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Approaches to Nutrition:

The case for investing in nutrition is clear. Poor nutrition during the first
1,000 days—from pregnancy through a child’s second birthday—can
cause life-long and irreversible damage, with consequences at the
individual, community, and national level.
When a child is malnourished during the first 1,000 days of life, it results in a weaker
immune system and a higher risk of severe infectious diseases, including diarrhoea
and pneumonia.1,2 As undernourished children become adults, they are more likely to
suffer from chronic diseases, such as high blood pressure, diabetes, heart disease,
and obesity.3,4 These health impacts have devastating consequences for social and
economic outcomes. Poorly nourished children are more likely to complete fewer
years of school and have lower productivity as adults, including 10 percent lower
earnings over their lifetime.4,5

When multiplied across an entire nation, it is estimated that poor nutrition can reduce
a nation’s economic advancement by at least 8 percent due to direct productivity
losses, and losses due to reduced schooling and poorer cognition.6

By improving nutrition, we can build human capital and fuel economic growth for
generations to come. However, nutrition’s full impact can only be unleashed when all
sectors do their part—as shown in the UNICEF conceptual framework below.

UNICEF Conceptual Framework of Malnutrition (adapted)


Long-Term Consequences
Short-Term Consequences
Cognitive development, health,
Mortality, morbidity, disability
economic productivity

Maternal and Child Undernutrition

Immediate Inadequate dietary intake Disease


Underlying Household food insecurity

Inadequate foods, feeding, House, environment and
Causes and care practices health services

Basic Inadequate access Inadequate financial and Sociocultural, economic and

Causes to services human resources political context
Achieving nutrition’s full impact on health and development
Nutrition-specific outcomes requires a multi-sectoral approach
interventions address Nutrition-specific interventions are key to accelerating progress. However, it is
the immediate causes of also critical that other sectors—like agriculture, education, and social welfare—
undernutrition, like inadequate develop nutrition-sensitive interventions. A truly multi-sectoral approach will
achieve optimal nutrition outcomes through greater coverage, while also helping
dietary intake and some of the other programmes achieve more powerful results and demonstrate their own
underlying causes like feeding potential for impact.
practices and access to food.
u Agriculture: Programmes that boost agricultural production, keep prices
Nutrition-sensitive low, and increase incomes are critical—but they can still leave children
vulnerable to the life-long effects of poor nutrition. Research shows that
interventions can address
nutrition-sensitive programmes can enhance access to diverse diets in poor
some of the underlying and populations, foster women’s empowerment, and support livelihoods.7
basic causes of malnutrition
by incorporating nutrition goals u Education: When education programmes invest in nutrition, it improves
academic achievement—with the potential for substantial gains in the cost,
and actions from a wide range
efficiency, and effectiveness of programmes.8 Keeping girls in school for
of sectors. They can also longer is proven to delay the age of first marriage, and prepares young
serve as delivery platforms for women to be more informed and empowered mothers.9 Deworming,
nutrition-specific interventions. micronutrient (including iron) supplementation, food fortification, and early
childhood development programmes all show tremendous potential for

u Social welfare: Efforts to lift poor families out of poverty are undermined
unless good nutrition is part of the investment. When social protection
programmes become nutrition-sensitive, they can improve diet quantity,
quality, and diversity; decrease vulnerability to food insecurity; decrease
child mortality; and help children reach their full potential.10,11,12,13

u Public health: Public health and nutrition are interdependent. Diarrhoea

and pneumonia are the biggest killers of children in the Asia and Pacific
region—deaths that are largely preventable through breastfeeding and
adequate nutrition, hand washing with soap, safe drinking water and basic
sanitation, and vaccination.14 Delivery of micronutrient supplements through
antenatal care services can also reduce maternal death and low birthweight

Key findings from The 2013 Lancet Series on Maternal and Child Nutrition show
that nutrition-sensitive programmes in agriculture, social welfare, early child
development, and schooling can be successful at addressing several underlying
determinants of nutrition. Once there is consensus for a multi-sectoral approach,
we can begin to tackle all the causes of malnutrition in a coordinated and
synergistic way.

Criteria for nutrition-sensitive development1

Nutrition-sensitive development seeks to integrate and promote nutrition as
a goal of multiple sector policies in order to accelerate national development.
Agriculture, social protection, health, and education programmes all have
specific and attainable actions they can make to improve their own outcomes by
incorporating nutrition.
Nutrition-sensitive programmes can:

u Incorporate specific nutrition goals and actions in addition to their own


u Directly address factors that influence undernutrition, like food security,

access to health services, or ensuring safe and hygienic environments.

u Target key audiences for nutrition information, including the poor, who have
the highest malnutrition rates.

u Deliver nutrition-specific interventions, like counseling on infant and young

child feeding, care, and hygiene.

