1. Millennium Development Goals Linkages with Early Child Development and Nutrition DR. S.K CHATURVEDI MD,MNAMS,FIAPSM,FIPHA UNICEF State Representative for NE/NW states New Delhi The Challenge in India

2. 1. Genesis of Millennium Development Goals 2. Conceptual Framework 3. The Link with Integrated Early Child Development & Nutrition 4. Millennium Development Goals 5. India – Challenges & Opportunities 6. Moving Forward

3. The Genesis Millennium summit of UN - September 2000 Commitment to reduce global deprivation and promote sustainable human development Millennium Development Goals/ Country Plan Goals Quantifiable targets for 2015 Some 10 th Plan Goals more ambitious than the MDGs A Rights Perspective Children’s & women’s rights fundamental to human rights UN Convention on the Rights of the Child Convention on Elimination of all forms of Discrimination Against Women Creating a World Fit For Children UN General Assembly Special Session on Children - Sept 2002 Placing children first on the development agenda

4. Millennium Development Goals 1. Eradicate Poverty & Extreme Hunger 2. Achieve Universal Primary Education 3. Promote Gender Equality & Empower Women 4. Reduce Child Mortality 5. Improve Maternal Health 6. Combat HIV/AIDS, Malaria & Other diseases 7. Ensure Environment Sustainability 8. Develop Global Partnership for development

5. Civil Society /State Natural Resource Base & Environment Efficient resource use & control Natural /Human / Economic/Organization Resources Education / Learning / Life skills / Information & Communication Household Securities (eg Food,Water,Shelter) Empowered Community & Change facilitators Access to quality Services (Health, CDN, WES) CARE Home Health Practices Home Hygiene Practices Infant and Young Child Feeding Psychosocial Care Care for Girls and Women Well nourished and healthy childSecure & Active Learner Fulfillment of the Rights of all children to survive grow and develop to their full potential without discrimination Basic Conditions Underlying Conditions Immediate Conditions Institutions and Governance Political, Economic & Social Structures & Systems Household/ Community Outcome Young children on the Development Agenda Child Family A conceptual Framework

6. Integrated Early Child Development & Nutrition Foundation for cumulative lifelong learning and human development Entry point for poverty reduction and human development strategy Early interventions most effective in addressing a life cycle of multiple deprivation -  Poverty  Gender Discrimination  Malnutrition Sensitive proxy indicator of human development - % children 0-5 years underweight Crucial for the achievement of first 6 MDGs

7. Halve, between 1990-2015, proportion of people… Target 1  …whose income is less than $1 a day Target 2  …who suffer from hunger Goal 1 Eradicate Poverty & Extreme Hunger Malnutrition erodes human capital, reduces learning abilities and productivity For human capital formation, it is critical to prevent malnutrition, as early as possible Early Care and Nurturing has a lasting impact on brain development- especially in the first 3 years The first 3 years are crucial. They are forever…

8. Goal 2 Achieve Universal Primary Education Ensure by 2015… Target 3  Children everywhere, boys & girls alike, will be able to complete full course of primary schooling 10 th Plan  All children in school by 2003 All children to complete 5 years of schooling by 2007 Early Child Development interventions Result in increased cognitive and social skills Improve retention and learning outcomes in primary education Equality of opportunity for disadvantaged groups Malnutrition reduces mental capacity & learning ability e.g. Micronutrient deficiencies such as Iodine (13 IQ points) Iron Deficiency Anemia (9 IQ points)

9. Goal 3 Promote Gender Equality & Empower Women Eliminate by 2005… Target 4  …Gender disparity in primary & secondary education, & at all levels of education no later than 2015 Positive early child care practices and parent education help promote equal learning opportunities for girls and boys Better nutriture and iron status of girls improves learning capacity, likely retention and future choices

10. Goal 4 Reduce Child Mortality Reduce by 2/3 between 1990-2015 Target 5  …Under 5 Mortality Rate 10 th Plan  IMR to be 45 by 2007 IMR to be 28 by 2012 More than 50% of all child mortality is directly or indirectly associated with malnutrition Around 25 % of young child mortality can be prevented through nutrition and early child care interventions

