Millennium Development GoalsLinkages with Early Child Development and Nutrition

DR. S.K CHATURVEDIMD,MNAMS,FIAPSM,FIPHA

UNICEF State Representative for NE/NW statesNew Delhi

The Challenge in India

1. Genesis of Millennium Development Goals

2. Conceptual Framework

3. The Link with Integrated Early Child Development & Nutrition

4. Millennium Development Goals

5. India – Challenges & Opportunities

6. Moving Forward

The Genesis

Millennium summit of UN - September 2000Commitment to reduce global deprivation and promote sustainable human development

Millennium Development Goals/ Country Plan Goals• Quantifiable targets for 2015• Some 10th Plan Goals more ambitious than the MDGs

A Rights Perspective• Children’s & women’s rights fundamental to human rights • UN Convention on the Rights of the Child• Convention on Elimination of all forms of Discrimination Against

Women

Creating a World Fit For Children• UN General Assembly Special Session on Children - Sept 2002• Placing children first on the development agenda

Millennium Development Goals

1. Eradicate Poverty & Extreme Hunger

2. Achieve Universal Primary Education

3. Promote Gender Equality & Empower Women

4. Reduce Child Mortality

5. Improve Maternal Health

6. Combat HIV/AIDS, Malaria & Other diseases

7. Ensure Environment Sustainability

8. Develop Global Partnership for development

Civil Society /State

Natural Resource Base & Environment

Efficient resource use & control Natural /Human / Economic/Organization Resources

Education / Learning / Life skills / Information & Communication

Household Securities (eg Food,Water,Shelter)

Empowered Community & Change facilitators

Access to quality Services(Health, CDN, WES)

CAREHome Health Practices Home Hygiene Practices

Infant and Young Child FeedingPsychosocial Care

Care for Girls and Women

Well nourished and healthy child Secure & Active Learner

Fulfillment of the Rights of all children to survive grow and develop to their full potential without discrimination

BasicConditions

UnderlyingConditions

ImmediateConditions

Institutions and Governance

Political, Economic & Social Structures & Systems

Household/Community

Outcome

Young children on the Development Agenda

Child

Family

A conceptual Framework

Integrated Early Child Development & Nutrition

• Foundation for cumulative lifelong learning and human development

• Entry point for poverty reduction and human development strategy

• Early interventions most effective in addressing a life cycle of multiple deprivation - Poverty Gender Discrimination Malnutrition

• Sensitive proxy indicator of human development - % children 0-5 years underweight

Crucial for the achievement of first 6 MDGs

Halve, between 1990-2015, proportion of people…

Target 1 …whose income is less than $1 a day

Target 2 …who suffer from hunger

Goal 1 Eradicate Poverty & Extreme Hunger

Malnutrition erodes human capital, reduces learning abilities and productivity

For human capital formation, it is critical to prevent malnutrition, as early as possible

Early Care and Nurturing has a lasting impact on brain development- especially in the first 3 years

The first 3 years are crucial. They are forever…

Goal 2

Achieve Universal Primary EducationEnsure by 2015…

Target 3 Children everywhere, boys & girls alike, will be able to complete full course of primary schooling

10th Plan All children in school by 2003All children to complete 5 years of

schooling by 2007

Early Child Development interventions Result in increased cognitive and social skills Improve retention and learning outcomes in primary education Equality of opportunity for disadvantaged groups

Malnutrition reduces mental capacity & learning ability e.g. Micronutrient deficiencies such as Iodine (13 IQ points)Iron Deficiency Anemia (9 IQ points)

Goal 3

Promote Gender Equality & Empower WomenEliminate by 2005…

Target 4 …Gender disparity in primary & secondary education, & at all levels of education no later than 2015

Positive early child care practices and parent education help promote equal learning opportunities for girls and boys

Better nutriture and iron status of girls improves learning capacity, likely retention and future choices

Goal 4

Reduce Child Mortality

Reduce by 2/3 between 1990-2015Target 5 …Under 5 Mortality Rate10th Plan IMR to be 45 by 2007

IMR to be 28 by 2012

More than 50% of all child mortality is directly or indirectly associated with malnutrition

Around 25 % of young child mortality can be prevented through nutrition and early child care interventions

Goal 5

Improve Maternal Health

Reduce by 75% between 1990-2015Target 6 …Maternal Mortality ratio

Maternal health is compromised by inadequate care and nutrition of girls and women

Malnutrition, including anemia, is associated with most major risk factors for maternal mortality

