STUNTING AND ITS IMPACT ON CHILD SURVIVAL IN ODISHA Odisha Development Conclave 20th Sep 2015

Stunted bodies Stunted brains Stunted lives Stunted Children Stunted bodies Stunted brains Stunted lives + Intergenerational

Effects of Stunting on Brain Development Normal Typical brain cells extensive branching Severe malnutrition early in life causes changes to brain cell development and reduction in the “connectivity” or “branching” between brain cells. In humans, this process of brain development happens in the first 2 years of life, which is a critical period of vulnerability. This slide shows microphotographs of the deep layers of the developing brain (cortex) of infants a few months old, at different levels of magnification. On the top, are normal brain cells, which have greater connectivity, both in number and span of branches [this is from a well nourished, 2.5 month old girl who ] On the bottom, are damaged brain cells that have developed in the context of STUNTING. there are fewer branches (dendrites) each of these branches is significantly shorter (amplitude of dendrites) the proportion of these damaged cells is higher At higher magnification, the branches are abnormal - the projections (called spines) are fewer, and abnormal in shape and size [this is from a severely stunted 2.6 month old girl] ------------------------------------------------------------------------------------------------------------------ Extra supporting information: Context: Chile (disadvantaged area) Human study: infants, children who died of pnuemonia, aged 3-4 months, 5 were well-malnourished and 5 were underweight/some were stunted. Primary motor cortex Malnutrition: “moderate” protein calorie malnutrition; we recalculated stunting Controls: well nourished Stunting Impaired brain cells - limited branching -abnormal branches Source: Cordero E et al, 1985 (Adapted from Figure 2 & Figure 4), Benıtez-Bribiesca et al. 1999 (Adapted from Figure 4)

Multiple Benefits of Eliminating Malnutrition in Young Children Prevent more than 1/3 of child deaths per year (Health) Improve school attendance by at least one year (Education) Increase wages by 5-50% Reduce poverty as well-nourished children are 33% more likely to escape poverty as adults (Protection) Empower women to be 10% more likely to run their own business (Gender equality) Boost gross national product by 11% in Africa and Asia Break the inter-generational cycle of poverty Source Haddad L. Child Growth =Sustainable Economic Growth: Why we should invest in nutrition. May 2013.

1,000+ DAYS The Critical “Window of Opportunity” Stunting: The Critical Window Source: Victora et al 2010 The Critical “Window of Opportunity” 1,000+ DAYS Pre-pregnancy (+), Pregnancy: 9*30 = 270 days 2 years after birth: 365*2 = 730 days Source: Victora et al 2010

Reduction of Stunting in Odisha - Trends Stunting reduced by 15.1% over the last 8 years Decline in Stunting among SCs and STs more rapid - 19.9% and 19.4% respectively Overall rate of decline is lower than the national average (19.4%) Rate of decline is not rapid enough to reach the WHA target of 40% reduction over the coming 10 years

Causes of Undernutrition and Multi-sector Actions Health & Family Welfare W & Child Dev. Agriculture Food & Civil Supplies Drinking Water & Sanitation Education Rural Dev.

Known Solutions: 10 Essential Interventions Infant and Young Child Feeding Practices Access to health services and healthy environment Care for women before and during pregnancy Immunization and Vitamin A Appropriate feeding in illness Therapeutic feeding for severe acute malnutrition Improve hygiene and sanitation and safe drinking water Delay in marriage, first pregnancy Adolescent and women’s nutrition Breastfeed in 1 hour of birth Exclusive breastfeed for 6 months Complementary foods at 6 months Age-appropriate foods for children six months to two years 1. Girls are born, protected; delay in marriage, first pregnancy and repeated pregnancies 2. Adequate food, nutrition and support for women (before, during and after pregnancy) to prevent anemia, undernutrition and care for those at risk Initiation of breastfeeding within 1 hour of birth Exclusive breastfeeding during the first six months of life Timely introduction of complementary foods at six months Age-appropriate foods for children six months to two years (quality, quantity an frequency and hygiene) Immunization and bi-annual Vitamin A supplementation with deworming Appropriate feeding for children during and after illness Therapeutic feeding for children with severe acute malnutrition Improve hygiene and sanitation practices and access to safe drinking water and sanitation commodities.

Access to some Essential Nutrition Interventions in Odisha Source: 2005-06 NFHS and 2013-14 RSOC state factsheet IYCF Micronutrients Health & WASH Adolescent and maternal nutrition

Key Actions Multi-sector convergent actions – GoO, community, PRI, media, CSO Equity: Focus on marginalized groups Community awareness, especially in tribal communities About optimal nutrition for women before, during and after pregnancy About optimal child nutrition, especially complementary feeding Support to obtain information