Breastfeeding, along with other

interventions, such as hand

➤ Protection
Social ➤ washing and vaccinations,
can help prevent diseases like

diarrhoea and pneumonia — the
Agriculture biggest killers of children in the
Health Asia and Pacific region.14



Women’s Development
Empowerment & Poverty

➤ ➤

Other sectors can take practical steps to develop nutrition-

sensitive programmes1
Programmes can become more nutrition-sensitive by:

u Strengthening their nutrition goals, design, and implementation. For

example, health programmes can often deliver nutrition services through
antenatal care services, routine immunisation, and family planning.

u Improving targeting, timing, and duration of exposure to

interventions. For example, integrating nutrition into programmes that
reach families with pregnant and lactating women and children between
0 and 24 months of age will optimise delivery of key services during the
critical window of opportunity.

u Using conditions to stimulate demand for programme services, while

ensuring good service quality. For example, cash transfer programmes
can set conditions on payments that require families to utilise key nutrition
services, enforce school enrolment and attendance, or require parent
participation in health and life skills education.
u Optimising focus on women’s nutrition and empowerment. For
example, when programmes are designed from the outset to increase
women’s decision-making power, it can increase investments in better
nutrition for the whole family.

Nutrition-sensitive programmes can help enhance the scale of nutrition-specific

interventions and create a stimulating environment in which young children can
grow and develop to their full potential.


Policy-makers and programme implementers from across sectors can help
ensure a brighter future by developing nutrition-sensitive interventions that
help individuals and nations benefit from the full impact of optimal nutrition. By
investing now, we can generate greater human capital, enable individuals to
escape poverty, and help nations fuel economic development. Together, we can
break the cycle of undernutrition for generations to come.

By improving nutrition, we
can build human capital and
fuel economic growth for
generations to come.

This is one brief in a five-part series on the importance of multi-sectoral approaches

to nutrition. To read the other briefs, visit

1. The Lancet, (2008). Maternal and Child Undernutrition, Special Series, 371.
2. The Lancet, (2003). Child Survival, Special Series, 361.
3. Thomas, D., & Strauss, J., (1997). Health and wages: evidence on men and women in urban Brazil, Journal of Econometrics, 77, 159-85.
4. Hunt, J. M., (2005). The potential impact of reducing global malnutrition on poverty reduction and economic development, Asia Pacific Journal of
Clinical Nutrition, 14, 10-38.
5. Horton, S., (1999). Opportunities for investments in nutrition in low-income Asia, Asian Development Review, 17(1,2), 246–273.
6. Horton, S., & Steckel, R. H., (2013). Global economic losses attributable to malnutrition 1990— 2000 and projections to 2050. In: Lomborg, B. How
much have global problems cost the world? A scorecard from 1900 to 2050, Cambridge University Press, Cambridge.
7. Alderman, H., & Ruel, M., (2013). Nutrition-sensitive Interventions and Programmes: How Can They Help to Accelerate Progress in Improving Maternal
and Child Nutrition?, The Lancet, 382, 536-551.
8. Bundy, D., et al., (2009). Rethinking School Feeding: Social Safety Nets, Child Development and the Education Sector, World Food Programme and the
World Bank.
9. IOB, (2011). Lessons learnt: Synthesis of literature on the effectiveness of investment in education, Ministry of Foreign Affairs of the Netherland, IOB
Evaluation, The Hague, Netherlands, (355).
10. DFID, (2009). The neglected crisis of undernutrition: Evidence for action, UKAID from the Department for International Development, London, U.K.
11. Gilligan, D., et al., (2008). The Impact of Ethiopia’s Productive Safety Net Programme and its Linkages, IFPRI, Washington, D.C.
12. Freeland, N., & Cherrier, C., (2012). Social Transfers in the Fight Against Hunger A Resource for Development Practitioners, Tools and Methods Series
Reference Document, European Commission.
13. Rasella, D., et al., (2013). Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities, The
14. UNICEF, (2012). Pneumonia and diarrhoea: tackling the deadliest diseases for the world’s poorest children, New York.
15. Bhutta, Z., et al., (2013). Evidence based interventions for improving maternal and child nutrition: What can be done and at what cost?, The Lancet,
382, 452-477.
16. The World Bank, (2013). Improving Nutrition through Multi-Sectoral Approaches, Washington, D.C.

This document has been produced with the financial assistance of the European Union, as part of the Maternal and Young Child Nutrition Security Initiative in Asia (MYCNSIA). The views expressed
herein can in no way be taken to reflect the official opinion of the European Union.
For more information on this and other partnerships of UNICEF and the EU, please go to