Suaahara II ProjectIn Nepal, 36% of children who are under the age of five remain underdeveloped in terms of growth and health despite progress in recent years. Through cooperation with USAID, the Nepalese Government and local private sector groups, Hellen Keller International (HKI) has provided impactful services that have helped rectify the systematic obstacles causing these health issues. Hellen Keller International is a non-profit organization that aims to reduce malnutrition. The Suaahara II project takes a pivotal role in these efforts.

What is the Suaahara II Project?

One of HKI’s most notable services is the Suaahara II project, which started in 2016 and was initially set to end in 2021. However, it will now extend to March 2023 due to COVID-19. Operating in 42 of Nepal’s districts with a $63 million budget, HKI partnered with these six organizations for the project:

  • Cooperative for Assistance and Relief Everywhere, Inc. (CARE)
  • Family Health International 360 (FHI 360)
  • Environmental and Public Health Organization (ENPHO)
  • Equal Access Nepal (EAN)
  • Nepali Technical Assistance Group (NTAG)
  • Vijaya Development Resource Center (VDRC)

Hellen Keller International’s primary role in the Suaahara II project deals with the technical assistance of child and maternal nutrition. This means that its tasks are oriented around building the skills and knowledge of health workers. This includes teaching health workers how to adequately measure and evaluate assessments; additionally, another technical facet relies on promoting governance that invests in nutrition.

A Multi-Sectoral Approach

Kenda Cunningham, a senior technical adviser for Suaahara II who works under HKI, told The Borgen Project that the Suaahara II consortium has taken a “multi-sectoral approach.” She believes in the importance of this as it pushes individuals to “learn and think beyond their sector.” The Suaahara II Project’s demonstrates its integrated strategy in the initiatives below:

  1. The WASH program focuses on water, sanitation and hygiene through WASHmarts, which are small shops dispersed across districts that sell sanitary products like soap and reusable sanitary pads. Kenda explained how this has helped “bridge a gap” so that poorer households can access hygiene enhancing products. This also allows assistance from private actors, who can expand their markets in rural areas.
  2. The Homestead Food Production program (HFP) encourages households to grow and produce micronutrient-rich foods through vegetable gardening and raising chickens, for example. As a result, 35 districts have institutionalized HFP groups.
  3. The Bhancchin Aama Radio Program is a phone-in radio program that runs twice every week. It hosts discussions among marginalized communities and demonstrations for cooking nutritious foods. It has encouraged the Nepalese to socially and behaviorally alter their health habits.

Advancements from Suaahara I

The Suaahara II project’s contribution to improved health and nutrition in Nepal is also illustrated in its progression from the Suaahara I project’s framework. In addition to understanding the changes made in household systems and at a policy level from Suaahara I, Cunningham told The Borgen Project that technological developments have elevated the Suaahara II Project’s impact in Nepal.

Specifically, smartphones expedite the data collection process when studying trends pertaining to the 2 million households across the districts. The development of new apps provided more households with access to smartphones and key information. This therefore allowed officers to transition from pursuing “a mother-child focus to a family focus” in terms of the Suaahara II project’s accommodations and services.

Challenges with Suaahara II

While the Suaahara II Project has led to institutional and social enhancements regarding health and nutrition, some districts had access to the project earlier. This created a dissonance in the rate of health improvements amongst the districts. Cunningham reported that “far western areas are much more remote and therefore disadvantaged and food insecure.”

This inconsistency was largely due to the “Federalism” that took place in Nepal in 2017, which was a decentralization process that created 42 municipalities for 42 districts. Since every municipality has a different political leader, some districts had the advantage of assistance from foreign NGOs while others did not because their leaders rejected involving foreign NGOs. In these cases, as Cunningham explained, it is like “you are creating your own NGOs from the ground up.”

Suaahara II Achievements

These obstacles, however, have not been pertinent enough to counter the consortium’s efforts in fulfilling the Suaahara II project’s objectives. For example, a primary objective for Suaahra II is to increase breastfeeding amongst babies under six months of age. Exclusive breastfeeding of children under six has increased from 62.9% in 2017 to 68.9% in 2019, according to data that Cunningham shared with The Borgen Project.

Expanding children’s access to diverse and nutritious foods is another objective that has been achieved under the Suaahara II project. The dietary diversity among women of reproductive age (WRA) has increased from 35.6% in 2017 to 45.3% in 2019, according to Cunningham. Given the efficient rate of improvement in women and children’s health, governance and equity in only the first two years of the Suaahara II project, it can be inferred that the consortium will continue to progress in achieving its targets among the Nepalese in the three years that remain.

Regarding how HKI has responded to challenges with the Suaahara II project, Cunningham said  “[We] don’t use a one size fits all approach.” The advancements in Nepal’s health and nutrition systems can be largely attributed to HKI’s multifaceted and integrated strategy, a model that could yield prosperity in the rest of the developing world.

