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December 2020
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Suggested citation: United Nations Children’s Fund. (UNICEF). Nutrition, for Every Child: UNICEF
Nutrition Strategy 2020–2030. UNICEF, UNICEF, New York
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Nutrition, for Every Child is the result of collaboration with a Initiative; Carolyn Moore, SPOON Foundation; Stineke
large number of individuals and organizations. UNICEF would Oenema, United Nations System Standing Committee
like to thank the following colleagues who willingly gave their on Nutrition; Victor Ochieng Owino, International Atomic
time and expertise to develop this vision document, which Energy Agency; Abigail Perry, United Kingdom Department
outlines the UNICEF Nutrition Strategy 2020–2030: for International Development; Ellen Piwoz, Bill & Melinda
Gates Foundation; Victoria Quinn, Helen Keller International;
LEAD STRATEGY TEAM Anushree Rao, Concern Worldwide; Juan Rivera, National
Víctor Aguayo, Maaike Arts, Yarlini Balarajan, France Bégin, Institute of Public Health of Mexico; Marion Roche, Nutrition
Nita Dalmiya, Stefano Fedele, Saul Guerrero, Chika Hayashi, International; Vincent Rousseau, Global Affairs Canada; Sarah
Diane Holland, Josephine Ippe, Roland Kupka, Joan Matji, Rowe, Nutrition International; Meera Shekar, World Bank
Christiane Rudert, Harriet Torlesse, Vilma Tyler, Amirhossein Group; Shelly Sundberg, Bill & Melinda Gates Foundation;
Yarparvar, and Noel Marie Zagre. Christine Stewart, University of California, Davis; Andrea
Torres, Bernard van Leer Foundation; Cesar Victora, Federal
INTERNAL ADVISORY GROUP University of Pelotas; Anne Walsh, Power of Nutrition;
Sophie Whitney, European Commission; Ramani Wijesinha-
Jessica Blankenship, Stanley Chitekwe, David Clark, Marco
Bettoni, Food and Agriculture Organization; and Keith West,
Antonio Estebanez, Grace Funnell, Maureen Gallagher,
Johns Hopkins University.
Melanie Galvin, Aashima Garg, Bernadette Gutmann,
Andreas Hasman, Annette Imohe, Jo Jewell, Julia Krasevec,
INTERNAL REFERENCE GROUP
Richard Kumapley, Anne-Sophie Le Dain, Ines Lezama,
Jennifer Lopez, Shahira Malm, Grainne Moloney, Reuel Youssouf Abdel-Jelil, Jennifer Asman, Bertrand Bainvel,
Kirathi Mungai, Louise Mwirigi, Vrinda Mehra, Siméon Mariavittoria Ballotta, Wivina Belmonte, Octavian Bivol, Pia
Nanama, Anuradha Narayan, Biram Ndiaye, Cristina Perez, Britto, Luciano Calestini, Geert Cappelaere, Philippe Cori,
Dolores Rio, Mawuli Sablah, Joseph Senesie, Deepika Jan Debyser, Alessandra Dentice, Jan Eijkenaar, Paloma
Sharma, Ruth Situma, Irum Taqi, Guy Taylor, Vanya Tsutsui, Escudero, Shaffiq Essajee, Gilles Fagninou, Mohamed
Arjan de Wagt, D’Arcy Williams, and Anna Ziolkovska. Malick Fall, Alison Fleet, Manuel Fontaine, Jean Gough,
Carla Haddad Mardini, Jumana Haj-Ahmad, Mark Hereward,
EXTERNAL ADVISORY GROUP Tomoo Hozumi, Karin Hulshof, Robert Jenkins, Etleva Kadilli,
Afshan Khan, Atif Khurshid, Sun Ah Kim Suh, Marcy Levy,
Nancy Aburto, Food and Agriculture Organization; Nina
Kerida McDonald, Gregor von Medeazza, Grainne Moloney,
Acharya, Global Affairs Canada; Philip Baker, Deakin
Kelly Ann Naylor, Ana Nieto, Bo Viktor Nylund, Luwei
University; Francesco Branca, World Health Organization;
Pearson, Maria Peel, Marita Perceval, Stefan Peterson,
André Briend, Tampere University; Carmen Burbano, World
Marie-Pierre Poirier, Lauren Rumble, Sagri Singh, Gary
Food Programme; Diana Carter, Food and Agriculture
Stahl, David Stewart, Rakshya Rajyashwori Thapa, and
Organization; Nicki Connell, Eleanor Crook Foundation;
Alexandra Yuster.
Antonella Cordone, International Fund for Agricultural
Development; Sandro Demaio, EAT Foundation; Carmel
STRATEGY SUPPORT TEAM
Dolan, Emergency Nutrition Network; Jessica Fanzo, Johns
Hopkins University; Wafaie Fawzi, Harvard University; Yousif Almasri, Christina Calabrese, Tatiana Harmon,
Rafael Flores-Ayala, Centers for Disease Control and Tatiana Nikolaeva, Nicole Ricasata, Joanna Rogowska, and
Prevention; Elizabeth Fox, Johns Hopkins University; Patrizia Sirjana Shakya.
Fracassi, Food and Agriculture Organization; Louisa Frey,
German Federal Ministry for Economic Cooperation and EDITING AND DESIGN
Development; Esther Goh, Bernard van Leer Foundation; Julia D’Aloisio (editing), Vicky Bell (copy editing), and Nona
Amador Gómez, Accion Contra el Hambre Spain; Caitlin Reuter (design).
Gomez, Nutrition International; Alison Greig, Nutrition
International; Hinke Haisma, University of Groningen; UNICEF SENIOR MANAGEMENT GROUP
Lawrence Haddad, Global Alliance for Improved Nutrition; Omar Abdi, Henriette Ahrens, Ted Chaiban, Vidhya Ganesh,
Corinna Hawkes, University of London; Tanya Khara, and Sanjay Wijesekera.
Emergency Nutrition Network; Lauren Landis, World
Food Programme; Anna Lartey, Food and Agriculture The development of Nutrition, for Every Child: UNICEF
Organization; James Levinson, Tufts University; Roger Nutrition Strategy 2020–2030 was made possible with
Mathisen, Alive & Thrive; Marie McGrath, Emergency financial support from the Governments of Canada,
Nutrition Network; Purnima Menon, International Food Germany, Luxembourg, the Netherlands, Norway, the
Policy Research Institute; Erin Milner, United States Agency United Kingdom, and the United States of America.
for International Development; Helen Moestue, Save the
Children, USA; Scott J. Montgomery, Food Fortification
ACRONYMS vi
PREFACE vii
EXECUTIVE SUMMARY viii
Every child has the right to nutrition. And nutrition – from the diets of children and women, to the
today, the need for diets, services and practices care from which they benefit, the food environments in
that protect, promote and support good nutrition which they live, and the ways in which governments and
has never been greater. Since 2000, the world has societies underpin children’s right to nutrition through
reduced the proportion of children under 5 suffering political commitment and societal values.
from undernutrition by one third and the number of
undernourished children by 55 million. This remarkable All UNICEF nutrition programmes across regions and
achievement proves that positive change for nutrition is countries share a universal premise: prevention comes
possible and is happening at scale – but there is more first, in all contexts; if prevention fails, treatment is
work to be done. In 2020, at least one in three children a must. This means that the primary objective of
is not growing well because of malnutrition, and at least our nutrition programmes is to prevent maternal and
two in three are not fed the minimum diet they need to child malnutrition in all its forms across the life cycle.
grow, develop and learn to their full potential. That hurts When efforts to prevent malnutrition fall short, our
not just children – it hurts us all. programmes aim to ensure the early detection and
treatment of children suffering from life-threatening
Our data indicate that the burden of undernutrition and malnutrition.
micronutrient deficiencies remains unsolved, particularly
in low- and middle-income countries, where about 200 The Strategy recommits to rights-based and context-
million children are affected by stunting or wasting specific programmes that are informed by evidence and
and almost twice as many suffer from deficiencies in innovation. We expand our traditional focus on early
vitamins and other essential nutrients. The added strain childhood to middle childhood and adolescence. We
of the COVID-19 pandemic could throw an additional 140 renew our focus on preventing stunting, wasting and
million children into poverty in 2020 and increase the micronutrient deficiencies while increasingly responding
number of undernourished children by 7 million. At the to the challenge of childhood overweight and obesity.
same time, overweight and obesity are rising, including And we propose a systems approach to nutrition that
in low- and middle-income countries. strengthens the ability of five key systems – food,
health, water and sanitation, education, and social
With 10 years remaining in the pursuit of the Sustainable protection – to deliver diets, services and practices
Development Goals, it is time for renewed action on that support adequate maternal and child nutrition,
ending child malnutrition in all its forms, everywhere. making these systems more accountable for sustainable
The COVID-19 pandemic should be a catalyst for nutrition results.
progress, so that no child is left behind: this is not a
time to lower our collective ambition. The UNICEF As Executive Director of UNICEF, I want to emphasize
Nutrition Strategy 2020–2030: Nutrition, for Every Child, my commitment, and the commitment of UNICEF,
sets forth our vision, goal and priorities to support to use all opportunities to work for better nutrition
governments – primary duty bearers of children’s right to in all programming contexts. I am underscoring this
nutrition – and partners, in scaling up policies, strategies commitment by launching the UNICEF Nutrition Strategy
and programmes to end child malnutrition in both 2020–2030: Nutrition, for Every Child. In a world living
development and humanitarian settings. with COVID-19 and increasing inequities, we look
forward to working with governments and other partners
Nutrition has long been at the core of UNICEF’s work. to put children’s right to nutrition first and pave the way
In 1990, our malnutrition framework broke new ground to a more equitable and sustainable future in the decade
in setting out the multiple causes of poor nutrition, to come.
with a focus on child undernutrition. In 2020, we have
rethought our framework to acknowledge the evolving Henrietta Fore, Executive Director
face of child malnutrition – including overweight and
obesity. We emphasize the determinants of good
A triple burden The goal of the Strategy is “to protect and promote
diets, services and practices that support optimal
In 2020, the burden of malnutrition remains unsolved, nutrition, growth and development for all children,
particularly in low- and middle-income countries, adolescents and women”. This goal aims to contribute
where about 200 million children are affected by to the goal of the 2030 Agenda for Sustainable
stunting or wasting and almost twice as many suffer Development to ensure children’s access to nutritious
from deficiencies in vitamins and other essential diets and to end child malnutrition in all its forms.
micronutrients. At the same time the number of
children with overweight and obesity continues to rise, Results areas
increasingly affecting children from poorer households.
Together, these problems can be characterized as a The vision and goals of the Strategy are realized
triple burden of malnutrition facing the world’s children: through programmes that share a universal premise:
undernutrition, in the form of stunting and wasting, prevention comes first, in all contexts; if prevention
widespread micronutrient deficiencies, and a growing fails, treatment is a must. UNICEF nutrition
prevalence of overweight and obesity. programmes aim to prevent child malnutrition in all its
forms across the life cycle. When efforts to prevent
The backdrop of nutrition has changed, and new forces malnutrition fall short, our programmes aim to ensure
drive the nutrition situation of children − globalization, the early detection and treatment of children suffering
urbanization, inequities, environmental crises, health from life-threatening malnutrition, both in development
epidemics and humanitarian emergencies − posing and humanitarian contexts. UNICEF organizes its
critical challenges to feeding children sustainably today programming for maternal and child nutrition into six
and for generations to come. The added strain of the results areas:
COVID-19 pandemic could throw an additional 140
million children into poverty in 2020 and increase the Results Area 1: Early childhood nutrition –
number of undernourished children by 7 million. encompasses UNICEF’s programming for the
prevention of all forms of malnutrition in the first
Vision and goal five years of life, including undernutrition – both
stunting and wasting – micronutrient deficiencies, and
The evolving nature of child malnutrition demands a overweight and obesity.
global multifaceted response that supports optimal
nutrition at every stage of life. The UNICEF Nutrition Results Area 2: Nutrition in middle childhood and
Strategy 2020–2030 sets forth UNICEF’s strategic adolescence – encompasses UNICEF’s programming
intent to support national governments and partners in for the prevention of all forms of malnutrition in
upholding children’s right to nutrition and ending child middle childhood (ages 5–9 years) and adolescence
malnutrition in all its forms. (ages 10–19 years), including through school-based
programmes.
Our vision is “a world where all children, adolescents
and women realize their right to nutrition”. This vision Results Area 3: Maternal nutrition – encompasses
is guided by the Convention on the Rights of the Child, UNICEF’s programming for the prevention of
which recognizes the right of every child to adequate malnutrition in women during pregnancy and
nutrition. breastfeeding − two stages of nutritional vulnerability
for women − and the prevention of low birthweight
in newborns.
Since 2000, the world has reduced the proportion which has an impact on their school readiness, learning
of children under 5 suffering from stunting by one performance and life opportunities. Children suffering
third and the number of children who are stunted from wasting have weak immune systems and face an
by 55 million. This remarkable achievement proves increased risk of infection and death. If they survive,
that positive change for nutrition is possible and they are more susceptible to stunted growth and long-
is happening at scale – but there is more work to term developmental delays.
be done.
