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

32 SaviNg liveS aND BUilDiNg a Better FUtUre: loW-coSt SolUtioNS that WorK
to improve improve Child nutrition,
educate girls
The evidence is clear: When better-educated
girls grow up and become mothers, they
tend to have fewer, healthier and better-
nourished children. Educating girls is one
of the most effective ways there is to fight
malnutrition and break the intergenera-
tional cycle of malnutrition.
Studies the world over have linked
maternal education with improved nutri-
tion status of children. For example, a 2003
analysis by the International Food Policy
Research Institute estimated that improved
female education was “responsible for
almost 43 percent of the total reduction in
undernutrition across 63 countries between
1971 and 1995.” 1995.”100 100
Improvements in maternal educa-
tion also lead to lower mortality rates in
children. UNESCO has estimated that
each additional year of girls’ education can
reduce child mortality by 9 percent and that
universal secondary education could save
1.8 million children's lives in sub-Saharan
Africa alone. alone.101 101
The “Copenhagen Consensus 2008” (a
panel of eight distinguished economists,
including five Nobel Laureates) ranked
investments in education, especially for
girls, as providing some of the best returns
of all development interventions. Lowering
the price of schooling and increasing and
improving girls’ education ranked 7th and
8th out of their top 10 best investments in
development.
development.102 102
Despite the many benefits to individuals
and society, far too many girls in developing
countries are still deprived of an educa-
tion. Worldwide, an estimated 36 million
primary-school-aged girls are not enrolled
in school. school.103 103
heaLth woRKeRs aRe Key to sUCCess
Frontline health workers have a vital role to play in ensuring good nutrition
in the first 1,000 days. In impoverished communities in the developing world
where malnutrition is most common, doctors and hospitals are often unavailable,
too far away, or too expensive. Frontline health workers meet critical needs
in these communities by supporting and promoting breastfeeding, distributing
vitamins and other micronutrients, counseling mothers about balanced diet and
improved complementary feeding, promoting hygiene and sanitation, screening
children for malnutrition, and treating diarrhea and pneumonia.
Frontline health workers deliver advice and services to families in their
homes and in clinics, serving as counselors, educators and treatment providers.
Because they often come from the communities they serve, community
health workers and midwives understand the beliefs, practices and norms of the
people, allowing them to provide health care that is more culturally appropriate,
and often highly effective.
The “lifesaving six” interventions highlighted in this report can all be delivered
in remote, impoverished places by well-trained and well-equipped local
health workers. In a number of countries, these health workers have contributed
to broad-scale success in fighting malnutrition and saving lives. Some
examples follow.
• In Cambodia, exclusive breastfeeding rates climbed dramatically from 11
percent in 2000 to 74 percent in 2010.104 Much of the credit goes to efforts
such as the Baby-Friendly Community Initiative, which organized “Mother
Support Groups” to provide education and individual counseling on infant
and young child feeding. These volunteer-led groups have reached approximately
517,000 women in 2,675 villages, promoting early and exclusive
breastfeeding, continued nursing to 2 years or beyond, and appropriate
complementary feeding starting at 6 months of age.105
• Nepal has 50,000 female community health volunteers, 97 percent of whom
are in rural areas.106 These volunteers are chosen from and work for the community.
They play an important role in contributing to a variety of public
health programs, including family planning, maternal care, child health,
vitamin A supplementation and immunization coverage.107 Anemia was a
serious public health problem in Nepal for many years, but now the health
volunteers have helped increase iron folate supplementation to 81 percent
(up from 23 percent in 2001).108 At the national level, the prevalence of
anemia in women of reproductive age decreased from 68 percent in 1998
to 35 percent in 2011.109 Through this and other efforts, Nepal succeeded
in cutting its maternal mortality rate in half – from 539 deaths per 100,000
live births in 1996 to 281 in 2006.110
• India’s Bihar State – one of the poorest in the nation – is at the forefront
of the battle against vitamin A deficiency, which afflicts up to 62 percent
of preschool-aged children in rural India. The state set the ambitious goal
of reaching out to all children, beginning with those traditionally excluded
from services – children from the lower castes and minority groups – in
which malnutrition and mortality rates are often highest. More than 11,000
health centers and 80,000 anganwadis, or child development centers, serve
as core distribution sites for vitamin A supplements in Bihar. In addition,