Joy Arkeh
Photo: Flickr

Fighting Malnutrition in Kenya
In Africa, about 257 million people do not know where their next meal will come from. This means that approximately 20 percent of the population is experiencing severe hunger as a result of the continent’s economic crisis and extremely dry conditions. Food prices soar in response to poor harvests and crop failures, leaving many to starve if action is not taken. Fortunately, humanitarian aid organizations like UNICEF reduce the impact of hunger in impoverished countries across Africa by stepping in with malnutrition prevention and treatment strategies that continue to save lives. This is how UNICEF is fighting malnutrition in Kenya.

The State of Malnutrition in Kenya

Kenya’s food insecurity issue is a direct byproduct of the country’s low agricultural productivity that is caused by a lack of rainfall. About 80 percent of the East African country’s land is arid.  These dry, drought-like conditions only exacerbate the dilemma of low crop and livestock production. This leads to a shortage of food, and the available food is often sold at an inflated, unaffordable price.

More than 3.4 million Kenyans are facing severe food insecurity and around 400,000 children under the age of 5 are malnourished. Approximately 26 percent of children 5 and under are stunted, while another 4 percent are chronically emaciated or “wasting.” With malnutrition being the leading cause of death in children, it is vital that something is done to prevent this hunger.

Taking Action

Luckily, UNICEF is taking action. Founded in 1946, UNICEF is fighting malnutrition in Kenya from the inside by providing millions of people with resources, medical treatment and even counseling. The organization’s Vitamin A Supplementation Policy helped more than 3 million children to receive Vitamin A, a nutrient that is crucial for the human body to develop properly. This supplementation program has helped children fight malnutrition by allowing them to build strong immune systems and reduce dehydration. According to UNICEF, Vitamin A supplements can increase a child’s chance of survival by as much as 24 percent.

In 2017, UNICEF provided malnutrition screenings to over 450,000 impoverished children through outreach services. This program was in response to Kenya’s national drought emergency that was declared in April of that year, which was projected to cause a rapid spike in food shortages. These screenings were able to provide life-saving treatments for children that were suffering from the effects of malnutrition.

Iron Folic Acid (IFA) prevents low iron levels in the body while also promoting proper growth and development. UNICEF recently donated Iron Folic Acid supplements to over 2.5 million women of reproductive age through the Girls’ Iron-Folate Tablet Supplementation (GIFTS) Programme, allowing adolescent girls and women to decrease their susceptibility to anemia. Since IFA is often used as a prenatal supplement, UNICEF is fighting child malnutrition in Kenya before it even starts.

In addition to increasing a child’s chance of survival, feeding practices like breastfeeding can promote optimal growth and development. Through the Community Health System, UNICEF counseled more than 1.7 million new mothers on safe and proper breastfeeding. By teaching mothers about the benefits of breastfeeding, UNICEF has saved even more children from experiencing malnutrition at an early age.

Moving Forward

Kenya has made significant progress in reducing malnutrition rates. By promoting good nutrition and providing resources and outreach services, UNICEF has improved the lives of millions of families. As far as 2022, UNICEF plans on continuing to integrate nutrition-specific strategies to help fight malnutrition in Kenya.

– Hadley West
Photo: Flickr

Malnutrition in GhanaMalnutrition in Ghana has cost its economy $2.6 billion annually or 6.4% of gross domestic product (GDP) due to increased health care costs, additional burdens on the educational system and lower productivity by its workforce, according to a new United Nations report.

In the Northern Region, malnutrition is much more prevalent with 20 percent of children under five being underweight. As a result, there is a high stunting rate of 32.4 percent. The region is also plagued by high rate of micronutrient deficiencies such as anemia and vitamin A deficiency.

The USAID Resiliency in Northern Ghana (RING), a collaborative project dedicated to sustainably reducing poverty and improving livelihoods and nutritional status of vulnerable populations, called for exclusive breastfeeding to combat malnutrition in Ghana.

“Mothers should stick to [exclusive] breastfeeding for the first six months after which they can introduce the sour foods to children,” nutrition officer of the USAID-RING Project, Kristen Kappos underscored.

Kappos also implored health workers, volunteers and farmers to continue raising people’s awareness on breastfeeding within their operational zones.

As far back as 1991, Ghana adopted the Baby-Friendly Hospital Initiative (BFHI) to promote and support the practice of exclusive breastfeeding. However, exclusive breastfeeding rate has remained unchanged for two decades at 64.7%, far lower than the World Health Organization would prefer.

According to a recent study, knowledge gaps in key nutritional areas, especially infant and young child feeding, are the main reason leading to a low rate of exclusive breastfeeding in Ghana.

