Regional Perspective: South Asia

Zivai Murira is the Regional Advisor for Nutrition at the UNICEF Regional Office for South Asia (ROSA), Kathmandu, Nepal

All forms of malnutrition – stunting, wasting and overweight – affect children in South Asia (UNICEF, WHO, & IBRD/World Bank, 2021). Poor complementary feeding practices have been linked with an increased risk of stunting, wasting and concurrent stunting and wasting in young children in the region (Harding et al., 2018; Kim et al., 2017). South Asia also faces increasing consumption of unhealthy food and beverages, even among children aged 6–23 months, increasing their risk of developing overweight/obesity (Pries et al., 2017). Only 58% of South Asian infants are likely to consume their first solid foods at the age of 6–8 months; among infants aged 6–23 months, only 45% receive an adequate number of meals each day, only 19% meet MDD and only 11% achieve MAD (UNICEF, 2021). Poor access to nutritious foods during the complementary feeding period contributes to 130 million children aged 6–23 months experiencing food poverty in the region, of whom 64 million suffer from severe food poverty (UNICEF, 2022). The micronutrient gaps of greatest concern in young children’s diets are iron, zinc, vitamin A, folate, vitamin B12 and, to some extent, calcium and vitamin C, but more data and evidence are required (Beal et al., 2021). An array of interrelated drivers and determinants influence young children’s diets and feeding practices in the region (UNICEF, 2021; Ryckman et al., 2021).

Opportunities

Concerted efforts are underway across South Asia to roll out multi-sector plans to address the multiple causes of poor nutrition in the region. In 2021, 58% of South Asian infants were likely to consume their first solid foods between the age of 6–8 months, an increase from 37% in 2000 (UNICEF, 2021). The evidence base on the status, drivers and determinants of complementary feeding in the region has been strengthened through a landscape analysis of complementary feeding in children aged 6–23 months in South Asia undertaken by UNICEF ROSA and regional partners. UNICEF ROSA has strengthened its collaboration with the South Asia Association for Regional Cooperation (SAARC) to support the implementation of the South Asia Regional Action Framework for Nutrition. Furthermore, regional Action Frameworks on complementary feeding provide a structure for countries in the region to operationalise multi-system approaches to improve the diets of young children. However, there remain untapped opportunities in South Asia to harness the power of business solutions to support improvements in accessing nutritious foods for children aged 6–23 months, while ensuring actions are aligned with the International Code of Marketing of Breastmilk Substitutes and subsequent Resolutions by the World Health Assembly, along with the 2016 WHO Guidance. Such public–private sector engagement opportunities and entrepreneurial solutions should be explored alongside other complementary strategies.

Actions

The stakes are high for improving the complementary feeding of young children in South Asia to accelerate progress towards Sustainable Development Goal 2 nutrition targets by 2030. To galvanise regional action, in 2019, UNICEF ROSA partnered with GAIN and the Alive & Thrive Project of FHI Solutions to undertake a regional analysis of complementary feeding in children aged 6–23 months in South Asia.

Through a series of working papers, the landscape review brought attention to the status, including the policy and programme context, of young children’s diets in the region. This provided SAARC member states and development partners in the region with consolidated evidence and knowledge for action. In September 2019, UNICEF ROSA and SAARC convened a Regional Conference on “Stop Stunting: Improving Young Children’s Diets in South Asia” to drive commitment and action to improve young children’s diets in the region. The Regional Conference highlighted the need for counties across South Asia to strengthen the policy environment and deliver programmes at scale to improve the diets of young children. Regional and country-level commitments were mobilised in the form of a Call to Action and country action plans. Regional frameworks for multi-system approaches to improve young children’s diets received technical endorsement during the Regional Conference and are supporting countries in the region to identify priority actions across systems to improve diets.