11. Goal 5 Improve Maternal Health Reduce by 75% between 1990-2015 Target 6  …Maternal Mortality ratio Maternal health is compromised by inadequate care and nutrition of girls and women Malnutrition, including anemia, is associated with most major risk factors for maternal mortality Severe anemia is a major cause of maternal deaths – around 20 % globally

12. Goal 6 Combat HIV/AIDS, Malaria & Other diseases Have halted by 2015… Target 7  …and begin to reverse the spread of HIV/AIDS Malnutrition  Hastens onset of AIDS among HIV-positive  Weakens resistance to infections and reduces malaria survival rates Infant & Young Child Feeding Informed choice important for prevention of mother to child transmission of HIV/ AIDS

13. Linking Nutrition & Development Mechanisms and Instruments More effective poverty reduction Nutrition key to addressing inter-generational cycle of poverty Helps targeting the most vulnerable and at risk Proxy indicator for multi-sectoral interventions Strengthened health sector reform Inclusion of early child care and nutrition increases efficiency and quality of health services Using nutrition tools and methods e.g. Mother Child Care Counseling Package Improved Governance Community based care interventions promote participatory processes and capacity

14. The Challenge in India Every fifth young child in the world lives in India Every second young child in India is malnourished Three out of four young children in India are anemic Every second newborn in India is at risk of reduced learning capacity due to iodine deficiency Vitamin A a public health issue Malnutrition limits development potential and active learning capacity of the child

15. 69 64 40 Source : SRS Bulletins - RGI IMR Reduction needs acceleration…

16. Children 0- 3 years Promoting early child development is crucial Addressing Malnutrition…

17. % children 0-3 years below -2 SD Weight-for-Age, NCHS Source : NFHS II, 1998-99  50 % 40-49 % 30-39% 20-29% Data NA Jammu & Kashmir Himachal Pradesh Uttaranchal Uttar Pradesh Bihar Arunachal Pradesh Nagaland Manipur Mizoram Tripura West Bengal Orissa J Andhra Pradesh Tamil Nadu Kerala Karnataka Goa Maharashtra (49.6%) Madhya Pradesh Gujarat Rajasthan Haryana Delhi Punjab Sikkim Assam Meghalaya Andaman & Nicobar Islands Lakshadweep Pondicherry Karaikal (Pondicherry) Dadar & Nagar Haveli Daman Diu Jharkhand Chattisgarh The boundaries and names shown in this map do not imply official endorsement or acceptance by the UN Prevalence of Underweight Children… (0-3 years)

18. Improve Infant and Young Child Feeding Practices Increase early initiation (colostrum feeding): 16% to 50% Increase exclusive breastfeeding 0-6 mths: 55% to80% (0-3 mths) (0-6 mths) Increase complementary feeding (6-9 mths): 34% to 75% Reduce the prevalence of Underweight (Children Under-3 years) from 47% to 40% Reduce prevalence of severe under-nutrition in children in the 0-6 years age group by 50% Reduce prevalence of anaemia by 25% and that of moderate/ severe anaemia by 50% Eliminate Vitamin-A deficiency Reduce prevalence of IDD to less than 10% by 2010 10 th Plan Goals…

19. Achieving the 10 th Plan Goals… It is possible to achieve these through relatively simple interventions Improved family community care behaviours, focusing on children Under-3 years of age –Infant and Young Child Feeding –Psychosocial Care –Care for girls and women –Hygiene –Health Positive evidence from community based care projects - even in challenging states

20. Preventable Under-5 deaths - India Through universal coverage with individual interventions (2000) Source : Lancet Series

21. Build upon innovative state-specific early child care approaches Enhance quality improvement initiatives in ICDS Increase emphasis on improving family/community early child care practices for younger children Under-3 years in RCH-II & ICDS e.g. Infant and Young Child Feeding Strengthen partnerships for WCD Panchayati Raj Institutions Women’s Self Help Groups and community groups National Nutrition Mission Moving Forward…