Definition

Programs that aim to prevent malnutrition and improve nutritious diets, essential nutrition services and positive nutrition practices for women of reproductive age and children in their early years and detect and treat child wasting when it occurs.

Rationale

Good nutrition is fundamental for the health and well-being of women and their unborn babies. Well-nourished women have better health, safer pregnancies, and are more likely to access equal opportunities and participate fully in society. A mother’s nutrition status is also a powerful determinant of her children's survival, growth and development, influencing nutrition and health status throughout life and into the next generation. Anaemia and undernutrition during pregnancy significantly increases the risk of maternal mortality, obstetric complications and low birthweight infants. The poorest and most disadvantaged women and adolescent girls are especially bearing the brunt of undernutrition, micronutrient deficiencies and anaemia, with consequences that carry over generations.

Infancy and early childhood (i.e. the first 5 years of life) are a time of rapid growth and nutritional vulnerability during which young children undergo vast physiological changes. The first two years of life are especially crucial, and the absence of exclusive breastfeeding in the first six months, and the lack of diverse and nutritious complementary foods, thereafter, can lead to stunting, wasting and micronutrient deficiencies and can predispose children to overweight, obesity and diet-related noncommunicable diseases.

Maternal and early childhood nutrition interventions to support optimal nutrition, growth and development are most impactful in the first 1000-day from conception until two years of age and continue until five years of age.

Globally, one in four children are living in severe child food poverty in early childhood, amounting to 181 million children under 5 years of age. Children living in severe child food poverty are missing out on many nutrient-rich foods, while unhealthy foods are becoming entrenched in the diets of these children, placing them at risk of becoming overweight. The global food and nutrition crisis and localized conflicts and climatic shocks are intensifying severe child food poverty and the risks of malnutrition, especially in fragile countries.

Key interventions

1. Support for good health and nutrition for women before and during pregnancy, and during breastfeeding

• Nutrition information, education and counseling, healthy weight gain monitoring, multiple micronutrient supplementation, family planning and prenatal counseling, and mental health, for all women before pregnancy.
• Multiple micronutrient supplementation (MMS) (or other iron-containing supplements), deworming prophylaxis, weight gain monitoring, quality nutrition information, education, counselling, and support for all pregnant women delivered through the health facilities and through community health and nutrition workers.
• Quality nutrition information, counseling, and support during antenatal and postnatal care in line with the WHO’s Recommendations on Antenatal Care for a Positive Pregnancy Experience.
• Anemia testing in pregnancy for early detection and support for preventive interventions for those at-risk; frequent follow-up visits and/or referral to higher health facility and promote effective information sharing for at-risk women among health workers and health facilities.
• Support for women for their own production of nutritious foods through home gardening, small livestock programmes through agricultural support services and community groups.
• Maternity benefits including social assistance (unconditional cash or vouchers) for all pregnant women and maternity leave including for those women working the informal sector.
• Food supplements, such as balanced energy protein supplements for women particularly in contexts of high food and nutrition insecurity.

2. Protection and promotion of breastfeeding

a. Breastfeeding Promotion and Support:

• Implementing the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.
• Improving access to skilled breastfeeding counselling as part of comprehensive breastfeeding policies and programmes in health facilities.
• Strengthening links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.
• Strengthening monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets.

b. Breastfeeding Protection:

• Fully implement the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.
• Enact paid family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.
• Inclusion of health, environmental and socio-economic benefits of breastfeeding as part of the True Cost Accounting (TCA) in food and agriculture.

3. Protection and promotion of age-appropriate complementary feeding, positive feeding practices and responsive care and stimulation in from 6 months to 2 years of age.

a. Complementary feeding services:

• Deliver quality counseling and nutrition services, investing in community health and nutrition workers, particularly in underserved areas.
• Provide appropriate food supplements, home fortificants and micronutrients for vulnerable children through national programmes, especially in food-insecure and humanitarian contexts.
• Promotion of child growth and development through regular monitoring and the early detection and management of malnutrition.
• Quality support for early childhood care and stimulation to promote child development, learning, and social skills with appropriate information and skills.

b. Complementary feeding regulations:

• Establish national complementary feeding guidelines promoting the use of nutritious foods and ensure they are aligned with global standards and address local drivers of poor diets.
• Set and enforce standards for the safety, quality and labelling of all commercially produced complementary foods.
• Implement and enforce WHO guidance on ending the inappropriate marketing and promotion of foods for young children.

c. Production of nutritious complementary foods

• Stimulate the production of and access to nutritious foods that can be included in young children’s diets, including locally produced foods, particularly for vulnerable children and in fragile and food-insecure contexts.
• Incentivize local production of safe, nutritious, affordable, sustainable commercially produced complementary foods that comply with the highest quality and safety standard and WHO guidance on ending the inappropriate marketing and promotion of foods for young children.

d. Micronutrient supplementation and deworming for young children: Especially in areas where children’s intake of vitamin A and iron through diets or fortified foods is poor and in settings where there is evidence of vitamin A and iron deficiency in young children. Interventions should be aligned with global and national guidelines and support for integration into routine services for children.