In 2020, UNICEF ROSA partnered with ENN to curate and disseminate a South Asia special edition of ENN's Nutrition Exchange on Improving Young Children’s Diets.¹ This documented country experiences and lessons learnt in leveraging various systems to improve young children’s diets. UNICEF and its partners continue to influence policy and programme action on multi-system approaches to improve young children’s diets in the region, with particular emphasis on leveraging food systems, health systems and social protection systems. Recognising the important role that business and private sector play in enabling access to nutritious foods for young children, UNICEF ROSA and its partners are undertaking a scoping review of social business enterprises and market-based nutrition entrepreneurship solutions and private sector engagement business models for improving the diets of young children at the bottom of pyramid population groups. The review findings will inform the development of a regional framework to harness the power of business to improve access to nutritious foods for young children. Lastly, UNICEF ROSA and partners will continue to document cross-country knowledge and evidence on models for scaling up access to nutritious diets in South Asia, including links with the social protection systems.

Next steps

ROSA will build on the momentum generated by the Call to Action from the UNICEF and SAARC Regional Conference on “Stop Stunting: Improving Young Children’s Diets in South Asia” to create a greater sense of urgency to improve young children’s diets in the region and to support the implementation of regional Action Frameworks. Urgent action is needed to harness the food, health, WASH and social protection systems to meet young children’s needs for nutritious, safe, affordable and sustainable diets. UNICEF will continue to support SAARC member states in developing, strengthening and implementing policies and programmes to improve the diets and feeding practices of young children aged 6–23 months. Greater emphasis will be placed on food system actions to improve young children’s diets and promote linkages with other systems to increase the availability and affordability of nutritious foods.

As drivers and determinants of young children’s diets vary from one context to another, UNICEF ROSA will continue to encourage countries in the region to undertake reviews at the country and sub-national level, where relevant, to deepen understanding and help identify strategic actions to improve the diets and feeding practices of young children. The untapped power of business solutions needs to be harnessed to support improvements in access to nutritious foods in the region. To this end, UNICEF will promote regional dialogue to explore social entrepreneurial and public–private sector partnership engagement opportunities for improving young children’s diets. A landscape analysis of potential business exemplar engagement approaches to improve access to nutritious foods and practices for children aged 6–23 months will be undertaken in India, Bangladesh, Nepal and Sri Lanka. A regional children’s diets innovation challenge will be launched to identify innovative solutions to improve the diets of populations at the bottom of the social and economic pyramid. The region is prone to flooding, droughts and cyclones, and the effects of climate change can be felt in the increased severity and magnitude of these natural disasters. Mitigating the impacts of emergencies on young children’s access to nutritious foods needs to be prioritised in country emergency preparedness and response strategies. As countries in the region grapple with mitigating the impacts of the global food and nutrition crisis and macroeconomic risks, governments and their partners – including donors, United Nations agencies, civil society and the private sector – should use this opportunity to build stronger and more resilient systems to improve the diets and feeding practices of young children in South Asia. A whole-of-government approach to ensuring these key systems work coherently to deliver nutritious diets for young children at scale will set children on course for a healthy and productive future.

For more information, please contact Zivai Murira at zmurira@unicef.org.

References

Beal T, White J, Arsenault J  et al (2021) Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment. Nutrition Reviews, 9, 79, 26–34.

Harding K, Aguayo V, & Webb P (2018) Birthweight and feeding practices are associated with child growth outcomes in South Asia. Maternal & Child Nutrition, 14, S4, e12650.

Kim R, Mejia-Guevara I, Corsi D et al (2017) Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan. Social Science & Medicine, 187, 144–154.

Menon P (2012) The crisis of poor complementary feeding in South Asia: Where next? Maternal & Child Nutrition, 8, 1–4.

Pries A, Huffman S, Champeny M et al (2017) Consumption of commercially produced snack foods and sugar-sweetened beverages during the complementary feeding period in four African and Asian urban contexts. Maternal & Child Nutrition, 13, e12412.

Ryckman T, Beal T, Nordhagen S  et al (2021) Affordability of nutritious foods for complementary feeding in South Asia. Nutrition Reviews, 79, 52–68.

UNICEF, WHO, & IBRD/World Bank (2021) Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition of the Joint Child Malnutrition Estimates. UNICEF, WHO, & IBRD/World Bank.

UNICEF (2021) Fed to Fail? The Crisis of Children’s Diets in Early Life. 2021 Child Nutrition Report. United Nations Children’s Fund.

UNICEF (2022) Child Food Poverty: A Nutrition Crisis in Early Childhood. United Nations Children’s Fund.