In 9 months, world leaders will descend on New York during the UN General Assembly and proudly proclaim the beginning of the Sustainability Development Goals (SDGs) era. Building on the experience of the Millennium Development Goals (MDGs), the SDGs will be the most broadly supported, comprehensive and specific development goals the world has ever established. The new goals will drive investment and action, touching millions of children’s lives.
UNICEF has outlined its priorities for the post-2015 SDGs in our Agenda for Every Child. Nutrition is central to this agenda and linked to almost all of these priorities: ending poverty, ending preventable child deaths, improving lives of adolescents, responding to humanitarian crises and building resilience. As our report Improving Child Nutrition: The achievable imperative for global progress states, optimal nutrition, especially during the first 1000 days of life, is foundational – enabling children to survive and develop to their full potential.
The recent Global Nutrition Report made the case for nutrition clear: all countries and about half of the world’s population are affected by malnutrition. Yet, progress is being made, and accountability systems for nutrition are being strengthened. Governments, donors and others are investing in nutrition – this is a smart investment. No matter where you are in the world, for every dollar invested in nutrition, the median return will be more than 16 dollars.
With this strong case for investment, where does nutrition feature in the proposed SDGs?
The UN Open Working Group has proposed 17 SDGs with 169 targets. Nutrition is only reflected in one goal (number 2), and in one target (target 2.2): by 2030 end all forms of malnutrition, including by achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.
Considering the overwhelming scientific evidence on the impact of malnutrition on poverty, health, survival, education, etc., nutrition is clearly understated in the SDGs. We must not undervalue or lose this opportunity for our children. There is a risk that with the call to limit the number of indicators linked to targets, that only one or two nutrition indicators will be endorsed.
This would be a mistake.
In 2012, 194 Member States of the World Health Organization already agreed upon six targets to improve maternal, infant and child nutrition, which were endorsed by the 65th World Health Assembly. The selected indicators are smart, not only because they are specific, measurable, achievable, realistic and time-bound, but because these represent markers to track the smartest investment to improve global welfare.
The World Health Assembly targets also included increasing the rate of exclusive breastfeeding for children under six months of age to at least 50 per cent by 2025. Breastfeeding is a cornerstone of child survival, nutrition and early childhood development, so it is imperative that breastfeeding is reflected in the SDGs.
Sub-optimal breastfeeding practices resulted in almost 12 per cent of all deaths among children under five years of age, or about 800,000 deaths in 2011. Breastfeeding prevents malnutrition and gives children the best start in life, whether the child is born in a high-income or low-income country, to a rich family or a poor one.
From the first hour of a baby’s life through age two or later, breastfeeding protects against illness and death.
Even in populations with low infant mortality, there may be risks associated with not breastfeeding, including certain infections, type 2 diabetes and childhood obesity. Breastfeeding supports healthy brain development, thus promoting long-term education benefits as well, including increased I.Q. scores and better school performance. For mothers, breastfeeding protects maternal health by increasing birth spacing and reducing risk of postpartum haemorrhage, certain cancers and cardiovascular disease.
Moreover, breastfeeding contributes to environmental sustainability. It provides a natural and renewable food that involves no packaging, transportation or fuel to prepare.
Early initiation of breastfeeding (within the first hour of birth) and exclusive breastfeeding (no additional foods or liquids, including water) for the first six months of life are globally recommended interventions, which bring about multiple dividends across many proposed sustainable development goals.
Not only could breastfeeding indicators be included under Goal 2, they could — for example — also be included to measure progress toward proposed Goal 3 which calls for an end to preventable deaths of newborns and children under age 5.
The scientific evidence in this regard is compelling. Colostrum, the first milk, provides a baby’s first immunization by transferring vital antibodies and growth factors from mother to child, preventing early death and protecting the newborns from infections. Immediate skin-to-skin contact and early initiation of breastfeeding within the first hour of life could significantly reduce neonatal mortality.
Currently, less than 40 per cent of children worldwide are exclusively breastfed for their first six months. This figure has remained relatively unchanged for nearly two decades. The SDGs provide an opportunity to change this for the better. We see optimal nutrition, which includes breastfeeding, in our vision for the Agenda for Every Child – providing a fair and equal opportunity to have the best start in life.
We urge Member States and all stakeholders involved in this process to include a wider set of nutrition indicators, including breastfeeding, in the SDGs.
After all, what is measured stands a chance of getting done.
Werner Schultink is the Chief of Nutrition at UNICEF HQ.