch of the project,
exclusive breastfeeding rates have increased from 41 to 51 percent and timely
initiation of breastfeeding within an hour of birth has risen from 34 to 72
percent.88 Madagascar also does well on measures of complementary feeding
(89 percent) and breastfeeding at age 2 (61 percent). Madagascar has enacted
most provisions of the breast-milk substitutes Code into law. As in Malawi,
Malawi