When one thinks of malnutrition, one often pictures starving children in extreme situations like famine or war. The problem is linked to nearly half of deaths in children under age five and has severe lifelong consequences: one in four of the world’s children are stunted because they suffer from chronic malnutrition.
However, experts say that until recently, the nutritional status of mothers had not received sufficient attention in the equation – and that what is most important to preventing malnutrition is putting women’s empowerment and gender equity at the center of strategy.
“Common sense and research point to the need to start from the beginning,” said Agnes Guyon, the director of the maternal, neonatal and child health center at JSI Research and Training Institute, the nonprofit arm of the healthcare consultancy John Snow, Inc.
According to the World Food Program (WFP), 795 million people around the world suffer from undernutrition, a form of malnutrition, meaning they do not eat enough food to lead a healthy, active life. There is now greater focus on intergenerational cycles of undernutrition. When mothers don’t have enough nutritious food to eat, their babies are more likely to be underweight; in turn, those babies have a 20 percent higher risk of dying before their fifth birthday, according to the WFP.
The cycle doesn’t stop with mothers giving birth to smaller babies.
The impact of undernutrition is more profound. Nutrition experts in a Lancet article that was part of an influential 2008 series outlined some of the lifelong consequences of undernutrition for the babies that survive. “Poor fetal growth or stunting in the first two years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income and decreased offspring birthweight,” the authors wrote.
There are far-reaching individual, national and ultimately global implications. “Along with girls’ education and access to family planning, nutrition is really one of those unsung issues that could radically change how we address both chronic and acute diseases,” said Katharine Kreis, director of strategic initiatives at the healthcare nonprofit PATH. “Our nutritional status has everything to do with our ability to fight off infection. It affects risk factors for noncommunicable diseases [like] diabetes, and we are seeing – with the increasing incidence of overweightness and obesity – nutritional status has a lot to do with our productivity. This is about personal growth and development, but also economic viability of nations.”
While undernutrition has widespread impact, it remains particularly harmful to women and girls and increases the risks they encounter when becoming mothers.
One-third of maternal deaths are nutrition related, Guyon said. Anemia increases the chances that a woman will die during childbirth due to postpartum hemorrhage, the number one cause of maternal death. Furthermore, while the benefits of exclusive breastfeeding in the first months of a baby’s life are widely acknowledged, “Lactation requires energy, but this is something that is not addressed as the focus is on the pregnancy period,” Guyon said.
Women and girls need better access to sufficient quantities of good quality food with appropriate diversity. In families in many cultures, women eat only after men and children have finished their meals; during crises, WFP research shows, it’s usually women who sacrifice their food for others. Many would benefit from supplements, as well: around half of all pregnant women in developing countries are anemic, which causes around 110,000 deaths during childbirth each year. The World Health Organization (WHO) recently issued guidelines that recommend daily oral iron supplements for women and girls in areas where more than 40 percent of the population is anemic.
“Where are you going to get your bang for the buck? It might not be in just feeding people more, but in giving women a better chance of growing themselves and helping their children survive and thrive,” said Kreis.
How to end intergenerational undernutrition? A big step would be providing women with better access to education.
This is not only correlated with major reductions in childhood malnutrition – even more than better access to food, according to the WFP – but it also delays a woman’s first pregnancy. If a mother is more than 18 years old, her baby tends to have a higher birthweight; her own health also benefits. “Teenagers stop growing when they are pregnant, so they stay shorter,” Guyon said.
Breaking the cycle is an multifaceted problem with women at the center – and one that requires more investment.
“Although there’s been a renewed focus on nutrition, it has gotten a disproportionately low amount of emphasis and money relative to the magnitude of the problem,” Kreis said. “Part of this is because it is a complex problem – there is no silver bullet.”