Severe anemia is a major cause of maternal deaths – around 20 % globally

Goal 6

Combat HIV/AIDS, Malaria & Other diseasesHave halted by 2015…

Target 7 …and begin to reverse the spread of HIV/AIDS

Malnutrition Hastens onset of AIDS among HIV-positive Weakens resistance to infections and reduces malaria survival rates

Infant & Young Child FeedingInformed choice important for prevention of mother to child transmission of HIV/ AIDS

Linking Nutrition & Development Mechanisms and Instruments

More effective poverty reduction• Nutrition key to addressing inter-generational cycle of poverty• Helps targeting the most vulnerable and at risk• Proxy indicator for multi-sectoral interventions

Strengthened health sector reform• Inclusion of early child care and nutrition increases efficiency and

quality of health services• Using nutrition tools and methods

e.g. Mother Child Care Counseling Package

Improved Governance• Community based care interventions promote participatory

processes and capacity

The Challenge in India

• Every fifth young child in the world lives in India

• Every second young child in India is malnourished

• Three out of four young children in India are anemic

• Every second newborn in India is at risk of reduced learning capacity due to iodine deficiency

• Vitamin A a public health issue• Malnutrition limits development potential

and active learning capacity of the child

0

20

40

60

80

100

120

14019

80

1984

1988

1992

1996

2000

2002

Rural Total Urban

6964

40

Source : SRS Bulletins - RGI

IMR Reduction needs acceleration…

51.5%47.1%

19.3%15.5%

45.5%47.0%

Underweight Stunted Wasted

NFHS 1 (1992-93) NFHS 2 (1998-99)

Children 0- 3 years

Promoting early child development is crucial

Addressing Malnutrition…

% children 0-3 years below -2 SD Weight-for-Age, NCHS

Source : NFHS II, 1998-99

50 %40-49 %30-39%20-29%Data NA

Jammu & Kashmir

Himachal Pradesh

Uttaranchal

Uttar Pradesh

Bihar

Arunachal Pradesh

Nagaland

Manipur

MizoramTripura

WestBengal

Orissa

J

Andhra Pradesh

Tamil Nadu

Kerala

Karnataka

Goa

Maharashtra (49.6%)

Madhya PradeshGujarat

Rajasthan

HaryanaDelhi

Punjab

Sikkim

Assam

Meghalaya

Andaman & Nicobar Islands

Lakshadweep

Pondicherry

Karaikal (Pondicherry)

Dadar & Nagar

Haveli

Daman

Diu

Jharkhand

Chattisgarh

The boundaries and names shown in this map do not imply official endorsement or acceptance by the UN

Prevalence of Underweight Children…(0-3 years)

Improve Infant and Young Child Feeding PracticesIncrease early initiation (colostrum feeding) : 16% to 50% Increase exclusive breastfeeding 0-6 mths : 55% to 80%

(0-3 mths) (0-6 mths)

Increase complementary feeding (6-9 mths) : 34% to 75%

Reduce the prevalence of Underweight (Children Under-3 years) from 47% to 40%Reduce prevalence of severe under-nutrition in children in the 0-6 years age group by 50%

Reduce prevalence of anaemia by 25% and that of moderate/ severe anaemia by 50%

Eliminate Vitamin-A deficiency

Reduce prevalence of IDD to less than 10% by 2010

10th Plan Goals…

Achieving the 10th Plan Goals…

• It is possible to achieve these through relatively simple interventions

• Improved family community care behaviours, focusing on children Under-3 years of age– Infant and Young Child Feeding– Psychosocial Care– Care for girls and women– Hygiene– Health

• Positive evidence from community based care projects - even in challenging states

Preventable Under-5 deaths - India

0 4 8 12 16

Antimalarial I PT in Pregnancy

Insecticide treated materials

Nivirapine & replacement feeding

Measles vaccine

Antibiotics for PRM

Tetanus Toxoid

Newborn temprature management

Antinatal streoids

Vitamin A

Zinc

Clean water, sanitation & hygiene

HiB Vaccine

Clean Delivery

Complementary Feeding

Breast Feeding

Through universal coverage with individual interventions (2000)

Source : Lancet Series

• Build upon innovative state-specific early child care approaches

• Enhance quality improvement initiatives in ICDS

• Increase emphasis on improving family/community early child care practices for younger children Under-3 years in RCH-II & ICDS e.g. Infant and Young Child Feeding

• Strengthen partnerships for WCD Panchayati Raj InstitutionsWomen’s Self Help Groups and community groups

• National Nutrition Mission

Moving Forward…