Micronutrient deficiencies: Deficiencies in essential
The triple burden of child malnutrition vitamins and minerals can result in devastating
consequences for children’s survival, growth and
In 2020, the nutrition situation of the world’s children development. Vitamin A deficiency, iron deficiency,
is characterized by a triple burden of malnutrition.1 The folic acid deficiency, zinc deficiency and iodine
first burden is the continuing scourge of undernutrition, deficiency – independently or in combination – are
in the form of stunting and wasting, which threatens associated with a significantly increased risk of
the survival, growth and development of millions of mortality, morbidity, blindness, hearing impairment,
children and hampers the development of economies anaemia, poor linear growth and cognitive
and nations. The second burden is micronutrient development, suboptimal learning and school
deficiencies, a hidden form of malnutrition in which performance, and lower productivity and wages in
children lack the vitamins and minerals that are adulthood.
essential for optimal immune response, skeletal
growth and brain development. The third burden Overweight and obesity result when children’s
is the growing prevalence of childhood overweight caloric intake from food and beverages exceeds their
and obesity, once regarded as a condition of the energy requirements. Children affected by overweight
rich and now increasingly affecting children from are at increased risk of obesity and behavioural
poorer households in low-, middle- and high-income and emotional problems in childhood, including
countries. stigmatization, low self-esteem and mental health
problems, including depression. They also suffer
Stunting and wasting result from poor nutrition in an increased risk of obesity and diet-related non-
utero, poor nutrient intake in early childhood and/or communicable diseases later in life, such as type 2
infection and disease. Children affected by stunting diabetes and cardiovascular disease, which is the
may never attain their full linear growth and their brains leading cause of death worldwide.
may never develop to their full cognitive capacity,
The UNICEF State of the World’s Children 2019: • 47 million children under 5 – about 7 per cent
Children, Food and Nutrition indicates that at least one – are wasted. Of these children, almost one third
in three children under 5 is undernourished (stunted, (more than 14 million) are severely wasted. More
wasted or both) or overweight, and at least half suffer than two thirds (69 per cent) of all children who are
from deficiencies in essential micronutrients. The wasted live in Asia and more than one quarter (27
latest available data in the 2020 edition of the UNICEF/ per cent) live in Africa. As many as 92 per cent of
WHO/World Bank Group Joint Child Malnutrition all children who are wasted live in low-income and
Estimates indicate that globally: lower middle-income countries (17 and 75 per cent
respectively).
• 144 million children under 5 – about 21 per
• 38 million children under 5 – nearly 6 per cent
cent – are stunted. In South Asia and sub-Saharan
– are overweight. In two regions, Eastern Europe
Africa, stunting affects one third of children under
and Central Asia, and the Middle East and North
5. About half (54 per cent) of all children who are
Africa, at least 1 in every 10 children under 5 is
stunted live in Asia and more than one third (40
overweight. Almost half (45 per cent) of children
per cent) live in Africa. Ninety-one per cent of the
who are overweight live in Asia and more than
children who are stunted globally live in low-income
three-quarters (78 per cent) of all children who
and lower-middle-income countries (27 and 64 per
are overweight live in lower middle-income and
cent respectively).
upper middle-income countries (37 and 41 per cent
respectively).
FIGURE 1
Distribution of children under 5 in the world by country
income grouping, and distribution of children under 5
affected by stunting, wasting and overweight by income
grouping in 2019
While only about half of all children under 5 live in lower-middle-income countries,
two thirds of all children affected by stunting and three quarters of all children with
wasting live there
Share of children under 5 Share of children under 5 Share of children under 5
affected by stunting in 2019 with wasting in 2019 affected by overweight in 2019
*Share is relative to the total number affected across the four country-income groups; this varies from the global totals reported elsewhere in this document because the official Joint Malnutrition
Estimates global total is based on a model of United Nations regions, 2019. The differences are as follows: Stunting official global estimate is 144.0 million; sum of four country-income groups = 145.8
million. Wasting official global estimate is 47.0 million; sum of country-income groups = 45.3 million. Overweight official global estimate is 38.3 million; sum of four country-income groups = 39.1 million.
144 million
56.1 1.6 are affected by
29.0 28.0 16.9 7.1 0.6
4.7 stunting
South Asia West and Central Eastern and East Asia Middle East Eastern Latin America North
Africa Southern Africa and the and North Europe and and the America2
Pacific Africa Central Asia1 Caribbean Global
FIGURE 5
Number (in millions) of children under 5 affected by stunting, by UNICEF region, 2019
Note: 1. Eastern Europe and Central Asia does not include Russian Federation due to missing data. There is no estimate available for the Europe and Central Asia region or the Western Europe
sub-region, due to insufficient population coverage. 2. North America estimate based on United States data. The sum of UNICEF regional estimates do not add up to global total as the global total
is based on a model for United Nations regions.
25.1 million
47.0 million
12.1 million with wasting 1 in every 3
5.7 million of which
3.3 million
14.3 million children with
0.7 million
have severe wasting is
7.7 m wasting
3.1 m 2.1 m 1.3 m 0.1 m 14.3 m
severely
South
Asia
Sub-Saharan
Africa
East Asia
and the
Middle East
and North
Latin
America
Global
wasted
Pacific Africa and the
Caribbean
FIGURE 6
Number (in millions) of children under 5 with wasting and severe wasting, by UNICEF region and global, 2019
Note: North America as well as Europe and Central Asia are not shown due to very small numbers for severely wasted; there is no estimate available for the
Europe and Central Asia region or Western Europe sub-region due to insufficient population coverage.
15
14 2000 2019
13
12
11 10.4
10
Number (millions)
9
8 7.9 The global
7
6
number of
5.4
5
4.2 4.2
children under
3.8 3.9
4
3
3.3
2.8
3.1 5 affected by
2.3 2.3 2.3
2 1.6 1.4
1.9
overweight has
increased from
1
0
East Asia
and the
Middle East
and North
South Asia Latin America
and the
Eastern and
Southern Africa
West and
Central Africa
Eastern
Europe and
North
America 30 to 38 million
Pacific Africa Caribbean Central Asia*
in the last two
FIGURE 7
Number (in millions) of children under 5 who are affected by overweight, by region, 2000 to 2019
decades
Notes: * Eastern Europe and Central Asia sub-region does not include Russian Federation due to missing data.
Source for all graphs: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2020 edition.
The world is not on course to meet the global The number of children who are stunted declined in all
nutrition targets for children country-income groups of concern except low-income
countries. Similarly, the number of children who are
Child malnutrition rates remain unacceptably stunted declined in all regions except in sub-Saharan
high. Trends indicate that current progress is Africa, where it increased by 7.5 million between 2000
insufficient to achieve the World Health Assembly and 2019.
global nutrition targets (2025) and the Sustainable
Development Agenda goals and targets (2030) Global progress over the last two decades is
for the reduction of child stunting, wasting and insufficient to reach the World Health Assembly and
overweight. the Sustainable Development Agenda target to reduce
the number of children who are stunted by 40 per cent
Stunting by 2025 and 50 per cent by 2030.
The global prevalence of stunting declined from 32.4
per cent in 2000 to 21.3 per cent in 2019, indicating Wasting
a one-third (34 per cent) decline at an average The prevalence of wasting is highly influenced by
annual rate of reduction of 2.2 per cent. The global seasonality in food insecurity and disease patterns −
number of children who are stunted declined from particularly diarrhoea, pneumonia and malaria − making
199 million in 2000 to 144 million in 2019 – a 28 it difficult to identify reliable trends over time.
per cent reduction, with an average annual rate of
reduction of 1.7 per cent.
FIGURE 8
Projections for stunting in children under 5 compared to 2030 targets
50
45
39.3
40 STUNTING
35.7
35
2030 Projected: 17.2%
32.4
30
29.2 Target: 12.1%
26.0
prevalence
24.8
25 23.1 21.3
20.8
20 19.0
17.2
15
10 12.1%
5 Stunting
Projected
0
1990
1995
2000
2005
2010
2012
2015
2019
2025
2030
2020
Notes: SDG 2030 target is a 50% reduction in the number of children under 5 who are stunted.
Source: UNICEF/World Health Organization/World Bank Group Joint Malnutrition Estimates, 2019 edition. Projections are based on analyses conducted by the UNICEF/WHO/World
Bank Income Group Joint Malnutrition Estimates Working Group.
However, in the last decade, the global prevalence who are overweight increased from 30.3 million in
of wasting has hovered around 7-8 per cent and the the year 2000 to 38.3 million in 2019, indicating a
number of children who are wasted has remained 26 per cent increase, with an average annual rate
stagnant at around 50 million. Thus, the global of increase of 1.3 per cent with sizable increases
declines seen in child stunting have not been seen in East Asia and the Pacific (32 per cent), North
in wasting, particularly in South Asia – the global America (35 per cent), Eastern Europe and Central
epicentre for wasting – where the prevalence among Asia (44 per cent) and the Middle East and North
children under 5 is about 15 per cent. Africa (64 per cent).
Global stagnation in child wasting indicates that, However, overweight estimates for older children
unless rates of decline improve significantly, the world help illustrate the true scale of the challenge.
will not achieve the World Health Assembly and the According to the NCD Risk Factor Collaboration, the
Sustainable Development Agenda target to reduce the proportion of children aged 5–19 who are overweight
prevalence of wasting to below 5 per cent by 2025 rose from around 1 in 10 (10.3 per cent) in 2000 to a
and below 3 per cent by 2030. little under 1 in 5 (18.4 per cent) in 2016.2
FIGURE 9 FIGURE 10
Trend in percentage of countries by World Bank income group where at least 10 per cent Increase in overweight among under-5 and
of children aged 5–19 years are overweight 5–19-year-old children and young people
100 18.4
High-income countries
75
Upper-middle-income countries
% 50
10.3 5–19 years
%
25
Lower-middle-income countries
5.5 5.6
Under 5 years
2000
2016
Low-income countries
0
2010
2015
2016
1990
1995
2005
2000
Note: Income classifications are based on World Bank FY19 classifications. Source: UNICEF/World Health Organization/World
Bank Group Joint Malnutrition Estimates and NCD Risk
Source: NCD Risk Factor Collaboration (NCD-RisC) (2017). ‘Worldwide trends in body-mass index, underweight,
Factor Collaboration (2017).
overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies
in 128·9 million children, adolescents, and adults’, The Lancet, 390(10113), pp. 2627–2642
Children’s diets are unacceptably poor across Globally, only about half (49 per cent) of newborns are
the life cycle put to the breast in the first hour of life and less than
half (44 per cent) of infants under 6 months of age are
Children’s nutritional needs evolve and change across exclusively breastfed. Almost all regions have made
every stage of development – in the womb, throughout gains in exclusive breastfeeding: the proportion of
childhood, until the end of adolescence. Despite the infants who are exclusively breastfed increased by 20
importance of good nutrition across the life cycle, per cent between 2005 and 2018. However, millions
an analysis of the most recent data indicates that of children are not receiving these benefits owing to
globally, at all ages, millions of children, adolescents a lack of support for breastfeeding as a public health
and women are not benefiting from diets that support priority, poor counselling and support to mothers who
healthy growth and development. choose to breastfeed, and the aggressive promotion
of breastmilk substitutes. Indeed, between 2008 and
Early childhood 2013, sales of milk-based formula grew by 41 per
cent globally and 72 per cent in upper middle-income
Infancy and early childhood (i.e., the first five years countries.
of life) are a time of rapid growth and nutritional
vulnerability during which young children undergo When children reach 6 months of age, breastmilk alone
vast physiological changes. The first two years of is no longer sufficient to meet their energy and nutrient
life are especially crucial. The absence of exclusive requirements. Children’s nutritional needs between
breastfeeding in the first six months, and the lack the ages of 6 and 23 months are greater per kilogram
of diverse and nutritious complementary foods of body weight than at any other time of life, making
thereafter, can lead to stunting, wasting and them especially vulnerable to nutritional deficiencies
micronutrient deficiencies and can predispose and growth faltering.5 Introducing a diverse range
children to overweight, obesity and diet-related non- of complementary foods alongside breastfeeding
communicable diseases.3,4 protects children against illness and death, ensures
healthy growth and development, prevents stunting,
Breastmilk has no substitute. UNICEF and the World wasting and micronutrient deficiencies in early
Health Organization (WHO) recommend that infants childhood and protects against overweight and
start breastfeeding within one hour of birth, be obesity later in life.
exclusively breastfed for the first six months and
continue breastfeeding until 2 years of age or beyond.
56
54
45
42
FIGURE 11 39 38
Trends in percentage of 35 34 35
33 31
infants aged 0–5 months 28 29
exclusively breastfed, by 23 25
UNICEF region, around 2005 20
and around 2018
Eastern South Latin America West and Eastern Middle East East Asia Global
and Southern Asia and Central Europe and North and Pacific
Africa Caribbean* Africa and Central Africa
Asia*
Notes: Analysis based on a subset of 80 countries with comparable trend data covering 74 per cent of the global population for around 2005 (2003–2008) and for around 2018
(2013–2018). Regional estimates are presented only where available data represent at least 50 percent of the region’s population. *To meet adequate population coverage, Latin
America and Caribbean does not include Brazil and Eastern Europe and Central Asia does not include Russian Federation.
Source: UNICEF Global Databases, 2019.
The most recent data on the quality of complementary cent) of children are fed a minimum diverse diet,
foods and feeding practices indicate that globally two suggesting that factors other than income are at play,
in three children aged 6–23 months (72 per cent) are such as knowledge, convenience and desirability.
not fed even the minimum diverse diet needed to Studies on infant feeding practices in low- and middle-
grow healthy. While most children (more than 75 per income settings have found that young children were
cent) in this age group are fed breastmilk and grains more likely to be fed commercially-produced snack
(wheat, rice, corn or others), 46 per cent are not fed foods than nutritious complementary foods and that
any fruits or vegetables and 60 per cent are not fed children’s preference for such foods outweighed
nutrient-dense foods such as eggs, fish or meat, affordability and other factors in mothers’ decision-
although global recommendations indicate that young making.7 In addition, there is widespread, inappropriate
children should consume such foods daily (or as often promotion of commercial foods, including labelling
as possible).6 and marketing that encourages the introduction of
food before 6 months of age, and the consumption
By region, the poorest dietary diversity figures are of products that contain high amounts of sugar and
recorded in South Asia (18 per cent) and sub-Saharan artificial flavours, with inappropriate food consistency
Africa (22 per cent). Globally, there are stark disparities and false nutritional and health claims.
in the prevalence of minimum dietary diversity by
wealth status. Less than one in five children (18 per Between the ages of 2 and 4 years, children start to
cent) from the poorest households are consuming choose their own food and may eat outside the home,
foods from at least five out of eight food groups, exposing them to new influences. During this stage
indicating that income is a barrier to accessing diverse of life, the positive eating habits and behaviours of
and nutrient-dense complementary foods. Yet even caregivers, family members, educators and peers
in richer households, less than two in five (38 per become particularly influential.8
28%
11% 6%
Notes: Between 2008 and 2013, sales of (typically cow’s) milk-based formula grew by 41 per cent globally and by 72 per cent in upper-middle-income countries such as Brazil,
China, Peru and Turkey. Analysis based on a subset of 73 countries with available data between 2013–2018, covering 61 percent of the global population. Regional estimates are
presented only where available data represent at least 50 percent of the region’s population. *To meet adequate population coverage, East Asia and Pacific does not include China
and Latin America and Caribbean does not include Brazil. Data not available for Europe and Central Asia and North America.