• Children aged 6–59 months should receive two high-dose vitamin A supplements per year, spaced four to six months apart and delivered through routine health services at facilities and in communities. Deworming prophylaxis should be provided to all children from 12 months of age in areas where the prevalence of soil-transmitted infections is high annually or biannually depending on the national protocol.
• To prevent iron deficiency anaemia (IDA) in early childhood, in geographies with a known high burden of IDA, children from 6 months of age should be provided with iron-containing supplements such as micronutrient powders (MNPs) or small quantity lipid nutrient supplements (SQ-LNS) that can be used through home fortification or therapeutic iron supplements or drops when iron deficiency anemia is confirmed.

4. Prevention, detection and management of child wasting

Prevention

• Ensure that infants benefit from early initiation and exclusive breastfeeding from birth to 6 months as a key preventive measure. One intervention to support this is the implementation of the Baby Friendly Hospital Initiative (BFHI) including the Ten Steps to Successful Breastfeeding in all maternity services, including through community-based health facilities.
• Ensure the adoption at national level down to community level of the nurturing care framework to deliver vital feeding, stimulation, and care practices in the first two years of life and beyond.
• Enable young children to benefit from adequate, quality, safe and appropriate complementary foods using locally produced foods, where possible – while breastfeeding continues – and nutrition supplements when required especially in food insecure and fragile contexts.
• Enable vulnerable households with pregnant and breastfeeding women and children under 2 years of age to access social protection programmes – including cash, vouchers, or in-kind food transfers.
• Invest in social behavioral change (SBC) interventions to be delivered at health facility and community level, including interpersonal counselling and mass media communication on IYCF practices, nurturing care and other healthy practices for child growth and development.

Early detection and referral for children with wasting

• Ensure implementation of regular community mass screening and active case finding in vulnerable areas/population as well as other health facilities and community-based approaches (e.g. mothers’ groups) to find children with wasting and refer to, or deliver the appropriate care for them and their families.
• Where feasible, use digital tools such as mobile health technology for real time monitoring to track growth metrics and screening outcomes to enable timely responses, adaptive management, and follow-up.

Management of wasting, children with severe and moderate acute malnutrition

• Ensure that all children with severe wasting and medical problems access life-saving care including nutritional treatment with therapeutic foods and medical treatment alongside essential psychosocial stimulation services. Care can be provided at hospital level or as close to the child’s home as possible, and in some contexts via community health workers directly in the community.
• Ensure that children with moderate wasting have access to outpatient nutritional care which may entail counselling alone or alongside assistance to increase access to local nutrient-dense foods or providing specially formulated foods (SFFs); depending on the needs of the individual child and/or the population.
• Ensure that services delivering care for children with wasting can carry out assessments of the mother or caregiver and refer to or provide appropriate support, taking a family-centered approach.
• Ensure that services offering outpatient nutritional care for children with moderate wasting have staff with the capacity to perform health assessments and refer where appropriate as well as providing psychosocial stimulation and counselling on nutrition and health.
• Prevent relapse and ensure ongoing healthy growth and development by investing in post-exit (from outpatient care) interventions: these include IYCF counselling; psychosocial stimulation; SBC interventions, food/cooking demonstrations and referral to - if eligible - social protection programmes that target poor and vulnerable households.
• Increase the availability of local, appropriate and affordable nutrient-dense foods to meet the elevated needs of children with moderate wasting to enable their recovery and ongoing healthy growth and development through technical and financial support to local producers while leveraging social protection mechanisms to ensure vulnerable households can access these foods.

5. Strengthen social protection systems for nutrition

• Formulation of social policies and social protection programmes that improve women’s and children’s nutrition, such as social protection (cash or vouchers) that enable the affordability of nutritious foods for women and other benefits such as parental and maternity leave, family-friendly policies and affordable childcare, health insurance and fee waivers for women.
• Promoting access to and use of nutritious, safe, diverse, and affordable foods as part of a young child’s diet including through social protection (cash or vouchers) and through the local production of nutritious foods.
• Women's empowerment: such as time management, workload, income support and decision-making power in relation to food practices and intrahousehold distribution.

6. Implement Social Behavior change interventions

• Develop and implement large-scale social and behavior change interventions to address the barriers and enablers of best health, nutrition, early stimulation and child protection practices among caregivers of young children.