About 26% of the mothers studied were unable to define exclusive breastfeeding and 22% of them said breastmilk only was not sufficient to meet the nutritional needs of the child. They believed that the child may not be satisfied and could die if fed with only breastmilk for six months. Nearly 90% of the mothers did not know that breast milk could be expressed, stored safely and given to the child when the mothers were absent.

In addition, cultural factors also create challenges for mothers to breastfeed. The majority of the mothers showed a lack of confidence in expressing and storing breastmilk, a taboo in the local context.

Interventions must be designed to increase women’s confidence and dispel their misconceptions regarding breast milk, USAID-RING Project urged. Meanwhile, Hajia Ayishetu Bukari, Central Gonja district director of Ghana Health Service, also emphasized the need for employers to create and maintain conducive workplaces for exclusive breastfeeding practices.

Yvie Yao
Photo: Flickr

Breastfeeding Advocacy Initiative
Only 38% of infants are exclusively breastfed for their first six months of life. Improper and insufficient breastfeeding contributes to nearly 800,000 preventable child fatalities every year. A breastfeeding advocacy initiative would not only challenge the social pariah of the practice but also contribute to the improvement of mothers’ and children’s health worldwide.

Breast milk contains all of the nutrients that babies need in their first six months and has the ability to strengthen a child’s immune system to protect against illness. Breast milk has also increased children’s physical and cognitive development.

The benefits of breastfeeding extend beyond a baby’s health. Mothers who breastfeed reduce their risk of suffering from postpartum hemorrhage, which is a leading cause of death among new mothers. Mothers also find themselves at reduced risk for diabetes and breast cancer.

Why Breastfeeding is No Longer the Norm

So why then are such a small percentage of babies exclusively breastfed? One reason for low breastfeeding rates is the issue’s generally low prioritization by political leaders and policymakers.

Women also feel that breastfeeding is looked down upon in the workplace and the public sphere. For instance, if women cannot find a comfortable place to breastfeed at work, then their child is less likely to receive his or her’s natural source of nutrients. Additionally, there are many companies that sell formula and aggressively market the concoction as being a better alternative to breastfeeding.

To improve breastfeeding statistics, there is a global breastfeeding advocacy initiative underway with support from organizations such as UNICEF and the World Health Organization. Initiatives focus on educating mothers and communities about the benefits of breastfeeding and supporting policies and programs that spread this message.

In the West African nation of Guinea-Bissau, one in 10 children will die before they reach five years of age. Organizations such as UNICEF and the non-governmental organization CARITAS work tirelessly to improve this statistic, and a fruit of their labor has been the nutrition bungalows that now exist in Guinea-Bissau.

Nutrition Bungalows

At these bungalows, mothers of children under five years old are invited to gather monthly for information sessions. The sessions are often interactive and they focus on promoting health for mothers and children. Mothers can also have their children measured and weighed to ensure that they are meeting developmental milestones.

These nutrition bungalows and all other projects incorporating a global breastfeeding advocacy initiative aim to spread awareness and increase support for exclusive breastfeeding in both the political and social spheres. In doing so, the lives of mothers and children can be saved and their quality of life improved.

Nathaniel Siegel

Photo: Pixabay

World Breastfeeding Week

Breastmilk is a baby’s best protection against illness and disease, but data has shown that the number of newborns breastfed within the first hour of life has not improved over the past 15 years. World Breastfeeding Week is celebrated annually from August 1–7 in over 170 countries, and global organizations are sharing how early breastfeeding can make the difference between life and death.

5 Things to Know About Breastfeeding

  1. Delayed breastfeeding, even only 24 hours after birth, increases the child’s risk of dying within the first 28 days of life by 80 percent, according to the World Health Organization (WHO). Several factors contribute to this issue—from inadequate healthcare during delivery to babies being fed less nutritious alternatives, such as formula, cow’s milk or sugar water. These alternatives all decrease a newborn’s chance of survival. As such, government policymakers and organizations are targeting this issue by raising awareness and encouraging others to protect and promote exclusive breastfeeding.
  2. Research has found a clear connection between breastfeeding and higher IQ scores and educational achievement. Giving children the proper nutrition at the start of life supports optimal development and leads to higher earnings later in life–specifically, 12 percent higher per hour in high-income countries, and 16 percent in low to middle-income countries.
  3. The Global Breastfeeding Advocacy Initiative led by UNICEF and WHO is working with international partners to help build a healthy society. Lawmakers can show their support by ensuring a minimum of four months paid maternity leave, requiring employers to provide protection for mothers to pump milk at work and preventing discrimination against women and mothers in the workplace.
  4. Approximately 200 million children alive today will fail to reach their full physical, mental and social potential. Why? Negative factors inhibiting early childhood development–not being breastfed is among those factors. For this reason, WHO is working with countries to increase the rate of exclusive breastfeeding for the first six months up to, at least, 50 percent by 2025, in order to turn things around and save millions of lives.
  5. Breastfeeding produces long-term health benefits for both the mother and the child. The act of breastfeeding produces oxytocin, protects against diarrhea and common illnesses like pneumonia, and reduces the risk of obesity in childhood and adolescence. It is crucial that people are knowledgeable on the subject of breastfeeding and the effects it has on a child’s life.