Source: UNICEF Global Databases, 2019.
28 18 21 24 39 62 36
Global South Asia West and Eastern and East Asia and Latin America Middle East and
Fewer than 1 in 3
Central Africa Southern
Africa
the Pacific and the
Caribbean
North Africa
(2018)
children eats foods from
FIGURE 13 the minimum number of
Percentage of children aged 6 –23 months eating at least 5 of 8 food groups
(Minimum Dietary Diversity), by UNICEF region, 2019 food groups
Note: Regional and global estimates based on the most recent data for each country between 2014–2019 with the
exception of China where the latest available estimates are from the year 2013. No data available for the Middle East
and Nort africa regions for 2019, therefore 2018 data is included.
FIGURE 14
Percentage of children aged
6–23 months eating at least 5
of 8 food groups by wealth
Only 1 in 5 children from
quintile and place of % the poorest households
residence, global, 2019
Note: Analysis based on a subset of 74
18 38 21 38 and rural areas eats
countries with disaggregated data available
between 2014-2019 with the exception of Poorest Richest Rural Urban
foods from the minimum
China where the latest available estimates
are from the year 2013.
number of food groups
%
Grains 78 60% of children
Breastmilk 76 worldwide are not
Dairy fed nutrient-dense
48
Vitamin A rich foods like eggs,
fruits & vegetables 44
meat or fish
Flesh foods 30
Other fruits
& vegetables 28 46% of children
Legumes 22 worldwide are not
Eggs 22 fed any fruits or
vegetables
FIGURE 15
Percentage of children aged 6–23 months fed each of the eight food groups, 2019
Note: Analysis based on a subset of 73 countries with data available between 2014–2019 covering 60 per cent of the global population.
While the majority of young children consume breastmilk, they are not eating
enough animal-source foods, fruits, legumes or vegetables and rely heavily
on grains
70
65
55
2 in 3 children aged 6–23
51
months are not eating
% 42
38
foods from the minimum
33 31 number of food groups
26 26
19 18
The youngest children –
15
14
those aged 6–11 months –
have the least diverse diets
FIGURE 16
Percentage of children fed food groups, by type and age, global, 2018
Source: UNICEF Global Databases, 2019
20
31
78 the percentage of young
25
children consuming any of
the other 7 food groups
is systematically higher
61
89
in upper-middle-income
What are young
countries than in low-
25
children eating
and lower-middle-income
18
based on country
income level? countries
83
57
Low-income countries
Upper-middle
income countries*
78
47
47
income countries is nearly
31 twice higher than in low-
48
80
50
and lower-middle-income
countries
FIGURE 17
Percentage of children aged 6–23 months fed food groups, by type, by World Bank income group, 2018
Note for Figure 17: Analysis based on a subset of 72 countries with data available between 2013–2018 covering 61 percent of the global population. Income groupings are based
on the FY19 World Bank income classification. Estimates by World Bank income groups are only displayed if available data represents at least 50 percent of the population. *To
meet adequate population coverage, upper-middle-income countries do not include Brazil, China and the Russian Federation.
Source: UNICEF Global Databases, 2019.
Less autonomy
Source: Elizabeth Fox, ‘Characteristics of children's dietary needs, intake patterns, and determinants that explain their nutrition behaviors’ (unpublished).
CHILDHOOD DIETS
3–19 years
EATING AT SCHOOL
EATING OUT WITH FRIENDS
More autonomy
• Snacking
• Skipping or missing meals
• Negative self-image
• Peer influence on food choice
well. Depending on the local context, adolescents may During pregnancy, diets lacking in nutrients such
perceive either excess weight or thinness as a sign of as iodine, iron, calcium and zinc carry negative
well-being and attractiveness. Research shows that consequences for the mother and the newborn,
eating disorders during adolescence are not limited to including maternal anaemia, pre-eclampsia,
high-income countries.18 haemorrhage, maternal death, newborn death,
premature birth, intrauterine growth retardation and
Food marketing, packaging and aspirational status low birthweight. Indeed, more than 20 million infants
symbols can also greatly influence adolescents’ food annually are born with low birthweight, more than half
choices. Fast food and prepared snacks are widely of them in South Asia.23, 24 Poor quality diets in the
available in urban areas and are especially appealing to post-partum period among breastfeeding mothers
young people; they can also be signs of social status. can negatively affect the quality of breastmilk,
Being able to afford fast food and soft drinks can be maternal micronutrient status, and weight retention.
perceived as a sign of middle- or upper-class status Globally, insufficient progress has been made in
in some contexts, leading adolescents from poorer reducing undernutrition and anaemia among women,
economic backgrounds to look forward to consuming including pregnant women and breastfeeding mothers.
fast food and soft drinks on special occasions to fit in Meanwhile, overweight and obesity have increased,
with their peers.19 with women now bearing a disproportionate burden
of overweight and obesity in low- and middle-income
Pregnancy and breastfeeding countries.25, 26
Inequities
crises
have left the countryside and moved to cities, leaving
ERG
Research shows that the cost of nutrient-rich foods low- and middle-income countries. Shaped by many
is a significant barrier to diversifying young children’s of the forces described above, as well as climate
diets, and that nutritious foods are often the least change and the human-animal interface, today’s health
affordable.36,37 Poorer families tend to select less epidemics can spread more quickly and widely across
expensive, lower-quality food.38 Those in cities may borders. The COVID-19 pandemic has exacerbated
live in ‘food deserts’ where food options that support maternal and child malnutrition through three major
children’s healthy growth and development are scarce, pathways − poor access to nutritious diets, essential
and nutrient-poor, high-calorie, ultra-processed foods nutrition services, and adequate feeding and dietary
are readily accessible and affordable.39 practices – resulting from measures implemented
to stop the spread of the virus (e.g., physical
Environmental crises, including climate-related distancing, school closures, trade restrictions, and
disasters such as extreme heat, drought, floods and country lockdowns); the pressure imposed on the
storms, have doubled in number since 1990. These health system to care for the people infected; and
conditions have damaged agriculture and dramatically the socio-economic shocks resulting from increased
altered the quantity, quality and price of food available unemployment and poverty.
to children and families, causing food crises and
increasing food and nutrition insecurity in rural and Humanitarian emergencies are increasing in
urban areas.40,41,42 Industrial food production also plays number, duration and complexity. Historically, efforts
a major role in climate change, contributing one third to address malnutrition in emergencies have focused
of the greenhouse gas emissions globally,43 and its on identifying and treating children with severe
heavy use of fresh water, fertilizers and pesticides wasting. However, other forms of malnutrition,
has an immense ecological impact, contributing to including stunting and micronutrient deficiencies,
environmental degradation and affecting children’s occur in and are aggravated by emergencies.48
nutrition. Food production is also implicated in the loss In protracted humanitarian crises, the prevalence
of biodiversity, which affects children’s food security of stunting is increasing, while rates of wasting
and dietary diversity.44,45 The lack of diversity in crop continue to be high.49 Between 2005 and 2017, the
production has led to increasingly homogeneous diets average length of crises that received an inter-agency
around the world:46 Just three crops – rice, wheat and funding appeal rose from four to seven years.50 As
maize – now account for nearly two thirds of the global a result, emergency preparedness and response
caloric intake.47 are turning to approaches that combine short- and
long-term solutions to prevent avoidable deaths while
Health epidemics have the potential to threaten protecting, promoting and supporting child growth
global health and nutrition security, with direct and development. In 2019, UNICEF and its partners
and indirect implications for maternal and child treated more than 4 million children with severe
nutrition. Diseases such as Ebola, influenza, severe acute malnutrition in humanitarian settings globally.51
acute respiratory syndrome (SARS) – and the However, future action needs to put emphasis on
coronavirus disease (COVID-19) pandemic – have reducing the number of children affected by wasting,
disproportionately affected vulnerable populations in while providing treatment to those in need.
Improving child nutrition requires a The benefits of a systems approach to maternal and
multifaceted response child nutrition are two-fold:
• It captures the interactions and interconnections
The evolving nature of child malnutrition demands a
across systems – food, health, water and sanitation,
new global response: one that delivers diets, services
education, and social protection – avoiding
and practices that support good nutrition at every
the simplistic thinking that malnutrition has
stage of life while sustaining nutrition-responsive
straightforward determinants that operate along
development for all children, adolescents and women.
linear pathways.
This response must acknowledge the central role of
the food system – working together with the health, • It crystallizes a shared purpose across systems
water and sanitation, education, and social protection – better diets and better nutrition for children,
systems – to provide nutritious, safe, affordable and adolescents and women – recognizing a shared
sustainable diets for children, adolescents and women, responsibility and the need to mobilize attention and
while ensuring adequate nutrition services and positive resources from a variety of governmental, public,
nutrition practices across the life cycle. private and societal actors.
FIGURE 19
Improving maternal and child nutrition requires a
systems approach
The health system needs to invest in the nutrition services by removing barriers to pre- and postnatal
knowledge and skills of primary health care workers, care and nutrition counselling and through vouchers
who are the front line between the health system, for school-based nutrition programmes, for example.
children and families. Services to prevent malnutrition In addition, the social protection system is essential
– such as support for breastfeeding, complementary to protect household food and nutrition security by
feeding, micronutrient supplementation, deworming, preventing the depletion of livelihoods, including in
dietary counselling, and maternal nutrition – must emergency situations.
be delivered during pre- and postnatal health care
contacts. Screening for and addressing anaemia, Nutrition has gained greater attention in recent years.
micronutrient deficiencies, growth faltering and Governments are increasingly laying out policies,
overweight also require health system skills and programmes and budgets to improve the nutrition
supplies. Finally, governments should systematically situation of children. For these investments to foster
integrate the early detection and treatment of children real change, governments and their development
with wasting into routine services, given the high partners must recognize two key realities:
mortality risk associated with wasting.
• The nutritional needs of children are unique, and
uniquely important. Preventing child malnutrition,
The water and sanitation system plays a critical
in all its forms, must be a national development
role in preventing all forms of malnutrition by ensuring
priority, and children, adolescents and women
access to free, safe and palatable drinking water and
must therefore be at the heart of food and nutrition
safe sanitation and hygiene services. Safe drinking
policies, strategies and programmes, in all contexts.
water is key to a good diet, and safe sanitation protects
children from infection and enteropathy, ensuring their • There are no magic bullets to address child
bodies can use nutrients fully. Although investments malnutrition sustainably. Countries will only meet
in water and sanitation infrastructure are important, the challenge of child malnutrition by working
social and behaviour change communication to protect, across five systems: food, health, water and
promote and support safe food handling and optimal sanitation, education, and social protection. These
feeding and hygiene practices – including handwashing systems need to be made accountable for nutrition
with soap at critical times – must be mainstreamed in results.
communities, health facilities and schools.
Governments must lead action against child malnutrition,
The education system can deliver interventions to in all contexts, driving policies, programmes and budgets
support good diets and good nutrition. In schools, for child nutrition. Yet, the path to good nutrition for all
nutrition education should ensure that children and children, adolescents and women demands a shared
families learn to make adequate food choices. Schools purpose, with commitments and investments required
should promote healthy food environments, with from governments, development partners, civil society
access to nutritious foods and safe and palatable organizations, the private sector, training and research
drinking water, and zero tolerance for junk food institutions, and the media.
and beverages. In some contexts, school feeding
programmes may be needed for vulnerable children.
In addition, schools can deliver integrated programmes
for the prevention of anaemia and micronutrient
deficiencies through micronutrient supplementation,
point-of-use fortification, deworming prophylaxis and
counselling to encourage dietary habits that support
healthy growth and development.
The social protection system can provide a crucial
safety net to improve the diets and nutrition of
children, adolescents and women from the most
vulnerable families. Social protection programmes can
improve access to nutritious and diverse diets through
food transfers, food vouchers or cash transfers.
They can also secure access to essential nutrition
This document lays out UNICEF’s strategic intent to support national governments
and partners in upholding children’s right to nutrition and ending child malnutrition
in all its forms.
Chapter 1, Child Malnutrition Today, describes the Chapter 5, Results Areas, describes what UNICEF
triple burden of malnutrition globally, its impact on nutrition programmes do in six results areas. Under
the lives of children, and the forces shaping children’s each results area, we describe the results to which we
diets and nutrition. It calls for a systems response intend to contribute and our programmatic priorities
that delivers diets, services and practices that support and actions. All UNICEF nutrition programmes across
good nutrition at every stage of life while sustaining regions and countries share a universal premise:
nutrition-responsive development for all children, prevention comes first, in all contexts; if prevention
adolescents and women. fails, treatment is a must.
Chapter 2, Vision, Goal and Objectives, presents Chapter 6, A Systems Approach to Nutrition,
a declaration of intent for UNICEF’s role in maternal outlines how UNICEF intends to strengthen five
and child nutrition. It outlines the vision, goal and key systems – food, health, water and sanitation,
objectives of the UNICEF Nutrition Strategy 2020– education, and social protection – to deliver diets,
2030, which are guided by the Convention on the services and practices that support adequate nutrition
Rights of the Child and contribute to the goal of the for children. It describes the results to which UNICEF
2030 Agenda for Sustainable Development to end aims to contribute and our priorities for engagement in
child malnutrition in all its forms. making these systems more accountable for nutrition.
Chapter 4, Programming Principles, presents the The Strategy Framework (right) reflects the
six universal principles of UNICEF programming for different elements of the UNICEF Nutrition
maternal and child nutrition. These principles guide Strategy 2020–2030 and how they are inter-linked.
the design and implementation of UNICEF nutrition
programmes that are rights-based, equity-focused,
gender-responsive, context-specific, evidence-
informed and systems-centred.
VISION
NUTRITION, A world where all children, adolescents and
FOR EVERY CHILD women realize their right to nutrition.
