|Reaching Mothers and Children at Critical Times of their Lives (WFP)|
1. Individuals have special food needs at critical periods in their lives - most notably expectant mothers and their unborn babies, children under five, and nursing mothers. Inadequate nutrition in the first years of life and before is likely to damage health, mental development and future labour productivity. The high demands of reproduction deplete a womans nutrient stores, increasing her vulnerability to disease and reducing her capacity to work and care for her children. The consequences of "early malnutrition" reach beyond the individuals and families involved: society as a whole suffers losses when children cannot learn, when poor health restricts productivity, and when malnourished women give birth to the next generation that will also be malnourished.
2. Today, approximately 30 percent of children under five (i.e., over 200 million, according to a recent WHO estimate) are more vulnerable to sickness and more likely to die because they are undernourished. Most of them live in South Asia and sub-Saharan Africa. It is estimated that 50 percent of disease-related mortality among infants could be avoided if infant malnutrition were eradicated.
3. WFP can help end the inheritance of hunger through supplementary feeding programmes which provide the energy and nutrients missing from the basic diet of those who have special nutritional requirements. At present, WFP reaches over four million expectant and nursing mothers and children under five through primary health care centres. This assistance, which addresses early malnutrition, has important long-term pay-offs that cannot be achieved with later interventions. At the same time, there are challenges: past supplementary feeding programmes have not been without difficulties, particularly in the poorest countries where often food is needed most but sufficient complementary resources and capacities are lacking.
4. This paper examines the conditions under which WFP can better contribute to protecting poor women and children against lasting damage from early malnutrition. It will make recommendations on WFPs future policy and operational principles for supplementary feeding programmes, including measures required to increase these activities in the countries with the greatest needs. Recommendations will also be made for better meeting critical food needs during crisis and rehabilitation, bearing in mind the special circumstances involved.
5. Assistance to mothers and children "at risk" features prominently in the core policies and strategies that govern WFP activities. One of the strategic goals set by the WFP Mission Statement is to provide food aid "to improve the nutrition and quality of life of the most vulnerable people at critical times in their lives". The World Food Summit Plan of Action includes a similar commitment to "develop within available resources well targeted social welfare and nutrition safety nets to meet the needs of the food insecure, particularly needy people, children and the infirm" (Commitment Two, Objective 2.2c).
6. WFP has begun to elaborate this mandate and the strategic implications of increasing its focus on tackling early malnutrition:
7. WFP has acquired much experience and expertise in over 30 years of assistance to Mother and Child Health (MCH) and other projects that provide supplementary feeding. Major findings from the recent assessment of WFPs programmes, including a portfolio review of ongoing supplementary feeding projects, are as follows:
8. Research findings show that malnutrition is the outcome of an array of inter-linked risk factors: poverty (unemployment, landlessness); lack of education (illiteracy, poor child spacing); poor health (lack of clean water, poor hygiene, parasitic infections); low social status (tribes, castes, minorities); unfavourable traditions (taboos, low status of women); and/or a harsh environment, all leading to insufficient access to food and/or micronutrients.
9. Not surprisingly, then, a key finding of the thematic evaluation of WFP assistance to address the food needs of women and children at critical times of their lives is that the effectiveness of a food aid intervention is maximized when the achievement of a direct dietary effect is combined with indirect effects such as a better utilization of health and education services; increased household food security and mothers caring capacity; and empowerment of women. The full text of the thematic evaluation is contained in document WFP EB.3/97/5/Add.5.
10. In WFPs experience, food assistance to address early malnutrition will be most effective under conditions of widespread food insecurity. Supplementary feeding will usually be a less preferable option where malnutrition is primarily the result of factors such as inadequate weaning or caring practices and unfavourable social traditions, which can be better addressed through services such as nutrition education, training, growth monitoring and a build-up of referral systems.
11. To be fully effective, WFP assistance through supplementary feeding needs to be integrated with other components. This requires policy, planning and management resources, apart from the actual handling of the food itself. However, the ideal - integrated utilization of a substantial number of complementary activities - is frequently not attainable. There are situations in which WFP is faced with a very practical choice: supplementary feeding with very limited, but viable, complementary activities or no assistance at all.
12. The policy issues and operational challenges which emerged from WFPs recent review of experiences are discussed in the following section. Action on these issues will be crucial if WFP is to increase the share of food assistance programmed to contribute to a better nutritional status of mothers and children at critical times in their lives.