Eliminate Maternal Malnutrition

How dare you complain and question why women have to eat after men. It is up to us whether we want you to eat after men or not to eat at all.

-Bhutan father to daughter

There is a gender gap in malnutrition...

with women accounting for the majority of underweight and overweight adults in the world. According to 2016 data, 244 million women are underweight compared to 216 million men, and 375 million women are obese compared to 266 million men. Further, 42% of women and 38% of pregnant women in the world suffer from iron-deficiency anemia. Nutritional deficiencies kill more females than males - 138,000 versus 114,000, and high body mass index (BMI) causes more deaths among women (2.54 million) than men (2.48 million), according to the Global Burden of Disease. Malnutrition among women aged 15 to 49 is particularly concerning because of its impact on women's and children's health, as well as on labor force and on educational performance. Women who are malnourished (underweight or obese and/or micronutrient deficient) are more likely to experience birth complications, and give birth to babies born preterm, with low birth weight, and/or congenital defects. These babies have an increased risk of malnutrition and death in early childhood and beyond. An estimated 144 million children are stunted, 47 million are wasted, and 20 million are born with low birth weight each year.

Almost half of undernutrition-related deaths among young women occur in just five countries - India, Pakistan, Bangladesh, Ethiopia, Indonesia, and Madagascar. Similarly, half of all obesity-related deaths among young women occur in a handful of countries, including India, Indonesia, China, Pakistan, and Brazil. Note India, Pakistan, and Indonesia appear on both lists, indicating that they are struggling with a "double burden" of female malnutrition. For example, in India, an estimated 1,900 young women aged 15 to 49 died from nutritional deficiencies, while 35,200 died from obesity-related causes in 2019. In Pakistan, an estimated 1,600 young women died from undernutrition, while 10,200 died from obesity-related causes. As deaths from undernutrition fall, deaths from obesity are rising in many countries.

National nutrition strategies should prioritize improving the nutritional status of women of reproductive age, and strengthen women’s capacity to provide nutritious diets for themselves, their children, and their families. Specifically, countries should set targets for halving underweight and anemia among women 15 to 49 years by 2025, and for eliminating both by 2030. To achieve these goals, nutrition stakeholders should work together to simultaneously increase the supply of foods and supplements designed to meet the nutritional needs of younger adult women, with a special focus on iron-folic acid supplements and iron-fortified staple foods, and encourage their use by educating women, by providing cash transfers conditional on their use, by making cash conditional on other healthy behaviors (e.g., childhood vaccination, prenatal care visits, etc.), and by making them available in the places women frequent daily (e.g., schools, workplaces, and shops). Governments should develop plans to close obesity gender gaps and halve obesity rates among women aged 15 to 49 years by 2030.

The United Nations (UN), its agencies, and partners should support this focus on the nutritional status of women aged 15 to 49 years as the key to achieving the Sustainable Development Goals of ending child malnutrition, addressing the nutritional needs of adolescent girls, pregnant, and breastfeeding women, and reducing by one-third deaths from non-communicable diseases. The UN should encourage all development partners with a stake in meeting these goals to increase investments in high-impact interventions with a proven track record of improving women’s own nutritional status and their capacity to reduce childhood malnutrition. New investments should target the largest populations of malnourished young adult women. Full engagement of the private sector is required to achieve these goals as food is a private market transaction in all but the most fragile of humanitarian settings. The UN should also lead the charge in a data revolution to fill the considerable gaps in our knowledge of the nutritional status of women of reproductive age at national and sub-national levels.

Updated 10 January 2021

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One in three people in the world today is malnourished, which means that either the person reading this is malnourished, or knows someone who is. Malnutrition, ranging from underweight to obesity, now impacts almost every country in one form or another. There are few development challenges that can make this claim.