To protect and promote diets, services and practices that support optimal
GOAL nutrition, growth and development for all children, adolescents and women
Results Area 6
Partnerships and governance for maternal and child nutrition
PARTNERSHIPS RESOURCES
Governments and partners Human and financial
IMPLEMENTING
THE STRATEGY
PROGRAMMING APPROACHES
• Situation analysis • Advocacy • Policy design • Programme scale-up • Community
engagement • Capacity building • Supply chains • Financing • Data, monitoring and evaluation
• Knowledge, innovations and learning
The Convention on the Rights of the Child builds on past guidance,54 strategic plans,55 and
recognizes every child’s right to nutrition, from birth programme experience,56 and supports the goals of
to 18 years of age. UNICEF has been a global force the 2030 Agenda for Sustainable Development.57
behind the ratification of the Convention by 196 The Strategy outlines UNICEF’s intention to support a
countries, making it the world’s most widely ratified global response to the challenge of child malnutrition
human rights treaty.52 As the Convention celebrates over the next decade, with national governments and
its thirtieth anniversary (1989–2019), we recognize partners.
the great progress achieved in realizing children’s right
to nutrition, while also acknowledging that millions of Four features make UNICEF uniquely positioned
children are still not growing, developing and learning to mobilize national, regional and global partners –
to their full potential as a result of malnutrition in its across public and private sectors – to tackle the global
multiple forms. challenge of child malnutrition:
• UNICEF's nutrition mandate for every child –
The 2030 Agenda for Sustainable Development
including children affected by humanitarian crises −
is a plan of action for people, planet and prosperity.
through our role as Sector and Cluster Lead Agency
Its 17 Sustainable Development Goals seek to end
for Nutrition.
poverty and hunger, in all their forms and dimensions,
ensuring that all human beings can fulfil their • UNICEF’s multisectoral mandate for children and our
potential in dignity and equality; protect the planet expertise and experience in nutrition, health, water
from degradation, including through sustainable and sanitation, education, protection and social policy.
production and consumption; and ensure current and • UNICEF’s wide on-the-ground presence, with over
future generations can enjoy prosperous and fulfilling 12,000 staff and nutrition programmes for children,
lives resulting from sustainable economic and social adolescents and women in more than 130 countries.
progress in harmony with nature.53
• UNICEF’s long-standing role as a trusted adviser
The UNICEF Nutrition Strategy 2020–2030, is to national governments and partners at national,
guided by the Convention of the Rights of the Child, regional and global levels.
The UNICEF Nutrition Strategy 2020–2030 is guided by the Convention of the Rights of the Child and supports the goals of the 2030 Agenda
for Sustainable Development, which – like children’s rights – are universal, indivisible and interdependent, balancing the economic, social,
cultural and environmental dimensions of sustainable development.
VISION
A world where all children, adolescents and women realize their right
to nutrition.
The vision of the UNICEF 2020–2030 Nutrition Strategy is guided by the Convention on the Rights of the Child,
which recognizes that adequate nutrition is the right of every child, everywhere.
GOAL Good
Diets
To protect and promote diets,
services and practices that support
optimal nutrition, growth and
development for all children,
Good
adolescents and women. Nutrition
The goal of the UNICEF 2020–2030 Nutrition for Children,
Strategy contributes to the goal of the 2030 Adolescents
Agenda for Sustainable Development to ensure and Women
children’s access to nutritious diets and to end
child malnutrition in all its forms.
Good Good
Practices Services
OBJECTIVES
The Strategy supports four nutrition objectives for children, adolescents and
women in both development and humanitarian contexts.
Objective 1: To prevent undernutrition, micronutrient deficiencies and overweight in early childhood (i.e., the first
five years of life).
Objective 2: To prevent undernutrition, micronutrient deficiencies and overweight in middle childhood and
adolescence (i.e., 5–19 years of age).
Objective 3: To prevent undernutrition, micronutrient deficiencies and overweight in women – particularly during
pregnancy and breastfeeding – and to prevent low birthweight in newborns.
Objective 4: To ensure the early detection and treatment of wasting and other forms of life-threatening acute
malnutrition in early childhood.
1 2 3
An explicit focus A comprehensive life A deliberate emphasis on
on addressing child cycle approach to improving diets, services
malnutrition in all its forms. nutrition programming. and practices.
The UNICEF Nutrition Strategy The Nutrition Strategy 2020–2030 The goal of the UNICEF Nutrition
2020–2030 is guided by the calls for UNICEF programmes Strategy 2020–2030 is to protect
Convention on the Rights of to focus on four key stages of and promote diets, services
the Child, which recognizes life – early childhood, middle and practices that support
every child’s right to nutrition. childhood, adolescence, and optimal nutrition for all children,
Malnutrition, in all its forms, is a motherhood – with specific adolescents and women. This
violation of this right. Hence, the programmatic priorities and goal is guided by the 2020
Strategy aims to contribute to intended results for each stage Conceptual Framework on the
addressing the triple burden of of life. While maternal and child Determinants of Maternal and
child malnutrition: undernutrition, nutrition during the first 1,000 Child Nutrition, which builds on
both stunting and wasting; days – from conception to age previous conceptual thinking
deficiencies in vitamins and other 2 years – remains core to UNICEF by UNICEF. Acknowledging the
micronutrients; and overweight, programmes in all contexts, good triple burden of malnutrition,
obesity and diet-related non- nutrition during middle childhood the Framework highlights the
communicable diseases. and adolescence is both a right centrality of nutritious, safe and
Therefore, the Strategy is aligned and a window of opportunity affordable diets and adequate
with the 2030 Agenda for for growth, development and nutrition services and practices as
Sustainable Development, which learning, particularly for girls, and the foundation of good nutrition
calls for an end to malnutrition in for breaking the intergenerational for children, adolescents and
all its forms. cycle of malnutrition. women.
4 5 6
A systems approach A greater attention A universal vision and
to maternal and child to private sector agenda relevant to all
nutrition. engagement. countries.
Most of the nutrition results Good governance for nutrition Children’s right to nutrition is
that we aim to achieve require requires public and private universal and so is the UNICEF
engagement with multiple partners that are accountable Nutrition Strategy 2020–2030.
systems to ensure that all children for supporting children’s right to Operationally, the Strategy is
benefit from nutritious and safe nutrition. National governments particularly relevant to low-
diets, adequate nutrition services, have primary accountability for and middle-income countries,
and positive nutrition practices. upholding this right; however, the where UNICEF programmes
Therefore, the Nutrition Strategy private sector has a key role to play and country presence are larger
2020–2030 calls for UNICEF as a provider of food, goods and and the triple burden of child
programmes to strengthen the services. The UNICEF Nutrition malnutrition is greater. However,
capacity and accountability of Strategy 2020–2030 calls for with the increasing burden of
five key systems – food, health, UNICEF programmes to engage child overweight, obesity and
water and sanitation, education, strategically with public and diet-related non-communicable
and social protection – to deliver private sector actors to advocate diseases, UNICEF is strengthening
nutritious diets, essential nutrition for business policies, practices its work through country offices
services and positive nutrition and products that support and national committees in high-
practices for children, adolescents optimal nutrition for all children, income countries to advocate
and women. As a multisectoral adolescents and women, in all for and support policies and
agency for children, UNICEF is contexts. programmes that protect the right
positioned to support a systems of all children to adequate nutrition.
approach to nutrition that drives
sustainable results.
The UNICEF Nutrition Strategy 2020–2030 • Second, it highlights the role of diets and care as
introduces UNICEF’s Conceptual Framework on the immediate determinants of maternal and child
Determinants of Maternal and Child Nutrition, 2020. It nutrition. Good diets are driven by adequate food and
builds on UNICEF’s 1990 Conceptual Framework on feeding. Good care is driven by adequate services
the Causes of Child Malnutrition,58 which has guided and practices. Diets and care influence each other.
nutrition programming over the last decades, and The co-occurrence of good diets and good care leads
differs from it in three ways: to adequate nutrition for children and women across
the life course.
• First, it acknowledges the evolving face of child
malnutrition, which manifests itself as a triple • Third, it uses a positive narrative about what
burden: undernutrition, including stunting and contributes to good nutrition in children and
wasting; deficiencies in essential vitamins and women, providing conceptual clarity about the
other micronutrients; and overweight and obesity. enabling, underlying and immediate determinants
These forms of malnutrition, which often coexist, of adequate nutrition; their vertical and horizontal
are driven by poor diets and poor care practices interconnectedness; and the positive survival,
and services. growth, development, performance and economic
outcomes resulting from improved nutrition.
DIETS CARE
Immediate Good diets, driven by adequate food and Good care, driven by adequate services and
determinants feeding for children and women practices for children and women
RESOURCES NORMS
Sufficient resources – including Positive social and cultural norms and
environmental, financial, social and human actions to advance children’s and
resources – to enable children’s and women’s right to nutrition
Enabling women’s right to nutrition
determinants
GOVERNANCE
Good governance – including political, financial, social and public and private sector actions –
to enable children's and women's right to nutrition
FIGURE 20
UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition, 2020.
A framework for the prevention of malnutrition in all its forms.
FOOD
FEEDING
ENVIRONMENTS
Enabling Underlying Immediate
Outcomes
determinants determinants determinants
IMPROVED NUTRITION FOR
GOVERNANCE DIETS CHILDREN AND WOMEN
RESOURCES CARE
NORMS
The enabling determinants • Governance: Good governance refers to the political, financial, social
are the political, financial, social, and public and private sector actions needed to enable children’s and
cultural and environmental women’s right to nutrition.
conditions that enable good
• Resources: Sufficient resources refer to the environmental, financial,
nutrition for children and women. In
social and human resources needed to enable children’s and women’s
the 2020 Conceptual Framework,
right to nutrition.
the enabling determinants are
organized into three categories: • Norms: Positive norms refer to the gender, cultural and social actions
to enable children’s and women’s right to nutrition.
The underlying determinants • Food, which comprises age-appropriate, nutrient-rich foods – including
are the food and nutrition services breastmilk and complementary foods for children in the first two years
and practices available to children of life – with safe drinking water and household food security for all
and women in their households, children and women.
communities and environments to
• Feeding, which comprises age-appropriate dietary practices – including
enable good nutrition. In the 2020
breastfeeding, responsive feeding and stimulation in early childhood
Conceptual Framework, they are
– with adequate food preparation, food consumption and hygiene
organized into three categories:
practices for all children and women.
• Environments, which comprise healthy food environments, adequate
nutrition, health and sanitation services, and healthy living environments
that prevent disease and promote good diets and physical activity for all
children and women.
The immediate determinants • Diets: Good diets are driven by adequate food and feeding to support
of maternal and child nutrition are good nutrition for children and women.
diets and care, which influence
• Care: Good care is driven by adequate services and practices to
each other.
support good nutrition for children and women.
The co-occurrence of good diets and good care leads to adequate nutrition
for children and women across the life course.
The outcomes resulting from • In childhood and adolescence – Improved survival, health, physical
improved nutrition for children and growth, cognitive development, school readiness and school
women manifest in the short and performance.
long term and include:
• In adulthood and for societies – Improved survival, health,
productivity and wages in adults, and improved prosperity and social
cohesion for societies.
The vision of the UNICEF Nutrition Strategy 2020–2030 is universal, applying equally to children, adolescents
and women everywhere. This vision is implemented through programming at the global, regional, national and
subnational levels, guided by six principles:
To achieve the vision, goal and objectives of the Nutrition Strategy 2020–2030, UNICEF organizes its
programming for maternal and child nutrition into six results areas, each of which encompasses a set of specific
programmatic priorities.
All UNICEF nutrition programmes across regions and countries share a universal premise: prevention
comes first, in all contexts; if prevention fails, treatment is a must.
• Prevention comes first, in all contexts: The • Treatment is a must if prevention fails: When
primary objective of UNICEF nutrition programmes efforts to prevent malnutrition fall short, UNICEF
is to prevent malnutrition in all its forms across nutrition programmes aim to ensure early detection
the life cycle: throughout early childhood, middle and treatment of children with life-threatening
childhood and adolescence and during pregnancy malnutrition through facility- and community-based
and breastfeeding. approaches, in all contexts.
The following sections outline UNICEF’s six results areas for nutrition, the intended results under each
NEEDS
STRATEGY
results area, and the programmatic priorities guiding their achievement between 2020 and 2030:
Results Area 1: Early childhood nutritionXT–-SPE Results Area 4: Nutrition and care for children
E C
encompasses UNICEF’s programming for the with wasting – encompasses UNICEF’s programming
IF I
C ON
C
prevention of all forms of malnutrition in the first for the early detection and treatment of wasting in
RESOURCES
G
PR
five years of life, including undernutrition –O Gboth early childhood, through facility-and community-based
IN
RAMM
stunting and wasting – micronutrient deficiencies and approaches, as part of a continuum of nutrition, care
PARTNERSHIPS
overweight. and support for children.
Results Area 2: Nutrition in middle childhood and Results Area 5: Maternal and child nutrition in
adolescence – encompasses UNICEF’s programming humanitarian action – encompasses UNICEF’s
for the prevention of all forms of malnutrition in middle nutrition programming in emergencies and is guided
childhood (ages 5–9 years) and adolescence (ages by UNICEF’s Core Commitments for Children in
10–19 years), including undernutrition, micronutrient Humanitarian Action and UNICEF’s commitments as
deficiencies and overweight. Cluster Lead Agency for Nutrition.
Results Area 3: Maternal nutrition – encompasses Results Area 6: Partnerships and governance for
UNICEF’s programming for the prevention of all nutrition – encompasses UNICEF’s programming
1
forms of malnutrition in women during pregnancy and to strengthen the enabling environment for 3maternal 2
breastfeeding − including undernutrition, micronutrient and child nutrition at global, regional and country
5 level
4
6
deficiencies and overweight − and the prevention of through improved partnerships, data, knowledge,
7
8
9
low birthweight in newborns. advocacy and financing. 10
10 inter-related
6
programming
Resources
approaches
10
Partnerships
A guiding principle of the Strategy is context-specific programming, which is informed
by an analysis of the nutrition situation of children, adolescents=
and women in a given
context (determinants, drivers and potential impact pathways) and the human and =
+ and partnerships+available. The triangulation of needs, resources and
financial resources
partnerships allows UNICEF to identify the results areas and programmatic priorities of
the Strategy that are relevant to a given context. The Strategy keeps UNICEF nutrition
programmes coherent across regions, countries and programming contexts.
