1. Maternal, Adolescent and Young Child Nutrition: the unfinished agenda for the transition from MGDs to SDGs Noreen Prendiville, Deputy Representative UNICEF Uganda

2. Outline Maternal, adolescent and young child nutrition in Africa WHA goals and the focus on maternal and adolescent and young child nutrition The achievements against the MDG Way forward: SDG and unfinished agenda

3. Maternal, adolescent and young child nutrition

4. Maternal Malnutrition Maternal malnutrition accounts for 7% of the global disease burden Contributes to at least a fifth of maternal deaths along with the increased probability of poor pregnancy outcomes Short maternal stature may lead to obstructed labour and maternal and fetal or neonatal death Widely prevalent in the regions of South East Asia, South America and Africa; some countries in the region have maternal undernutrition prevalence as high as 35%.

5. Adolescent Nutrition: Important for Girls, and for the Future Generation As many as half of all adolescent girls in some countries are stunted, increasing risk of complications in pregnancy and delivery and of poor fetal growth 5

6. Importance of Nutritional Status in Women Before and During Pregnancy Maternal stunting and low Body Mass Index increases the risk of fetal growth restriction (small for gestational age) Maternal obesity leads to gestational diabetes, pre- eclampsia, haemorrhage and higher risk of neonatal and infant death The prevalence of low BMI (<18.5 kg/m2) among women in Africa and Asia still looms higher than 10% Simultaneously, prevalence of overweight (BMI ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) has been rising in all regions reaching more than 40% in Africa by 2008. 6

7. Maternal Anemia

8. Trends in thinness (BMI <18E5 kg/m2), overweight (BMI.25 kg/m2), and obesity (BMI.30 kg/m2), using population weighted average prevalences for women aged 20.49 years in Africa, 1980-2008 Maternal Nutrition Trends in Africa 8 BMI ≤ 18.5 BMI ≥ 25 BMI ≥ 30

9. Maternal BMI (<18.5 kg/m 2 )

10. Low Birth Weight

11. Prevalence of SGA Births 32.4 million babies were born SGA in 2011; 27% of all births in LMICs 11

12. Risks of SGA for Mortality and Preterm Birth for Neonatal Mortality 12 Reductions in child mortality could be achieved by targeting interventions to reach babies born too small or too soon

13. Risk of SGA for Stunting 13 20% of stunting by 24 months can be attributed to being SGA 20% of stunting by 24 months can be attributed to being SGA

14. Interventions to address maternal nutrition 14

15. ANC4+ Visits

16. Skilled Birth Attendance

17. WHA goals and the focus on maternal and adolescent and young child nutrition

18. 39 Stunting children under 5 Wasting children under 5 Overweight children under 5 Anemia women aged 15-49 years Exclusive Breastfeeding, 0-6 months Adult Overweight + Obesity (BMI≥ 25) Adult Obesity (BMI≥ 30) Adult Diabetes high blood sugar 60 15 79 63 84 8 115 67 39 5 32 63 24 22 24 180 10 36 190 193 185 5 3 Global Target Missing data Off course, little/no progress Off course, some progress On course On course, at risk Number of countries at various stages of progress against global targets on nutrition 3

19. WHA Data gaps are closing, but remain large

20. In Africa, the number of stunted children is rising Number of children under 5 stunted, by United Nations region, 1990 and 2014 UNICEF – WHO – World Bank Group joint child malnutrition estimates, 2015

21. Potential contribution of adolescent to WHA targets Source: Adolescent Nutrition: Policy and programming in SUN+ countries, Safe the Children, 2015

22. The achievements against the MDGs

23. MDG 1: Eradicate extreme poverty and hunger Africa still lags behind most other developing regions in achieving the target on underweight children. Performance at the country level shows wide disparities with some countries having achieved the target, while many others made only marginal progress. Wide disparities also exist among children from rich and poorhouseholds, as well as between those from rural and urban areas. Halving prevalence of underweight children under five years of age is still a challenge

24. MDG 4: Reduce Child Mortality

25. Under 5 Mortality Rate

26. MDG 5: Improve Maternal Health Trends in estimates of the maternal mortality ratio (MMR) across African regions

27. Maternal Mortality Ratio

28. Way forward: SDG and unfinished agenda

29. Sustainable Development Goals – 17 goals and 169 targets Goal 1 End poverty in all its forms everywhere Goal 2 End hunger, achieve food security and improved nutrition and promote sustainable agriculture Goal 3 Ensure healthy lives and promote well-being for all at all ages Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Goal 5 Achieve gender equality and empower all women and girls Goal 6 Ensure availability and sustainable management of water and sanitation for all Goal 7 Ensure access to affordable, reliable, sustainable and modern energy for all Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Goal 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Goal 10 Reduce inequality within and among countries Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable Goal 12 Ensure sustainable consumption and production patterns Goal 13 Take urgent action to combat climate change and its impacts* Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable development Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development

30. Key actions to address maternal, adolescent nutrition Actions Scope Deliver services for mothers and children Provide services in fragile/emergency contexts Support programs in low-capacity contexts Build management capacity at sub-national level Procure and deliver supplies Empower communities Engage for social and behavior change Generate demand Strengthen accountability Support program delivery Build resilience Influence government policies Support evidence-based policymaking and budgeting Promote scale-up of effective interventions / innovations Share knowledge & promote south-south exchange Advocate for every child's right to health Support evidence generation Conduct situation analyses Lead and engage in partnerships at global, regional, and country-level Expand available resources for health

31. Key actions to address maternal, adolescent and child nutrition Program Areas Scope Reduction of early pregnancy Inclusion of family planning as part of comprehensive package of interventions targeting adolescent girls Quality of maternal and newborn care Initiatives to improve quality of care during pregnancy, childbirth and first 28 days of life Equitable access to primary health care Strengthening primary health care platforms to deliver core packages of multi-sector interventions and services for child health Equitable access to life- saving commodities and vaccines Identifying and addressing key bottlenecks to procurement and delivery of life-saving commodities and vaccines via routine channels Early childhood development and nutrition Delivery of nutrition and ECD interventions and services via primary health care platforms NCD prevention Integrated health / education / nutrition programs addressing key risk factors for NCDs (nutrition, insufficient physical activity) Adolescent health Reduction of early pregnancy, NCD prevention, mental health, substance abuse

32. Way Forward There is a need to prioritize investment in the scale-up of nutrition-specific interventions with concomitant efforts to maximize the implementation of nutrition sensitive programs Implementation barriers, including lack of personnel, ineffective monitoring and supervision, lack of coordination and financial sustainability, must be overcome for optimal gains. The nutrition community, and its natural allies in the food security, agriculture, WASH, gender and health communities, should advocate for nutrition within the SDG framework.

33. THANK YOU