More than one in four children in poor countries are underweight, many to a life-threatening degree, UNICEF reports today. The situation has improved somewhat in the last 15 years, but much more needs to be done to help children in developing countries, UNICEF says, noting that half of the world's underweight children live in Bangladesh, India or Pakistan.
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United Nations System Standing
Committee on Nutrition (SCN)
Information
Meeting
The
Critical Role of Nutrition for Reaching
the
Millennium Development Goals
7th June 2005 (10.00 am. – 12
noon)
ECOSOC Chamber, UN,
Statement
by Ambassador Kirsti Lintonen
Permanent
representative of
Nutrition,
women's health and gender equality
Excellencies,
ladies and gentlemen,
It is
an honour and a pleasure for me to participate in this panel today. The theme of
our discussion is both important and topical, as already pointed out in the
opening remarks and background materials of the meeting. Nutrition and food
security are at the core of several Millennium Development Goal targets, and
bear some relevance for all of them. In view of the ongoing preparations for the
September Summit, it is timely to look at the MDGs thematically, in a
cross-cutting manner, and to examine the interlinkages between the various
targets.
The
goal related to maternal health (MDG 5) and the MDG related to promoting gender
equality and empowering women (MDG 3) are very obviously interrelated. As is
increasingly recognised, gender equality is a prerequisite for the attainment of
all MDGs, but this is most obviously true for MDG 5: it will be virtually
impossible to achieve improvements in maternal health without reducing gender
inequalities. Poor maternal nutritional status forms an important part of these
linkages, and is an area that should receive more attention.
As
things stand, the MDG 5 target of reducing maternal mortality by three quarters
between 1990 and 2015 does not seem likely to be met. There is little evidence
that maternal mortality is decreasing anywhere, and in parts of
The
messages contained in the World Health Report 2005, entitled "Make every mother
and child count", are very welcome ones. More attention should be given to
maternal health and nutrition by national governments and UN agencies, and the
proposed continuum of care that extends from pregnancy (and even before) through
childbirth and on into childhood is the ideal that we should all be supporting
and aspiring to.
There
are, however, some areas that should be prioritized if we are serious about
achieving these MDGs, and it is these areas that I want to focus on today.
One
thing that all countries that have successfully reduced maternal mortality have
in common is high levels of access to a skilled attendant at birth and effective
referral. It is increasingly clear, however, that an emphasis on providing
emergency obstetric care alone is not going to be enough to resolve this
problem, or the host of other problems associated with it.
Poor
maternal nutrition is directly associated with maternal ill health. Poor
nutrition reduces the mother's resistance to infection and infections contribute
to the poor nutritional status of the mother. This nutrition-infection complex,
unless controlled, places both the mother-to-be and her foetus at increased
risk.
Poor
maternal nutrition is very common in most developing countries. About half of
all pregnant women in developing countries are anaemic, and about a half of this
anaemia is due to iron deficiency. Iron deficiency anaemia among pregnant women
is associated with one tenth of maternal mortality in developing countries. Iron
supplementation during pregnancy helps to prevent severe anaemia, but such
programmes often lack effectiveness because they are given little
priority.
Women
that are underweight are more likely to have unsuccessful pregnancies. More than
a third of women of reproductive age are underweight in sub-Saharan
Improvements
in maternal weight can also be achieved by delaying the age of first pregnancy,
an issue closely linked to marital age. Child marriages are still common for
girls in many countries. In sixty per cent of countries that UNICEF has data on,
more than a third of women were married at under eighteen years of age, and in
ten per cent of countries this is the case for more than half of women. In most
countries where child marriages are common, it is the girls rather than the boys
that marry early.
Around
15 million young women aged 15 to 19 give birth each year, accounting for more
than 10 per cent of all babies born worldwide. Girls aged 10 to 14 are five
times more likely to die in pregnancy or childbirth than women aged 20 to 24,
while girls aged 15 to 19 are twice as likely to die. Pregnancy-related deaths
are the leading cause of mortality for 15 to 19 year-old girls
worldwide.
It has
been estimated that delaying marriage and first birth, preventing unwanted
pregnancy and eliminating unsafe abortion would avert up to one third of
maternal deaths. Wider birth spacing and prevention of pregnancy in very young
women could also reduce low birth weight rates, improve child growth and reduce
child mortality by half.
There
are of course other broader gender issues that also have bearing on maternal
health. The household gender division of labour in many societies, rooted in
social norms and values, means that women bear most of the domestic, farming and
childcare tasks. Restriction of women's movement outside the home in some
societies, on the other hand, limits their access to services.
Inequitable
property and inheritance rights can also disempower women, increase their
vulnerability and limit their access to health care and economic opportunities.
The challenge here s to reform legislation in order to protect the rights of
women, to educate women in communities on their rights and responsibilities with
respect to property and inheritance and to ensure that existing legislation is
enforced. Gender relations are obviously also at the heart of domestic violence,
which poses some of the most severe risks to women's health and rights all over
the world.
The
effects of HIV/AIDS reach far beyond those immediately affected, and can have
devastating consequences for families of victims, and especially for women. In
families affected by AIDS, women in particular are often forced to abandon or
delay farming activities to care for family members or to engage in wage labour
to cover medical expenses or purchase food. In addition, gender biases in food
distribution can leave women and girls more susceptible to decreased household
food availability. A key challenge, therefore, is to implement integrated
responses to address HIV/AIDS, food security and gender
equality.
Improvements
in the nutritional status of women and girls, in turn, will contribute to
reducing gender inequality. An emphasis on nutritional outcomes focuses on the
biologically weak - women and infants - who are also made vulnerable by
socio-political processes. Good nutritional status early in life promotes the
cognitive development of all children - girls and boys. If boys and girls are
more equally prepared for school, the gap in enrolment and attainment is more
likely to close, as is the gap in their returns to the workforce.
School
feeding programmes have been shown to enhance children’s access to education, to
help keep them in school and improve their attendance and performance. The
benefits of girls' education reach far beyond their own lives; by ensuring girls
their right to education, we take the critical first towards dismantling gender
discrimination that threatens all other rights.
In
conclusion, continued and increased efforts should be made to improve maternal
nutritional status as a way to improve women's health and early childhood
development. Improved maternal nutrition will not only contribute to attaining
the MDG 5 target for maternal mortality reduction, it is also important for the
targets on reducing hunger and child undernutrition (MDG 1) and achieving
universal primary education (MDG 2). Giving an emphasis to women's improved
nutrition will also contribute to improving gender equality and advancing
women's empowerment (MDG 3).
A
concerted effort is needed to achieve the MDGs, and as has been made clear here
today, one effective way is investment in food and nutrition programmes. A
coherent approach by governments, UN agencies and donors is required to realise
the right to adequate food and the right to be free from hunger, enshrined in
the Universal Declaration of Human Rights and the human rights covenants. After
all, while goals such as the MDGs are a valuable means of establishing targets
and measuring progress, we must not lose sight of the fact that rights,
including those to a decent standard of living, are obligations that states must
implement. Our MDG commitments, therefore, must be understood as not just about
producing progress and development, but about implementing
rights.
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