Needs
+ + =
prioritize and tailor to local contexts
Resources Partnerships
Nutrition situation
of children and women + Relevant results areas
and programmatic priorities
= Context-specific
nutrition programming
0 0-5 6 23
Start breastfeeding Breastfeed exclusively for Provide nutritionally adequate, age-appropriate and safely prepared complementary
within one hour of birth the first 6 months of life foods starting at 6 months; and continue breastfeeding until age 2 or longer
2. Women’s nutrition during pregnancy: UNICEF 5. Innovations for maternal nutrition: UNICEF
advocates for and supports policies, strategies and tests innovations for improving women’s nutrition
programmes that reflect global recommendations during pregnancy and breastfeeding, such as those
on healthy eating, micronutrient supplementation related to the provision of high-quality nutrition
(either iron and folic acid or multiple micronutrients, counselling, monitoring pregnancy weight gain, use
and calcium), deworming prophylaxis, weight of multiple micronutrients and calcium supplements
gain monitoring, physical activity and rest for during pregnancy, and the use of balanced energy-
pregnant women, and strengthen the quality of protein supplements for adolescent mothers and
nutrition counselling during antenatal care, in line nutritionally at-risk women. Globally, we aim to
with the Recommendations on Antenatal Care for a shape markets to increase access to low-cost,
Positive Pregnancy Experience.62 high-quality micronutrient supplements and other
commodities, and drive product innovation.
The WHO Recommendations on Antenatal Care • Supplementation with iron and folic acid or multiple
micronutrients
for a Positive Pregnancy Experience63 provide an
unprecedented opportunity to ensure the integrated • Deworming prophylaxis
delivery of nutrition services as part of routine antenatal • Calcium supplementation
care. In implementing these recommendations, countries • Care and support for nutritionally at-risk women
Programme commitments for nutrition begin with They are accompanied by an indicators framework to
coordination and nutrition information. They are streamline institutional reporting (see annex for the
complemented by commitments to ensure access to full text of UNICEF’s Core Commitments to protect,
diets, services and practices through the life cycle, and promote and support maternal and child nutrition in
reflect the imperative of prevention first and treatment humanitarian action).
HEALTH: Strengthening primary HIV: Eliminating parent-to- WASH: Universal and equitable
health care services for children child transmission of HIV. access to safe drinking water and
and women. Strengthening Early and effective testing and sanitation. Strengthening national
primary health care and providing treatment for HIV infection systems to deliver safe drinking
equitable access to essential health among pregnant women and their water, end open defaecation
services for children and women infants, and expanded treatment and support the safe disposal of
improves pregnancy outcomes, with antiretrovirals, can prevent faecal waste – including through
including birthweight, and the mother-to-child transmission community-led approaches to
prevention and treatment of of HIV. Expanded access to total sanitation – helps children
infection in children and women. HIV services for adolescents stay healthy and free of disease.
Nutrition outcomes are better – including prevention, Nutrition outcomes are better
among children born to women counselling, testing and treatment among children, adolescents and
who have access to maternal and – can contribute to the virtual women living in households with
child health services, including elimination of parent-to-child access to safe drinking water and
reproductive health, antenatal transmission of HIV. Nutrition sanitation facilities.
care, immunization and services outcomes are better among
for the treatment of common children born to parents who have
childhood illnesses. access to HIV prevention, testing
and treatment services.
The evolving face of child malnutrition demands a Improving the quality of children’s diets, for example,
new global response: one that delivers diets, services requires a food system that produces a range of
and practices that support good nutrition for children, nutritious foods that are available and affordable to
adolescents and women while sustaining nutrition- families; a health system with well-trained staff at
responsive development at every stage of life, in facility and community level to counsel caregivers on
all contexts. Some of the nutrition results outlined the benefits of a nutritious, diverse diet for children; a
in Chapter 5 can be achieved with the support of water and sanitation system that provides free, safe
only one system, but most require engagement and palatable drinking water for a healthy diet and
with multiple systems to ensure that all children, the safe preparation of foods; and a social protection
adolescents and women benefit from nutritious system that reduces inequalities by ensuring that
diets, adequate nutrition services and positive nutritious foods are affordable to vulnerable children
nutrition practices. and families.
FIGURE 21
A systems approach to
maternal and child nutrition
Source: UNICEF. Maternal and Child Nutrition UNICEF Strategy 2020–2030. UNICEF: New York; 2019
58 UNICEF NUTRITION STRATEGY 2020 –2030
A SYSTEMS APPROACH TO NUTRITION
The food The health The water and The education The social
system needs to system is a key sanitation system system offers protection system
empower children, delivery platform plays a critical role in a large platform can provide a
adolescents and for the prevention preventing all forms for improving crucial safety net
families to demand and treatment of malnutrition by children’s diets, for improving
nutritious foods. of malnutrition, ensuring access delivering nutrition the diets and
Secondly, it needs providing to free, safe and services, and nutrition of children
to ensure that multiple contact palatable drinking fostering positive from the most
nutritious and opportunities water and safe nutrition practices vulnerable families
safe foods are with children, sanitation and among children, by addressing the
available, affordable adolescents hygiene services. adolescents and underlying causes
and sustainable. and women. Safe drinking water families, while of malnutrition.
Finally, it needs As such, health is an essential nurturing a new Social protection
to create healthy systems need to component of generation of programmes
food environments. promote nutritious good diets, while well-nourished and can improve the
Evidence shows and safe diets, safe sanitation nutrition-literate affordability of
that when deliver preventive and hygiene boys and girls nutritious and
nutritious options nutrition services, services foster across contexts, diverse diets,
are affordable, treat severely clean and healthy including rural, increase access to
convenient and undernourished environments that urban, development essential nutrition
desirable, children, children, and protect children, and humanitarian services and
adolescents and foster positive adolescents and settings. contribute to the
families make better nutrition practices women from adoption of positive
food choices. in households and nutrient losses. nutrition practices.
communities.
The food system comprises the policies, services As highlighted in Chapter 1, the food system needs to
and actors needed to ensure a population’s access operate in ways that empower children, adolescents
to good diets – defined as diets that are nutritious, and families to demand nutritious foods. Secondly,
safe, affordable and sustainable. Food systems it needs to ensure that nutritious foods are available
bear critical responsibility for the nutritional quality, and affordable. Finally, it needs to create healthy food
safety, availability and affordability of children’s environments. Governments must set standards that
diets.73 However, food systems often fail to account are aligned with children’s best interests and create
for the special nutritional needs of children when a level playing field for food producers and suppliers.
determining what foods need to be produced, Producers and suppliers need to ensure that their
processed, packaged, stored and marketed. Further, actions – including food production, labelling and
the cost of nutritious foods puts them out of reach for marketing – are aligned with such standards. Evidence
many households, whereas ultra-processed and less shows that when nutritious options are affordable,
nutritious foods may be widely available, affordable convenient and desirable, children and families make
and marketed. Food environments are often profit- better food choices. UNICEF works to improve the
driven rather than child-centred, making it challenging quality of children’s foods, food environments and
for children and families to make good food choices. food practices. This involves leveraging the policies,
services, resources and actors of the food system to
make them more accountable for improving the diets
and dietary practices of children, in all contexts.
UNICEF works to improve the quality
of children’s foods, food environments
and food practices. Drivers of Social
food systems and cultural
Personal food environments drivers
(Individuals and households)
Political
and economic
Demographic drivers
drivers
Key components
Production of food
Storage and distribution Key components
Processing and packaging Socioeconomic characteristics
Retail and markets External food environments Intra-household dynamics
Acceptability and desirability of food
(Retail and commercial markets, Food preparation and eating patterns
schools, informal food vendors)
Biophysical
18% 1%
and environmental
FIGURE 22 drivers
Key components
The Innocenti Framework Innovation and Availability of food
technological Price of food
on Food Systems for drivers Quality and safety of food
Children and Adolescents Marketing and regulation of food
The health system comprises the policies, As highlighted in Chapter 1, the health system needs
programmes and actors that ensure a population’s to invest in the nutrition knowledge and skills of health
access to health services. Strong health systems workers, who are the front line between the health
promote nutritious and safe diets, deliver preventive system, children and families. Services to prevent
nutrition services, treat severely undernourished malnutrition – such as counselling and support for
children, and foster positive nutrition practices in breastfeeding, complementary feeding, and maternal
households and communities. They also enable and child nutrition – must be delivered during pre-
equitable nutrition outcomes in the context of universal and postnatal health care contacts. Prevention of
health coverage, ensuring that nutrition services anaemia, micronutrient deficiencies, growth failure
reach all children in need.75 Health systems are a key and overweight also require health system skills and
delivery platform for the prevention and treatment of supplies. Finally, governments should systematically
malnutrition, providing multiple contact opportunities integrate the early detection and treatment of child
with children and women, such as antenatal and wasting into routine health services, given the high
postnatal care services, immunization and well-child mortality risk associated with wasting. UNICEF
visits, sick-child consultations, community-based leverages the policies, programmes, resources and
services, and facility-based care. However, all too actors of the health system to make them accountable
often, health systems do not effectively integrate for improving maternal and child nutrition, in
nutrition services. all contexts.
The water and sanitation system comprises the Safe drinking water, sanitation and good hygiene are
policies, programmes, services and actors needed to critically important in households, schools, health
ensure a population’s access to safe drinking water and facilities and communities, in both development and
safe sanitation and hygiene services. As highlighted humanitarian contexts. Although investments in water
in Chapter 1, the water and sanitation system plays a and sanitation infrastructure are important, social and
critical role in preventing all forms of malnutrition by behaviour change communication to promote safe
ensuring access to free, safe and palatable drinking food handling, optimal feeding and hygiene – including
water and safe sanitation and hygiene services. handwashing with soap at critical times – must be
mainstreamed in communities, health facilities and
Safe drinking water is an essential component of schools.
good diets, while safe sanitation and hygiene services
foster clean and healthy environments that protect UNICEF leverages the policies, strategies and
children from nutrient losses arising from diarrhoea, programmes of the water and sanitation system to
intestinal worm infections and environmental enteric make them more accountable for improving the diets
dysfunction, ensuring children’s bodies can use and nutrition of children, adolescents and women, in
nutrients fully. all contexts.76
The education system comprises the policies, free, safe and palatable drinking water; and zero
programmes, services and actors that ensure a tolerance for ‘junk’ food and beverages. In some
population’s access to education. The education contexts, school feeding programmes may be
system offers a large infrastructure – including pre- needed for vulnerable children. The education system
primary, primary and secondary schools – to help can also deliver programmes to address anaemia,
children acquire knowledge, develop skills and realize micronutrient deficiencies through micronutrient
their right to learn. All countries have more schools supplementation and deworming prophylaxis.
than health facilities and more teachers than health Finally, schools can be a key platform to encourage
workers. The education system therefore offers an and support dietary habits that promote healthy
important platform for improving children’s diets, growth and development and contribute to building
delivering nutrition services and fostering positive a new generation of well-nourished and nutrition-
nutrition practices among children, adolescents and literate boys and girls.
families across a range of contexts, including rural,
urban, development and humanitarian settings. UNICEF leverages the policies, strategies and
programmes of the education system to make them
In schools, nutrition education should ensure more accountable for improving the diets, physical
that children and families learn how to choose activity and nutrition of children and adolescents, in
nutritious foods. Schools should promote healthy all contexts.77
food environments, with access to nutritious foods;
Social protection comprises a set of policies and Social protection programmes can also be designed
programmes aimed at protecting all people against to facilitate and ensure access to nutrition, health and
poverty, fragility and social exclusion, with a particular education and other services. This may include, for
emphasis on vulnerable groups.78 As highlighted in example, providing incentives for accessing pre- and
Chapter 1, the social protection system can provide a postnatal care and nutrition counselling, or removing
crucial safety net for improving the diets and nutrition barriers to school-based nutrition programmes through
of children from the most vulnerable families by vouchers. Cash plus schemes and other programmes
addressing the underlying causes of malnutrition. can also contribute to the adoption of positive nutrition
Social protection programmes such as food transfers, practices.
vouchers or cash transfers can improve access to
nutritious and diverse diets. They can also increase UNICEF leverages the policies, strategies and
household resources, make nutritious foods programmes of the social protection system, as well as
more affordable and improve dietary diversity and those of the broader public financing system, to make
quality. Social protection systems should be shock them more accountable for improving the diets and
responsive in times of humanitarian and economic nutrition of the most vulnerable children, adolescents
crisis. and women, in all contexts.
Our intended result 3. Social policies for maternal and child nutrition:
UNICEF advocates for and supports the design
• Social protection systems protect, promote and and implementation of social policies that protect,
support diets, services and practices that prevent promote and support maternal and child nutrition.
malnutrition in all its forms among vulnerable These include maternity protection and other
children. family-friendly policies, such as paid parental leave,
breastfeeding breaks, dedicated nursing spaces,
Our priority areas for engagement childcare in the workplace, and the inclusion
of maternity and paternity benefits in national
1. Evidence on poverty, malnutrition and social
legislation.
protection: UNICEF supports the generation
of data and knowledge to better understand the 4. Nutrition-responsive social protection systems
linkages between poverty and child malnutrition – for children and women: UNICEF advocates
including social and economic determinants – and for and provides technical support to make social
identify potential response pathways through the protection policies, programmes and strategies
social protection system. Data and knowledge responsive to maternal and child nutrition objectives
support the integration of nutrition objectives and targets. For example, we support the design
and indicators into information systems for social of cash plus social protection programmes that
protection, and inform the design, implementation facilitate access to diets, services and practices
and evaluation of social protection programmes for that support maternal and child nutrition, with an
reducing child malnutrition. emphasis on the 1,000 days from conception to the
age 2 years.
