After five years leading USAID’s multi-sectoral nutrition project, Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), JSI is proud to have contributed to reaching the Sustainable Development Goals for health through improved nutrition worldwide. Our efforts have largely focused on the critical first 1,000 days between pregnancy and a child’s first birthday, but our experience makes it clear that we cannot stop there. Nutrition messaging must expand to include women—especially adolescent girls—before they become pregnant, as well as children of all ages who are the next generation of health consumers, parents, siblings and friends.
Older children represent an important but often-overlooked group for nutrition programming. While the first 1,000 days is a period of rapid and critical development with direct implications on health later in life, sustaining attention on children outside this window is necessary for a number of reasons:
- Nutrition for older children is important to addressing the growing epidemic of the double burden of malnutrition including underweight and overweight. Overnutrition and risk factors for noncommunicable diseases increasingly begin during childhood.
- Older children are often caregivers for their younger siblings and need guidance on how to support the nutritional needs of those children.
- Children are the next generation of caregivers and form habits that they may carry into adulthood.
- Older children often have more opportunities to receive messages from sources other than caregivers in the household or health workers in the community.
SPRING is reaching children and adolescents in Bangladesh, Ghana, and Nigeria through nutrition and hygiene initiatives with partner organizations, which may serve as examples for further activities. In Bangladesh, SPRING leveraged community nutrition champions from farmer nutrition schools to support vitamin-A campaigns for children under five. The project has partnered with Sisimpur, the Bangladeshi version of Sesame Street, to use mass media and awareness days to reach primary school-age children with messages that focus on developing good hygiene behaviors and improving dietary diversity. Primary and secondary schools in Ghana host water, sanitation, and hygiene (WASH) clubs. In Nigeria, the project created a modular curriculum to help facilitators deliver nutrition and hygiene messages to orphans and other vulnerable children aged 2-17, focusing on activities and games appropriate for different age groups.
During adolescence, girls achieve almost half of their skeletal growth and have the opportunity to acquire knowledge essential for later parenthood and employment. Adequate adolescent nutrition is essential to this growth and underpins later maternal nutrition. When an adolescent girl becomes pregnant, however, her body takes nutrients otherwise intended to support this critical period of growth and diverts them to the developing fetus.
Although research and interest in this topic have increased, adolescent girls are largely ignored in nutrition programming and development programs targeting adolescents rarely address their diet and eating practices. Even as we encourage norms and practices to delay marriage and pregnancy until adulthood, we must acknowledge the importance of good nutrition at this age and address the reality that many girls become pregnant in adolescence. By intentionally including adolescent girls in nutrition programming, we can contribute to girls’ individual development, prepare them for pregnancy and motherhood, and establish good nutrition behaviors for lifelong health.
SPRING has identified gaps in the global community’s understanding of nutrition-related behaviors and determinants, and in response to adolescent girls’ nutritional needs. The project has also initiated a process to develop global guidelines for diet and eating practices of adolescent girls with WHO and PAHO.
Women of Reproductive Age
Recent research shows that the greatest risk factor for stunting is poor fetal growth during pregnancy. Healthy growth during pregnancy depends on the mother’s nutrition even before she becomes pregnant. Before a woman may know she is pregnant, the fetus has critical needs for iron, folic acid, protein, and other nutrients that many women lack, especially in low- and middle-income countries. By expanding the focus of nutrition messages and programming to all women of reproductive age—and, importantly, including early adolescent girls in this category—we can improve the likelihood that a woman is better nourished when she becomes pregnant, and therefore has the best chance of having a healthy pregnancy and child.
SPRING has begun reaching women before they might become pregnant by introducing nutrition education to health care services, counseling, and women’s groups. Through community video in India, Niger, Burkina Faso, Guinea, and Senegal, the project has engaged women of all ages to improve dietary diversity and promote intake of nutrient-rich foods. In the Kyrgyz Republic, Senegal, and Uganda, mass media nutrition campaigns have a broad reach that generates interest among a diverse audience.
These examples are only part of a multi-sectoral approach to improving health and nutrition around the world, but represent opportunities to provide continuity in nutrition programming and ensure that children sustain positive outcomes during and beyond the 1,000-days window.
This Universal Children’s Day, as SPRING moves into its final year of implementation, we encourage the global development community to think strategically, creatively, and inclusively in addressing nutrition before and after the 1,000-day window. We look forward to continued conversations that contribute to developing and strengthening frameworks supporting these efforts.