Session 2: Focus on the nutrition of women and children

Purpose:

To describe critical events during pregnancy, breastfeeding and weaning that place women and children at high risk of malnutrition. To illustrate the relationship between malnutrition, infection and child spacing.

Time: 1-2 hours

Materials:

- Newsprint and marking pens or chalkboard and chalk

- Wall chart - "Stages of Fetal and Infant Growth"

- Handout - "Stages of Fetal and Infant Growth"

- Handout - "Focus on Women and Children"

Steps:

1. Ask trainees: " Who suffers most from malnutrition?" List their answers on the flipchart. Then explain that poor women and children under three years suffer most from malnutrition in both normal and disaster situations because of their special nutritional needs and susceptibility to diseases that can lead to malnutrition.

2. Display the chart - "Stages of Fetal and Infant Growth." Review the characteristics of pregnancy, early infancy and weaning in terms of the nutritional requirements and common illnesses and problems at each stage.

Use the table on the next page to prepare your presentation.

HANDOUT

STAGES OF FETAL AND INFANT GROWTH

Stage	Nutritional Requirements	Common Symptoms
Pregnancy	- 350 extra calories per day or about ½ extra plate of food each day* - green leafy vegetables and meat to prevent anemia - weight gain of at least 12.5 kg	- anemia - inadequate weight gain - low birth weight(<2500 grams) - premature delivery - maternal depletion
Breastfeeding (0-6 months)	Mother: - 550 extra calories per day or about one extra plate of food each day extra liquids for the breastfeeding mother Child: breastfeeding should begin immediately after birth (give colostrum) - breastfeeding should be on demand - breastfeeding for 4-5 months without supplements	- early introduction of foods other than breast milk leading to diarrhea and decreased production of breast milk - early termination of - use of feeding bottles leading to diarrhea and other infections
Weaning/ Breastfeeding (6 months -2 years)	- begin giving semi- solid food by 6 months - give 4-6 small meals per day from 6 months to 2 years - continue breastfeeding - high energy/mixed diet	- inadequate weight gain - diarrhea - measles - other infections

* Calculation of additional caloric requirements are for a woman weighing 50 kg. Normal daily requirement is 2,000 calories; in pregnancy, calorie requirement increases to 2,350 calories; during the first six months of breastfeeding, it increases to 2,550 calories per day. Calculations for extra plates of food are based on the assumption that women eat three meals per day, under normal circumstances.

During the presentation, encourage trainees' participation in the following ways:

3. Emphasize the importance of a woman's health and nutrition to the health and survival of her child. Ask trainees to tell the group about cases of women they know who have been sick during pregnancy and how this affected the child.

4. Ask trainees: "What happens when an infant is not breastfed during the first year of life? Why do women stop breastfeeding?" Emphasize the role of maternal nutrition in successful breastfeeding. (This topic will be discussed in greater detail in a later session.)

5. Discuss the incidence and the effects of illness, especially diarrhea and measles, during the weaning period. Trainees should understand the need to deal with both illness and feeding habits to improve the nutrition of women and children.

6. Draw the chart below - Effects of Birth Spacing on Child Survival. Ask trainees to brainstorm reasons why large, poorly spaced families are more likely than smaller families to have malnourished children and children who die.

Effects of Birth Spacing on Child Survival

7. To summarize this session, divide trainees into small groups (four-five persons) and ask the groups to agree on one important rule to improve nutrition for each of the topics discussed during this session:

- Pregnancy

- Breastfeeding

- Weaning

- Illness

- Birth Spacing

Each rule should improve some aspect of the nutrition status of women and/or children.

8. When groups finish, ask them to present their rules for improved nutrition. Rules might look like this:

- Eat one extra plate of food every day during pregnancy.

- Begin breastfeeding immediately after birth.

- Do not give foods besides breast milk to infants under four months.

- Breastfeed to prevent diarrhea.

- Allow at least three years between the births of your children.

9. Close the session and bridge to the next:

"In this session, we reviewed the reasons for increased risk of malnutrition during pregnancy, early infancy and wearing. As managers, we are concerned with using our limited resources to produce the best results possible. In order to do that, we must decide who needs our help the most and who will benefit the most from it. In nutrition and health care, we emphasize the needs of mothers and children and strategies for working with them because they are the ones who suffer the most from malnutrition."

Distribute the Handout - "Focus on Women and Children" as a reference.

Stages of fetal and infant growth

HANDOUT

STAGES OF FETAL AND INFANT GROWTH

Stage	Nutritional Requirements	Common Symptoms
Pregnancy	- 350 extra calories per day or about ½ extra plate of food each day* - green leafy vegetables and meat to prevent anemia - weight gain of at least 12.5 kg	- anemia - inadequate weight gain - low birth weight(<2500 grams) - premature delivery - maternal depletion
Breastfeeding (0-6 months)	Mother: - 550 extra calories per day or about one extra plate of food each day extra liquids for the breastfeeding mother Child: breastfeeding should begin immediately after birth (give colostrum) - breastfeeding should be on demand - breastfeeding for 4-5 months without supplements	- early introduction of foods other than breast milk leading to diarrhea and decreased production of breast milk - early termination of - use of feeding bottles leading to diarrhea and other infections
Weaning/ Breastfeeding (6 months -2 years)	- begin giving semi- solid food by 6 months - give 4-6 small meals per day from 6 months to 2 years - continue breastfeeding - high energy/mixed diet	- inadequate weight gain - diarrhea - measles - other infections

* Calculation of additional caloric requirements are for a woman weighing 50 kg. Normal daily requirement is 2,000 calories; in pregnancy, calorie requirement increases to 2,350 calories; during the first six months of breastfeeding, it increases to 2,550 calories per day. Calculations for extra plates of food are based on the assumption that women eat three meals per day, under normal circumstances.