2. Public financing for maternal and child nutrition:
UNICEF advocates for increased domestic financing 5. Shock-responsive social protection systems for
for nutrition, particularly for children, adolescents maternal and child nutrition: UNICEF advocates
and women from the most vulnerable families. We for and provides technical support to develop social
strengthen national and subnational capacities to protection systems that are shock responsive in
improve the allocation of existing public resources, times of stress. This includes considering how
earmark budgets, and track public expenditures programme objectives, scale-up and monitoring
for maternal and child nutrition, while exploring can be designed to meet the needs of nutritionally
innovative financing mechanisms for maternal and vulnerable children and families during times of
child nutrition. crisis. Where appropriate, we support the design
and use of humanitarian cash transfers to achieve
nutrition outcomes for children, adolescents
and women.
STRATEGIC PARTNERSHIPS
Strategic partnerships are core to UNICEF’s NGOs and CSOs: National and international
mandate for maternal and child nutrition and are NGOs and CSOs play a critical role in protecting,
a critical lever for implementing the Strategy.79 promoting and fulfilling children’s right to nutrition.
UNICEF convenes and supports multisectoral, Partnerships between UNICEF, NGOs and CSOs
multi-stakeholder partnerships – at global, regional, use numerous strategies to achieve nutrition
national and subnational levels – to accelerate results, including advocating for gender-responsive,
progress towards the nutrition targets for children equity-focused and well-designed nutrition policies,
and women of the 2030 Agenda for Sustainable strategies and programmes; enforcing accountability
Development. for the coverage, quality and equity of nutrition
services; supporting the implementation of
Strategic partnerships allow UNICEF to share nutrition programmes in hard-to-reach areas and in
responsibilities, optimize resources, and maximize response to humanitarian crises; and facilitating the
results. Governments are UNICEF’s primary participation of children, adolescents and women,
partners for the implementation of the Strategy, including those from marginalized groups, in
as it is primarily with governments and partners programme design, implementation and evaluation.
that UNICEF sets its programme priorities in every
country and programming context. UNICEF’s main United Nations Agencies: UNICEF is a founding
nutrition partners can be clustered as follows. member of UN Nutrition. Our main United Nations
partners for nutrition are FAO, UNHCR, WFP
Governments: UNICEF’s main partners are national and WHO. UNICEF supports FAO and WHO in
and subnational governments, as they hold the fulfilling their mandate as providers of standards
primary responsibility for the protection, promotion and normative guidance on food and nutrition.
and fulfilment of children’s right to nutrition in UNICEF plays the lead role in translating standards
any country. With strong presence in seven and normative guidance on nutrition into advocacy,
regions, nutrition programmes in more than 130 policies, and programmes for children and women
countries, and over 12,000 staff globally, UNICEF in development and humanitarian settings. In
advocates for and supports the efforts of national humanitarian settings, we work with UNHCR
and subnational governments to scale up policies, and WFP to provide nutrition services to refugee
strategies and programmes to protect, promote and children and children living in fragile settings.
support adequate nutrition for children, adolescents Working with the United Nations Educational,
and women through multi-year programmes. Scientific and Cultural Organization (UNESCO) and
UNICEF’s decentralized presence and convening WFP, we support the scale-up of nutrition policies
role at national and subnational levels fosters and programmes for school-age children.
synergies and convergence among central and local
governments, districts and municipalities.
Private sector: UNICEF engages strategically with influencing policy agendas, and amplifying the voices
the private sector in its role as provider of essential of children, adolescents and women. We work
goods and services (e.g., industry support for large- strategically to sensitize editors and journalists on
scale food fortification and fortified complementary nutrition-related issues, fostering long-term capacity
foods); as employer (e.g., industry support to within media outlets to report on these issues in
breastfeeding, maternity protection and family- an evidence-informed manner, furthering UNICEF’s
friendly policies in the workplace); advocating for vision, goal and objectives.
improved private sector’s impact on communities
and the environment (e.g., producing nutritious, Global and regional partnerships: UNICEF
safe and affordable food options sustainably); headquarters and regional offices seek to engage
leveraging business technology and innovation (e.g., strategically in global and regional partnerships and
strengthening supply chains to support reliable access collaborative relationships for maternal and child
to low-cost ready-to-use therapeutic foods for children nutrition. UNICEF leads, coordinates, and provides
with wasting); and through strong social corporate technical support to multiple global initiatives including
responsibility (e.g., supporting adequate nutrition the Scaling Up Nutrition movement and the Global
among vulnerable children and women).84 Nutrition Cluster, among many others, to shape global
nutrition narratives and agendas for action. Regionally,
Media: UNICEF enjoys strong, trusting relationships UNICEF works to leverage the potential of partnerships
with thousands of media partners at country, regional with regional economic commissions, professional
and global levels, and engages proactively with them associations, development partners, and media
to promote key messaging on maternal and child partners, to create regional momentum and accelerate
nutrition. This media network allow UNICEF to achieve country-level results.
substantial reach across a broad range of audiences,
shaping the discourse on maternal and child nutrition,
• Advocating for the right to nutrition and • Supporting the implementation of nutrition
the adoption of specific nutrition policies, programmes, including in hard-to-reach
strategies and programmes; areas and in response to emergencies and
humanitarian crises;
• Promoting accountability for the coverage,
quality and equity of nutrition policies, • Facilitating participation and raising the
programmes and services; voices of children, adolescents and women,
including those from marginalized social
• Generating context-specific knowledge on
groups. 87
the extent and severity of malnutrition, its
determinants and drivers, and the potential
pathways for achieving positive nutrition
impact;
UNICEF’s partnerships with civil society organizations take various forms to meet a range of
nutrition objectives, with selected examples presented below:
• Advocacy and cross-country learning – • Upholding child rights – UNICEF and CSOs
UNICEF supports global, regional and country- successfully made the case to the Committee
level partnerships in alliance with CSOs to on the Rights of the Child that implementation
advocate for improved infant and young child of the International Code of Marketing of
feeding policies, strategies and programmes Breast-milk Substitutes and relevant World
and foster demand for improved information, Health Assembly resolutions are measures
counselling and nutrition services for infants that governments are obliged to take when
and young children, everywhere. they ratify the Convention on the Rights of the
Child.
• Community engagement – UNICEF partners
with national, sub-national, and community- • Protective legislation – UNICEF joins forces
based CSOs and faith-based organizations to with CSOs to advocate for legislation on
reach and engage communities in the early the use of front-of-pack warning labels to
detection and treatment of children with help children, adolescents, caregivers and
wasting and other forms of life-threatening consumers understand that certain food
acute malnutrition, both in development and products have a high content of salt, sugar, or
humanitarian contexts. unhealthy fats and contribute to overweight,
obesity and diet-related non-communicable
• Humanitarian action – During emergencies,
diseases.
partnerships with local and international
NGOs and CSOs help UNICEF reach children,
adolescents and women most in need, achieve
better coverage of nutrition interventions,
and ensure a coordinated response within
the nutrition cluster or sector and with other
relevant clusters or sectors.
• Contributing to the delivery of public services, • Influencing consumer demand, for example by
for example by distributing food and nutrition ensuring the availability and affordability of
commodities and building health care centers, nutritious and safe food choices and marketing
schools, supermarkets and infrastructure; practices that respect consumer rights;
• Shaping markets, prices and products, for example • Influencing national and global economies, for
by investing in local production of nutritious, example through climate-smart solutions that
affordable and sustainable food or by producing support nutritious, safe, and affordable diets that
fortified foods for children locally; are produced in sustainable ways.
• Providing employment and livelihoods, for
example by employing agricultural workers,
women and young farmers and by securing
positive food and childcare environments in the
workplace;
Private sector actors are bound by international standards that outline the actions they should take
to protect and support children’s rights. All businesses – including those in the food and beverage sector
– have a responsibility to adhere to the United Nations Guiding Principles on Business and Human Rights,89
the Child Rights and Business Principles,90 and to the Convention on the Rights of the Child’s provision to
uphold children’s right to nutrition. Five key entry points for engaging with business to improve maternal and
child nutrition include:
• Business as a provider of essential goods and • Business as a positive influence in society, for
services for children and families, for example, example through stronger corporate responsibility
through industry support for large-scale food directed to protect, promote and support maternal
fortification and fortified complementary foods; and child nutrition.
• Business as an employer, for example through
industry support to breastfeeding by ensuring UNICEF nutrition programmes engage strategically
maternity protection policies, nursing breaks and with public and private sector actors to advocate
breastfeeding rooms in the workplace; for business policies, practices and products
that support optimal nutrition for all children,
• Business impact on communities and the adolescents and women, in all contexts. Our overall
environment, for example by producing engagement with the private sector is guided by
nutritious, safe and affordable food options UNICEF’s due diligence criteria and processes and
sustainably, and making them available at local UNICEF programme guidance on private sector
retail outlets; engagement for maternal and child nutrition.91,92
• Business technology and innovation, for
example by strengthening supply chains to
support reliable access to low-cost ready-to-use
therapeutic foods for children with wasting;
Working with partners, UNICEF employs a range of UNICEF uses a strategic mix of 10 inter-related
programming approaches that support 1 governments
2
programming approaches. We prioritize and tailor
3
and other duty-bearers to protect and5 promote4 these approaches as appropriate to the programming
6
diets, services
+ and practices enabling9 adequate context, in consultation with governments and
=
7
8
nutrition for children, adolescents and women.10
93
partners, and considering the needs, resources and
At the same time, these programming approaches partnerships available. These are the programmatic
prioritize and tailor 10 inter-related
empower children, adolescents, women, families
toapproaches
local contexts Programming
used by UNICEF at national, regional and
and communities to participate inprogramming
the design global levels: approaches are
approaches
and implementation of policies, strategies and context-specific
programmes that shape children’s right to nutrition,
in all contexts.
FIGURE 23
Programming approaches to improve maternal and child nutrition
In consultation with national and subnational Illustrative actions include the following:
governments, non-governmental and civil society
• Assess the nutritional status of children by using
organizations, public and private sector partners,
population-level surveys and administrative data,
and communities, UNICEF conducts a systematic
with data disaggregated by age, gender and other
analysis of the nutrition situation of children,
factors that affect nutritional vulnerability.
adolescents and women; its determinants and
drivers; and the potential pathways for positive • Conduct institutional capacity and budget analyses,
impact on nutrition outcomes. The situation analysis map current and potential partnerships and
involves reviewing quantitative and qualitative data networks, and assess public and private funding
and other sources of information and evidence, trends and gaps for maternal and child nutrition.
as well as assessing available resources and • Analyse policy frameworks across five systems
partnerships. – food, health, water and sanitation, education,
and social protection – to assess complementarity
The situation analysis gives us a solid understanding and gaps.
of the key nutrition issues facing children and
women, their immediate and underlying causes, and • Assess vulnerabilities that drive the nutritional
the depth and breadth of the nutrition challenge, status of children, adolescents and women, and
informing the scope and scale of our programming. identify barriers, bottlenecks and opportunities in
It also facilitates consensus with governments and the delivery of nutrition services across systems.
partners on priority actions, roles and responsibilities; • Support secondary data analyses of Demographic
informs the theory of change of our nutrition and Health Surveys and Multiple Indicator Cluster
programming; guides the development of a results- Surveys to identify the main drivers of poor child
based framework for programme monitoring and diets and feeding, hygiene and care practices in
evaluation; and supports advocacy and resource different national, regional and global contexts.
mobilization.
Advocacy is the deliberate process of using rights- Illustrative actions include the following:
and evidence-informed arguments and strategies for
• Develop and implement an advocacy strategy
convincing decision makers and other stakeholders
with a clear theory of change and multichannel
to lead and support actions that protect, promote and
communication plans to achieve measurable
fulfil children’s right to nutrition. To this end, UNICEF
positive change for maternal and child nutrition.
aims to generate evidence, convene partners, leverage
media and communication opportunities, use digital • Develop investment cases for maternal and child
platforms, and strengthen relationships with decision nutrition by using global and context-specific
makers and opinion setters to make the ethical, evidence to quantify the costs, benefits and impact
political, social and financial case for nutrition. of investing in nutrition.
• Equip parliamentarians with the evidence they need
Such advocacy strategies seek to achieve buy-in from to prioritize investments for maternal and child
governments, parliaments, civil society, development nutrition in national budget processes as a non-
partners, the private sector and other duty-bearers to partisan national priority.
enact or enforce positive change for maternal and child
nutrition. To guide our advocacy work, we consider key • Build the capacity of global and national
questions, such as what we want to achieve and who ambassadors to advocate for greater investments
can make it happen, how we can influence them to in nutrition policies and programmes, particularly for
act, what tools and resources we need to take action, the most vulnerable children and women.
and how we monitor progress. • Partner with youth coalitions, strengthening their
capacity to advocate for healthy food environments
in and around schools, and amplifying their voice
through multiple platforms.
This programming approach aims to equip Illustrative actions include the following:
governments and partners with the knowledge
• Strengthen the capacity of public and private
and skills to improve maternal and child nutrition
stakeholders in national food systems to support
sustainably. At national and subnational levels,
nutritious diets, healthy food environments, and
UNICEF works to strengthen the organizational
positive food practices for children.
capacities of governments and partners to design,
implement and monitor improved policies, strategies, • Support the development and roll-out of pre- and
programmes, and budgets for maternal and child in-service training curricula and materials to develop
nutrition. the capacity of workforces across systems for
maternal and child nutrition.
At practitioner level, we strengthen the nutrition • Strengthen the capacity of the national education
capacities of workforces across systems, through system to promote and support nutritious diets,
up-to-date technical guidance and pre-service and healthy food environments and positive nutrition
in-service knowledge and skills development. At practices in and around schools.
the community and household level, we strengthen
the knowledge and skills of children, adolescents, • Develop the capacity of primary health care workers
families and communities to adopt individual in facilities and communities to protect, promote and
behaviours and social norms that improve nutrition support optimal feeding practices in early childhood
(see ‘Engaging communities for nutrition action’). and related maternal nutrition.
We aim to strengthen our core capacities regularly • Develop the capacity of UNICEF staff and partners
to ensure that our staff can provide technical, to prepare for and respond to the nutrition needs
programmatic and managerial support across of children and women affected by environmental
systems and programming contexts, including in shocks and humanitarian crises.
response to humanitarian crises.
