Introduction

by John Mason, Technical Secretary, ACC/SCN.

The cycle of infants’ nutrition contributing to their success as future mothers and of mothers’ nutrition determining that of infants is fundamentally important to the long-term solution to malnutrition. For example, it is now better understood that the period of growth up to around two to three years of age provides a window of opportunity for ensuring adequate future growth, development, and nutritional status¹. Before that, the relation between low birth weight, survival and child growth is also well established. And, going further back, growth in utero even from the time of conception is now known to be crucially affected by nutrition, and to have effects throughout the individual’s life.

^1. See (a) ACC/SCN (1993). ACC/SCN Statement on the Benefits of Preventing Growth Failure in Early Childhood. P.36 in: Nutritional Issues in Food Aid. ACC/SCN Symposium Report Nutrition Policy Discussion Paper No. 12. ACC/SCN, Geneva; and (b) Beaton, G. (1993). Which Age Groups Should be Targeted for Supplementary Feeding? P37-54 of above ACC/SCN publication.

The nutritional status of young children determines to a considerable degree their educability and intellectual development². Adolescent growth may possibly also provide a final chance for intervention to assure adequate maternal development and nutritional status. Mother’s pre-pregnancy nutrition affects intrauterine growth and birthweight. Thus, under conditions of deprivation a vicious cycle can be set up which perpetuates malnutrition generation by generation - this is shown in figure 1. Here, small maternal size is shown leading to low birth weight, hence growth failure in children, leading to small adults. This vicious cycle of malnutrition between the generations requires intervention at many stages: for example, initially to prevent low birth weight; and, when birth weight is low, to assure as much growth as possible particularly in girl children such that as a mother she is better able to have adequate birthweight infants herself. Interacting with all this is the need for more attention to education and literacy in women, itself helped by better nutrition.

^2. See Martorell, R. (1992). Long-Term Effects of Improved Childhood Nutrition. SCN News No. 8, 10-12.

Figure 1. Intergenerational cycle of growth failure

(Source: Figure 4.9, p.56 in: ACC/SCN (1992). Second Report on the World Nutrition Situation. Volume I: Global and Regional Results. ACC/SCN, Geneva)

These intergenerational effects can be turned into a virtuous cycle. That is to say, a self-reinforcing process which accelerates nutritional improvement could be generated whereby low birth weight declines, child growth improves, early pregnancy is avoided, and healthy women are better able to give birth to and to rear healthy well-nourished children.

The other side of this is equally important: malnutrition in women - as shown in the SCN’s Second Report on the World Nutrition Situation³ - is a major nutrition problem in its own right. Women’s nutrition needs to be improved through the same processes, for the sake of the health and individual development of the person herself.

^3. ACC/SCN (1992). Women’s Nutritional Status. Chapter 4 in: Second Report on the World Nutrition Situation. Volume I: Global and Regional Results. ACC/SCN, Geneva.

There is nearly enough data becoming available to look at the combined trends in birthweight and in underweight children. It would be good to extend this into women’s nutritional status itself, but such data are not yet available over time. In figure 2 the changes in birthweight and underweight between 1980 and 1990 are illustrated.

This shows the high correlation and the progression towards adequate birthweight and reduction in underweight in children. The period here, of ten years, shows only limited progress towards these goals, certainly not fast enough to match the international goals of the World Summit for Children and the International Conference on Nutrition, of halving the prevalence of underweight children in the 1990s. In South Asia progress was slow (top right hand part of figure 2) and in Sub-Saharan Africa there was no progress during this period. Successfully intervening on the intergenerational cycle of growth failure would lead to more rapid progress towards eliminating low birthweight and underweight in children. This relationship should be monitored more closely in the future.

Figure 2. Changes in prevalence of low birth weight and underweight in children, approx. 1980-1990.

(Source: Figure 4.11, p.57 in: ACC/SCN (1992). Second Report on the World Nutrition Situation. Volume I: Global and Regional Results. ACC/SCN, Geneva)

Figure 3. Structure of SCN News No. 11 “Features” Section Focussing on Maternal and Child Nutrition 1. Adolescent Growth by Kathleen M. Kurz, PhD. International Center (or Research on Women, Washington, D.C. 2. Prepregnancy Nutritional Status and Its Impact on Birthweight by Rae Galloway, Nutrition Advisor, MotherCare and Mary Ann Anderson, Cognizant Technical Advisor, USAID 3. Maternal Nutrition During Pregnancy as It Affects Infant Growth, Development and Health by Rebecca Norton, Consultant, ACC/SCN 4. The Consequences of Iron Deficiency and Anaemia In Pregnancy on Maternal Health, the Foetus and the Infant by Fernando E. Viteri. M.D.. ScD., FACN, Professor Department of Nutritional Sciences. University of California at Berkeley 5. Impact of Maternal Infection on Foetal Growth and Nutrition by Andrew Tomkins, Susan Murray, Patricia Rondo and Suzanne Filteau, Centre for International Child Health, Institute of Child Health, University of London. 6. Maternal Micronutrient Malnutrition: Effects on Breast Milk and Infant Nutrition, and Priorities for Intervention. by Lindsay H Alien. PhD. RD. Department of Nutrition, University of California. 7. Vitamin A in the Mother-Infant Dyad by Rebecca J. Stoltzfus, PhD, Division of Human Nutrition. School of Hygiene and Public Health. The Johns Hopkins University 8. Maternal Protein-Energy Malnutrition and Breastfeeding by Ted Greiner, SIDA Nutrition Advisor. International Child Health Unit, Uppsala University, Sweden. 9. Maternal Nutritional Depletion by Kathleen M. Merchant. PhD., Consultant to the International Food Policy Research Institute, Washington. D.C.

The SCN has published a number of materials concerning women’s nutrition, child nutrition, and their relationships⁴. On previous occasions SCN News has drawn together thematic maternal, most recently on micronutrients⁵. With current interest in women and children’s nutrition, proposals were made to again take a thematic approach in this issue of SCN News, and to develop joint materials with “Mother’s and Children”⁶, which is planned for the future. For this issue, a number of researchers in the area were invited to provide short articles for SCN News, which fit together as illustrated in the diagram in figure 3. These articles then are intended to provide an overview of current issues in maternal and child nutrition, as background for all those whose concern is to improve this central aspect of nutrition.

^4. For example: (1) ACC/SCN (1990). Women and Nutrition. ACC/SCN Symposium Report. Nutrition Policy Discussion Paper No. 6. ACC/SCN, Geneva; (2) ACC/SCN (1992). Nutrition and Population Links: Breastfeeding, Family Planning and Child Health. ACC/SCN Symposium Report. Nutrition Policy Discussion Paper No. 11. ACC/SCN, Geneva. (3) ACC/SCN (1992). Women’s Nutritional Status, (see endnote no. 3); and (4) SCN News Articles - “Breastfeeding, Birth Spacing, and Nutrition” in SCN News No. 7, mid 1991, p7-14. “The Lesser Child” in SCN News No. 6, late 1990, p24-25.

^5. ACC/SCN (1993). SCN News No. 9. Focus on Micronutrients. ACC/SCN, Geneva.

^6. “Mothers and Children” is the newsletter of the American Public Health Association’s Clearinghouse on Infant Feeding and Maternal Nutrition in Washington, D.C.