Sustainable nutrition programming requires that Illustrative actions include the following:
essential nutrition supplies be available, accessible
• Provide technical support to governments to
and affordable, both in development and humanitarian
forecast demand for essential nutrition commodities
contexts. UNICEF advocates for governments to
for children and women, including for emergency
allocate funds for essential nutrition commodities to
preparedness and response.
ensure sustainable programme delivery. We also work
with governments and partners to strengthen systems • Advocate for including essential nutrition supplies
along the supply chain and support the forecasting, on national lists of essential medicines or essential
costing, procurement, quality assurance and delivery commodities for children, adolescents and women.
of essential nutrition commodities as appropriate • Identify potential local and global suppliers to
to programming context. To ensure ownership and increase competition for the production of essential
sustainability, we encourage local production of nutrition commodities, catalyse scalable innovation,
commodities and support local producers in attaining and increase value for money.
international standards while shaping local and global
markets and reducing carbon footprint. • Advocate with governments to allocate financial
resources for the procurement, storage and
Supply provision is critical to ensure sustainable distribution of essential nutrition commodities
programmes during humanitarian response. Half of our for children, adolescents and women.
global procurement of nutrition commodities supports • Provide procurement services to national
emergency response. These commodities may include governments to ensure the timely procurement
therapeutic milks, RUTF, micronutrient powders, of nutrition commodities for children and women,
micronutrient supplements, deworming tablets, mid- including for emergency response.
upper arm circumference measurement tapes, height
boards and weighing scales among others.96
Financial investments are critical to reach the global Illustrative actions include the following:
nutrition targets. A specific objective of UNICEF’s
• Develop investment cases that quantify the cost,
advocacy is to mobilize greater financial resources
effectiveness, benefits and impact of improved
to support policies, strategies and programmes for
policies, strategies and programmes for maternal
maternal and child nutrition. The investment case for
and child nutrition.
nutrition is among the strongest in development:97
it is estimated that every dollar spent on preventing • Develop and implement an advocacy strategy aimed
stunting delivers over $10 in returns and that an at increasing domestic financing to improve the
additional investment of about US$10 per child quality, coverage, equity and impact of nutrition
annually would help reach the global targets to improve services for children and women.
exclusive breastfeeding rates, reduce stunting in • Strengthen national and subnational capacity to
children, scale up the treatment of severe wasting in conduct budget analyses, financial tracking and
children, and reduce anaemia in women. public expenditure reviews for maternal and child
nutrition.
We advocate for increased domestic and external
financing for maternal and child nutrition, including • Develop robust proposals to mobilize national and
through innovative financing mechanisms. We also international financial resources for the scale-up
advocate for a more efficient and equitable allocation of maternal and child nutrition programmes in
of existing financial resources to prioritize the partnership with national governments.
prevention of all forms of malnutrition in children and • Mobilize public and private financing – domestically
women as well as the early detection and treatment and internationally – to test cost-effective and
of wasting. scalable innovations that improve diets, services and
practices for children and women.
Collecting, analysing, sharing and using the latest Illustrative actions include the following:
data and information is key to informing advocacy,
• Support the development and functioning of national
policies, strategies and programmes for maternal and
data and information systems to generate timely
child nutrition. Establishing and strengthening national
and good-quality nutrition information and monitor
and subnational data and information systems allows
resources and results.
countries to obtain timely and good-quality data to
inform nutrition policies, strategies and programmes • Convene partners to review data, monitor progress,
and track progress towards national nutrition targets. and agree on corrective actions to improve
Investments in data and information systems are also programme performance for maternal and child
important for emergency preparedness and response, nutrition.
especially in fragile contexts. • Develop capacity to collect, analyse and use good
quality nutrition data and information to inform
UNICEF provides technical support and guidance to policies, strategies, programmes and decision-
strengthen data, monitoring and evaluation systems making in real-time.
for nutrition; support the development of strong
results frameworks; and strengthen the capacities • Support countries to report good quality programme
of governments and partners for results-based data through NutriDash, and leverage these data
management. Globally, we act as the custodian for advocacy to guide programme actions, allocate
of data and information systems to track progress resources and promote accountability.
towards key indicators for maternal and child nutrition, • Maintain global databases on key nutrition
including those used to monitor progress towards indicators, set standards, develop new metrics,
the Sustainable Development Goals and other pioneer innovation in measurement and improve
global targets. overall data collection, quality and analysis.
UNICEF seeks to create environments in which Illustrative actions include the following:
knowledge, innovations and learning are harnessed
• Support quantitative and qualitative research to
to drive advocacy, policies, programmes and research
understand the practices and social norms that
to improve the quality of diets, nutrition services
shape the nutritional status of children and women,
and nutrition practices for children, adolescents
particularly among vulnerable groups.
and women.
• Identify and prioritize knowledge gaps and plan,
We strive to act as a knowledge broker and thought commission and implement contextually relevant
leader to strengthen the quality of advocacy, policies, research on maternal and child nutrition, including in
strategies, programmes and research for maternal and response to humanitarian crises.
child nutrition at national, regional and global levels. • Generate and share programme results and lessons
This includes documenting, sharing and using learnings learned from programme design, implementation
from programme design and implementation. and scale-up in diverse programming contexts,
including in emergencies.
We also foster a culture of innovation to design,
test, evaluate and scale up new policy concepts • Lead the translation of knowledge into programming
and programme approaches in ways that inspire by synthesizing evidence, developing guidance and
governments, partners and communities. In a rapidly documenting programme successes, failures and
changing world with faster information flows and lessons learned.
interconnected teams, technology-driven innovations • Engage with knowledge networks, including
can help us scale up successes, maximize resources through technology platforms, social networks and
and effectiveness, and fast track progress and communities of practice for knowledge exchange on
impact in making good nutrition a reality for children, maternal and child nutrition.
adolescents and women everywhere.
To deliver on the Nutrition Strategy 2020−2030, regional and global partners – across public and
UNICEF counts the largest nutrition workforce globally. private sectors – to tackle the global challenge of child
In 2019, our workforce for nutrition included 640 staff malnutrition.
members and more than 1,500 consultants leading
and supporting the design and implementation of Our financial resources to lead and support the design
advocacy, policies and programmes for maternal and implementation of nutrition policies, strategies
and child nutrition in development and humanitarian and programmes have grown steadily over the last
settings, in 130 countries across 7 regions worldwide. decade. In 2019, our annual budget for maternal
and child nutrition reached US$687 million.98 Of this
Further, more than 3,600 programme staff lead and budget, US$494 million (72 per cent) was provided by
support the design and implementation of advocacy, public sector partners, US$136 million (20 per cent)
policies and programmes for health, education, water was provided my public-private multi-donor partners,
and sanitation, child protection and social policy. and US$57 million (8 per cent) was contributed by
private sector donors. US$29 million (4 per cent)
As highlighted in Chapter 1, UNICEF’s multisectoral was allocated as flexible thematic funds for broad-
mandate for children, wide on-the-ground presence, based support to the UNICEF Nutrition programme,
and long-standing role as a trusted adviser to national while US$658 million (96 per cent) was earmarked to
governments position UNICEF to mobilize national, support specific results areas and geographies.
Central Asia
Regional Office,
Geneva
South Asia
Regional Office,
West and Kathmandu
Central Africa
Regional Office, Dakar
Latin America and
the Caribbean
Regional Office, Panama City East Asia and
the Pacific
Regional Office,
Bangkok
Eastern and
Southern Africa
Regional Office, Nairobi
FIGURE 24
UNICEF’s global nutrition workforce, 2020
More than half (US$387 million; 56 per cent) of are needed to strengthen the capacity of national
UNICEF’s 2019 budget for maternal and child nutrition systems to deliver large-scale nutrition results in
was allocated to support programming in fragile low- and middle-income countries – including most
contexts, including most countries in the Horn of countries in Asia and Latin America – where the
Africa, the Sahel and the Middle East. Geographically, number of children affected by stunting and wasting
US$445 million (65 per cent) was spent to support is largest and the emerging epidemic of childhood
nutrition programming in Eastern and Southern overweight and obesity requires urgent action.
Africa and West and Central Africa. This reflects the
high prevalence of undernutrition in these regions, Reaching the Sustainable Development Goal targets
the reduced fiscal space and domestic funding for for nutrition requires significant investments by
maternal and child nutrition in most of these countries, all partners. UNICEF will continue to increase its
and the higher fragility and operating costs. institutional commitment to maternal and child nutrition
guided by our Nutrition Strategy 2020–2030. Together
To fully deliver on the UNICEF Nutrition Strategy with our partners, we will contribute to increasing
2020–2030, we need increased and predictable financing for nutrition, including by working closely
financial resources. Flexible resources – such as with national governments to secure the domestic
regular resources and thematic funding – facilitate resources needed to fulfil children’s right to nutrition.
longer-term planning, cost savings, ownership and
sustainability.
$387 million
Fragile contexts
2019 $687 million 56%
250 $228.8
million $216.4
million
200
150
US$ million
$111.2
million
100 $75.4
million
50 $25.2
million $12.8
million $2.7
million
0
Eastern and West and Middle East South East Asia and the Latin America Eastern Europe and
Southern Africa Central Africa and North Africa Asia Pacific and the Caribbean Central Asia
FIGURE 27
UNICEF total budget for nutrition ($687 million), by region, 2019
Digital applications for nutrition including through online pre- advocacy, policy, and programme
counselling and in-service training, capacity efforts to address micronutrient
UNICEF continues to leverage building workshops, and peer-to- deficiencies. UNICEF is
the use of digital applications and peer learning. collaborating with experts and
live video streaming to improve partners to develop low-cost,
information and counselling on Digital devices to measure field-friendly technologies that
maternal and child nutrition and anthropometry allow children's micronutrient
expand the reach and impact The devices currently used to status to be assessed in the
of social and behaviour change measure children’s height have context of programmes and
communication strategies on not been updated in more than population surveys, with minimal
nutrition outcomes. Similarly, a century. UNICEF is working training.
UNICEF plans to leverage digital to develop a height measuring
solutions to reach school-age board with digital output and auto Innovations to improve data
children and adolescents with transfer to address inaccuracies collection and quality
information, counselling and in measuring children’s height. UNICEF is testing innovations to
behaviour change messaging We are also monitoring other improve the collection, timeliness
about healthy diets and physical advancements, including a hand- and quality of nutrition data. Some
activity. Such digital interventions held device that uses photo or mobile phone technologies can
are to be designed in consultation video images combined with be used in nutrition surveys, while
with youth leaders and networks. artificial intelligence to estimate individual tracking applications
children’s weight, height and head can be used to provide real-time
E-learning to strengthen circumference. Once ready for data about nutrition programmes.
nutrition capacities use at scale, these devices will In some settings, geographic
UNICEF is leveraging e-learning revolutionize the way children’s information systems are being
tools to develop the nutrition nutritional status is measured in tested to improve nutrition
capacities of frontline workers, surveys and programmes. surveys and monitoring systems.
service providers, and government For example, spatial sample
and partners’ staff. These include Low-cost technology to surveys can help pinpoint where
interactive online training courses measure micronutrient malnourished children are
on maternal and child nutrition deficiencies located and facilitate targeted
that are made available as public Micronutrient deficiencies are a programming to improve equity,
goods through Agora and other widespread form of malnutrition efficiency and effectiveness.
learning platforms. Working with among children, adolescents
academic partners, UNICEF and women. However, they
leverages the latest innovations in are costly to assess and are
remote learning to strengthen the therefore not routinely included
nutrition knowledge and skills of in nutrition surveys. This leads to
facility and community workers, a major data gap that hampers
Artificial intelligence to improve recommended volume and number anaemia, and poor growth and
food environments of meals by age group, while development. As part of our
Digital technologies and the the slotted spoon ensures that efforts to prevent micronutrient
internet influence the ways in foods are of the correct energy deficiencies and anaemia,
which children, young people density and not watered down. one of the most common
and caregivers interact with The bowl and spoon can also be forms of malnutrition in middle
the food system, including by used in training counselors on childhood and adolescence,
increasing their exposure to the child feeding. UNICEF plans to support
marketing of ultra-processed the development of multiple
foods. UNICEF and partners Redesigned vitamin A micronutrient supplements to
are testing novel technology- supplements for children improve micronutrient intake,
led approaches using artificial The current vitamin A capsule has growth, development, learning
intelligence, screen capture, remained largely unchanged since and academic achievement
and avatars to map marketing the 1970s. A redesigned vitamin among school-age children and
campaigns and assess children’s A supplement, in the form of a adolescents.
exposure to the marketing of sachet, dissolvable tongue-strip, or
ultra-processed foods. While a micro patch, will simplify delivery Lower cost and effective ready-
further work is needed to by community-based workers to-use therapeutic foods
refine these technologies, the and caregivers. A new, user- UNICEF is testing new RUTF
evidence generated through such friendly redesigned supplement formulations − with a chickpea,
monitoring approaches will be will accelerate the integration soy or oat base − and comparing
essential in empowering families, of vitamin A supplementation their effectiveness with
communities, and governments to in primary health care and other the standard peanut-based
protect children’s rights online. routine services for children; in- formulation. We are also exploring
crease the reach of programmes, alternatives to milk powder (the
A complementary feeding bowl enhancing their coverage, equity more expensive component of
and spoon and impact; empower women, the current RUTF formulation),
This simple and low-cost families and communities; and including other animal protein
innovation, based on research by reduce the time and cost of sources such as egg-based
Emory University, aims to help service delivery. products. The aim is to reduce the
caregivers improve the diets of cost of RUTF while maintaining or
children aged 6–23 months with Multiple micronutrient improving its effectiveness, and
guidance about what to feed supplements for school-age to increase the coverage, equity
(diverse food groups), how much children and impact of programmes to treat
to feed (quantity and consistency Many school-age children and children with wasting.
of food), and how often to feed adolescents consume nutrient-
(feeding frequency). Demarcations poor diets that put them at risk
inside the bowl indicate the for micronutrient deficiencies,
At the launch of the UNICEF Nutrition Strategy Guided by the goal and programmatic priorities
2020–2030, the nutrition situation of the world’s outlined in the UNICEF Nutrition Strategy
children is characterized by a significant decline in 2020–2030, we have an important opportunity to
the number of children who are undernourished. contribute to ending malnutrition among children,
The one-third decline in the prevalence of child adolescents and women across countries and
stunting between 2000 and 2019 indicates that regions over the final decade towards 2030. A
positive change for child nutrition – at scale – is systems approach to nutrition is critical to facing
possible. Yet, this significant decline remains this challenge sustainably, allowing us to leverage
insufficient to achieve the ambitious Sustainable the potential of five critical systems − food,
Development Goal targets to address child health, water and sanitation, education and social
undernutrition. In addition, the number of children protection − to deliver diets, services and practices
who suffer from overweight and obesity is that support good nutrition for children, adolescents
increasing in almost all age groups, regions, and and women.
country-income groups, while a widespread burden
of micronutrient deficiencies in children coexists National governments have primary responsibility
with undernutrition and overweight. for upholding children’s right to nutrition. We never
lose sight of this foundational principle. Yet, the
New forces are driving this triple burden of child path to nutritious diets, essential nutrition services
malnutrition around the world. Globalization and and positive nutrition practices for all children,
urbanization are changing children’s access to adolescents and women demands a shared
food as well as children’s food environments and purpose, with commitments and investments
practices. Increasing socio-economic inequities limit required from a range of government, societal,
the ability of millions of families to afford a healthy public and private partners. UNICEF stands ready
diet for their children, access essential nutrition to support national governments and their partners
services and maintain/adopt positive nutrition in upholding the right to nutrition for every child
practices. Finally, the climate and environmental and securing a more just and equitable future for
crisis, and the increasing number, duration and children and their families – today, and on the path
complexity of health epidemics and humanitarian to 2030.
crises, pose critical challenges to children’s right to
nutrition across the world.
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60 World Health Organization & United 124(10 Suppl), 2082S-2105S. https://doi. files/ForesightReport.pdf
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infant feeding in emergencies: Operational Fauveau, V., Briend, A., Chakraborty, J., inclusion of information about the nutri-
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61 United Nations Children’s Fund. (2021). Nutrition Bulletin, 12(3), 1–6. https://doi.
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Strategy). Colford, J. M., et al. (2020). Causes and ing Approach.
consequences of child growth failure
62 World Health Organization. (2016). WHO in low- and middle-income countries. 76 United Nations Children’s Fund. (2016).
recommendations on antenatal care for MedRxiv, 2020.06.09.20127100. https:// UNICEF Strategy for Water, Sanitation and
a positive pregnancy experience. https:// doi.org/10.1101/2020.06.09.20127100 Hygiene 2016–2030. https://www.unicef.
www.who.int/reproductivehealth/publica- org/wash/files/UNICEF_Strategy_for_
tions/maternal_perinatal_health/anc-posi- 68 Myatt, M., Khara, T., Schoenbuchner, S., et WASH_2016_2030.PDF
tive-pregnancy-experience/en/ al. (2018). Children who are both wasted
and stunted are also underweight and 77 United Nations Children’s Fund. (2019).
63 World Health Organization. (2016). WHO have a high risk of death: A descriptive Every Child Learns UNICEF Education
recommendations on antenatal care for epidemiology of multiple anthropometric Strategy 2019–2030. https://www.unicef.
a positive pregnancy experience. https:// deficits using data from 51 countries. org/media/59856/file/UNICEF-educa-
www.who.int/reproductivehealth/publica- Archives of Public Health = Archives tion-strategy-2019-2030.pdf
tions/maternal_perinatal_health/anc-posi- Belges De Sante Publique, 76, 28. https:// 78 United Nations Children’s Fund. (2019).
tive-pregnancy-experience/en/ doi.org/10.1186/s13690-018-0277-1 UNICEF’s Global Social Protection Pro-
64 There are many technical definitions 69 United Nations Children’s Fund. (2020). gramme Framework. https://www.unicef.
and classifications involved in child Core commitments for children in org/media/64601/file/Global-social-pro-
wasting and many anthropometric ways humanitarian action. https://www. tection-programme-framework-2019.pdf.
of assessing and diagnosing it. Over unicef.org/media/84086/file/Core%20 These components of the UNICEF Social
time, the terminology has become very Commitments%20for%20Children%20 Protection Progamme Framework include
technical and specialized, with multiple (English).pdf evidence, policies, programmes and
classifications (global acute malnutrition, administrative system.
severe acute malnutrition, moderate acute 70 The GNC Technical Alliance fills a long-
recognized gap in the global emergency 79 United Nations Children’s Fund.
malnutrition, marasmus, kwashiorkor) and (2009). UNICEF strategic framework
diagnostic tools (weight-for-height, MUAC, nutrition architecture by presenting a clear
and predictable process to efficiently for partnerships and collaborative
oedema) used to describe wasting at relationships. https://www.unicef.org/
population and child level. The global effort respond to technical needs and emerging
issues. The Alliance responds to technical about/execboard/files/N0928210.pdf
to prevent and treat this condition at scale
would benefit from clearer terminology, requests by leveraging and building on 80 At the time of writing its Nutrition
and the Sustainable Development Goals existing nutrition resources, capacities, Strategy 2020–2030, UNICEF’s top
provide us with an opportune agreed initiatives and coordination structures. It five bilateral partners for maternal
term: wasting. Although the technical supports practitioners by delivering the and child nutrition are (in alphabetical
definition of wasting may differ from the following services: order) the governments of Germany,
technical definition of acute malnutrition, 1. Access to high-quality information, the Netherlands, Republic of Korea, the
for the purposes of this document and in capacity strengthening resources, United Kingdom and the United States of
all future references by UNICEF, wasting guidance and learning that has been America.
will be used to encompass prevention and curated by global nutrition specialists 81 At the time of writing its Nutrition
treatment of all forms of acute malnutri- and agencies; Strategy 2020–2030, UNICEF’s top
tion (wasting and kwashiorkor) including 2. Where guidance is limited, timely philanthropic partners for maternal and
those diagnosed using WHZ (<-2WHZ), access to interim consensus-driven child nutrition are (in alphabetical order):
oedema and/or MUAC (<125mm). guidance for emerging technical issues the Bill & Melinda Gates Foundation, the
65 Pelletier, D. L., Low, J. W., Johnson, F. in humanitarian nutrition, including Children’s Investment Fund Foundation,
C., et al. (1994). Child anthropometry guidance on program adaptation; the Eleanor Crook Foundation, the IKEA
and mortality in Malawi: Testing for Foundation, the Mittal Foundation and
3. Access to experienced nutrition tech- Power of Nutrition.
effect modification by age and length of nical specialists to answer questions,
follow-up and confounding by socioeco- or to provide more in-depth support 82 See <https://scalingupnutrition.org/>
nomic factors. The Journal of Nutrition, (remote or in-country). 83 SUN movement principles of engagement
124(10 Suppl), 2082S-2105S. https://doi. (2016–2020) include (1) be transparent
org/10.1093/jn/124.suppl_10.2082S; and 71 See: United Nations Children’s Fund.
(n.d.). NutriDash 2.0. https://www.unicef- about intentions and impact; (2) be inclu-
Fauveau, V., Briend, A., Chakraborty, J., sive; (3) be rights-based; (4) be willing to
et al. (1990). The contribution of severe nutridash.org/
negotiate; (5) be predictable and mutually
malnutrition to child mortality in rural 72 United Nations Children’s Fund. (2019). accountable; (6) be cost-effective; (7) be
Bangladesh: Implications for target- The State of the World’s Children 2019. continuously communicative; (8) act with
ing nutritional interventions. Food and Children, food and nutrition: Growing well integrity and in an ethical manner; (9) be
in a changing world. https://www.unicef. mutually respectful; and (10) do no harm.
84 UNICEF has due diligence criteria, pro- 95 Sanghvi, T., Seidel, R., Baker, J., et al.
cesses and guidance in place to inform (2017). Using behavior change approach-
our engagement with the private sector. es to improve complementary feeding
Key internal documents include: practices. Maternal & Child Nutrition,
1. United Nations Children’s Fund, 13 Suppl 2. https://doi.org/10.1111/
UNICEF due diligence criteria and pro- mcn.12406
cesses for corporate fundraising and 96 See <https://www.unicef.org/supply/
partnerships, UNICEF, New York, July nutrition. In 2018, UNICEF’s procurement
2016. in nutrition totalled US$183.9 million. This
2. United Nations Children’s Fund, Pro- included 1) 47,760 tonnes of RUTF, 65 per
gramme guidance on engagement with cent of which was sourced in programme
business, UNICEF, New York, August countries; 2) 518 million vitamin A treat-
2019. ments; 3) 122 million deworming tablets;
4) 197 million sachets of multiple micro-
3. United Nations Children’s Fund, nutrient powder; and 5) 877 million iron
UNICEF Programme guidance on pri- folic tablets. For more information, see:
vate sector engagement for maternal United Nations Children’s Fund. (2018).
and child nutrition. UNICEF, New York Supply annual report 2019. https://www.
(forthcoming at the time of finalizing unicef.org/sites/default/files/2019-07/
the Strategy). UNICEF-supply-annual-report-2018.pdf
85 See <https://www.nutritioncluster.net/> 97 Shekar, M., Kakietek, J., & Dayton J. E.,
86 United Nations Children’s Fund. (2012). et al. (2017). An investment framework
Civil society guide to working with for nutrition: Reaching the global targets
UNICEF. https://www.unicef.org/about/ for stunting, anemia, breastfeeding,
partnerships/files/civil_society_guide_ and wasting. The World Bank. https://
LoRes.pdf openknowledge.worldbank.org/han-
87 United Nations Children’s Fund. (2012). dle/10986/26069
Civil society guide to working with 98 United Nations Children’s Fund. (2020).
UNICEF. https://www.unicef.org/about/ Global annual results report 2019:
partnerships/files/civil_society_guide_ Goal Area 1. https://www.unicef.org/
LoRes.pdf media/73351/file/Global-annual-results-
88 Based on: United Nations Children’s Fund. report-2019-goal-area-1.pdf
(2019). UNICEF’s programme guidance on 99. United Nations Children’s Fund. (2020).
engagement with business. Core commitments for children in
89 See: United Nations Human Rights Office humanitarian action. https://www.
of the High Commissioner. (2012). Guid- unicef.org/media/84086/file/Core%20
ing principles on business and human Commitments%20for%20Children%20
rights. United Nations. https://www.ohchr. (English).pdf
org/Documents/Publications/GuidingPrin-
ciplesBusinessHR_EN.pdf
90 See: Save the Children, United Nations
Children’s Fund, & United Nations
Global Compact. (2012). Children’s rights
and business principles. https://www.
unglobalcompact.org/docs/issues_doc/
human_rights/CRBP/Childrens_Rights_
and_Business_Principles.pdf>
91 United Nations Children’s Fund. (2016).
UNICEF due diligence criteria and
processes for corporate fundraising and
partnerships.
92 United Nations Children’s Fund, UNICEF
Programme guidance on private sector
engagement for maternal and child nutri-
tion. UNICEF, New York (forthcoming at
the time of finalizing the Strategy).
93 UNICEF’s internal operational policies
and procedures are detailed in the
Programme Policy and Procedure Manual,
which is now available as a wiki-style on-
line manual known as PPPX. This manual
provides up-to-date guidance on UNICEF
programme operations for use by country
offices, regional offices, and headquarters
divisions, as well as other partners, to
support programme development, im-
plementation, management, monitoring,
reporting and evaluation.
94 See < https://www.unicef.org/cbsc/index.
php>
UNICEF’s Core Commitments to Children in diets, services and practices through the life cycle, and
Humanitarian Action provide a framework for reflect the imperative of prevention first and treatment
engagement in humanitarian response and outline when prevention fails, in all contexts. In addition, they
UNICEF’s commitment to deliver on its mandate for outline key considerations for advocacy, coordination
children affected by humanitarian crises.99 Programme and partnerships, quality programming and standards
commitments for nutrition begin with leadership and bridging the humanitarian-development nexus. They are
coordination and nutrition information. They are accompanied by an indicators framework to streamline
complemented by commitments to ensure access to institutional reporting.
Strategic result
Children, adolescents and women have access to diets, services and practices that improve their
nutritional status
Commitments Benchmarks
1. Leadership and coordination • Nutrition cluster/sector coordination and leadership
functions are adequately staffed and skilled at national
Effective leadership and coordination are established and sub-national levels
and functional • Core leadership and coordination accountabilities are
See 2.1.2 Coordination delivered
2. Information systems and nutrition assessments • Relevant data and evidence on the type, degree,
extent, determinants and drivers of maternal and child
Monitoring and information systems for nutrition, malnutrition and of the groups most at risk are available
including nutrition assessments, provide timely • Multisectoral data and evidence guide timely decision-
and quality data and evidence to guide policies, making, support monitoring, and enable course
strategies, programmes and advocacy correction of preparedness and response
3. Prevention of stunting, wasting, micronutrient • Caregivers of children aged 0–23 months are supported
deficiencies and overweight in children aged under to adopt recommended infant and young child feeding
five years (IYCF) practices, including both breastfeeding and
complementary feeding
Children aged under five years benefit from diets, • Children aged 0–59 months have improved nutritional
practices and services that prevent stunting, wasting, intake and status through age-appropriate nutrient-
micronutrient deficiencies and overweight rich diets, micronutrient supplementation, home-
fortification of foods and deworming prophylaxis,
according to context
4. Prevention of undernutrition, micronutrient • Children in middle childhood have access to
deficiencies, and anaemia in middle childhood and community- and school-based package of interventions
adolescence that includes at a minimum: iron supplementation,
deworming prophylaxis, nutrition education,
Children in middle childhood (5–9 years) and counselling and support, according to context
adolescent girls and boys (10–19 years) benefit from • Adolescent girls and boys have access to community-
diets, practices and services that protect them and school-based package of interventions that includes
from undernutrition, micronutrient deficiencies at a minimum: iron and folic acid supplementation,
and anaemia deworming prophylaxis, nutrition education,
counselling and support, according to context
December 2020
Published by:
UNICEF
Nutrition Section, Programme Division
3 United Nations Plaza
New York, NY 10017, USA
Email: nutrition@unicef.org
Website: www.unicef.org