Though some of the statistics given might seem shocking, World Breastfeeding Week takes the initial steps necessary to create change by raising awareness of the problem and producing individuals that can implement solutions.

Mikaela Frigillana

Photo: Flickr

The importance of breastfeeding is not limited to health benefits. Higher rates of breastfeeding reap economic benefits too, which in turn can alleviate the strain of poverty in developing nations.

According to a series of studies published in The Lancet, a British medical journal, if a greater number of women breastfed from birth through at least six months of their baby’s life, it could save nearly 820,000 lives and billions of dollars.

The United States Department of Agriculture (USDA) estimates that if 50 to 75 percent of mothers breastfed through six months, the U.S. alone would save $3.6 billion each year.

The actual savings could be even higher, as these figures come from the cost savings of only three illnesses that are most common among children who are not breastfed. Breastfeeding reduces the risk factor of many other diseases and health complications as well.

In poorer countries, breastfeeding substantially reduces the number of childhood deaths from preventable diseases such as pneumonia and diarrhea.

These diseases are most commonly found in children in poor and underdeveloped countries, which typically already suffer huge economic losses from health problems.

Not only can breastfeeding greatly reduce the risk of these health problems, it can also save millions that would be spent treating these diseases after the fact.

The continued evidence of the importance of breastfeeding is greatly heartening. The difficulty is in getting this critical information to the women who need it most.

As a Huffington Post article explains, the real and current battle involves increasing awareness and education specifically to poorer mothers about the importance of breastfeeding.

Investments in healthcare programs in developing countries should continue focusing on health education, with a strong priority on basic elements of women’s health.

By increasing awareness of women’s health, including the importance of breastfeeding, countries can save many precious lives and valuable resources.

Emily Milakovic

Photo: Flickr

Destigmatization of Breastfeeding in Urban India
World Breastfeeding Week is celebrated internationally every year from August 1-7th. Each year, there are various events and activities intended to educate about the benefits and encourage the practice. The theme this year was ‘Women and work – Let’s make it work.’ This year, added emphasis was placed on advocating for widespread maternity leave and other accommodations for working mothers.

Many organizations such as UNICEF, World Health Organization (WHO), and the Breastfeeding Promotion Network of India (BPNI) have worked both independently and jointly with the Indian government to provide information and spread awareness throughout the country. The breastfeeding rates are higher in the rural Northern states than in the urban South.

UNICEF Nutrition Specialist, Gayatri Singh states, “The government of India has laws, policies and programs to protect, promote, and support breastfeeding. UNICEF supports national and state governments in the development and implementation of infant and young child feeding policies and plans for promoting optimal breastfeeding.”

Singh goes on to say, “Communication and advocacy activities on breastfeeding are also a key component of UNICEF’s support. We also support governments to design strategies for social and behavior change communication and in the implementation of the strategies through multiple communication channels.”

In an effort to promote breastfeeding, the Indian government enacted the Infant Milk Substitute (IMS) Amendment Act in 2003 which prohibits any form of advertising claiming newborn formula as an equivalent option.

“In India, between 2006 and 2013, there has been an improvement in the breastfeeding rates. The latest data shows that 44.6% of children are put to breastfeeding within one hour of birth and 64.9% of children under six months of age are exclusively breastfed,” states Singh. He goes on to add that while knowledge of health benefits appear to be even higher, there are societal factors hindering the practice.

Dalvinder Kaur, a public relations specialist, states, “A lot of people, while thinking of breasts, automatically think of sex, as if that’s their primary reason for existence. I feel that it is pretty much the heart of the matter. Women’s breasts are often defined as sex objects–and nothing more. And since sex is basically a taboo in the public realm, breastfeeding ends up being perceived as some sort of indecent, out-of-bounds behavior.”

Dhanya Ranjit, a software engineer and mother speaks on the stigma attached to breastfeeding, “Women find it difficult to breastfeed and more so, to nurse in public because of the lack of support from any quarter. They also don’t see it happening around them. While I was very hesitant to breastfeed my older child in front of others but the encouragement and exposure to information through the Facebook support groups made me realize that it is as natural as an adult eating food in public.”

As is the case with many social movements, the internet can be utilized very effectively to raise awareness and garner support. “Big Latch On” is an international gathering that occurs in many cities during World Breastfeeding Week and event calls for mothers to join together publicly and breastfeed together. Through a social media campaign, a “Big Latch On” event was held this past August 1st in Hyderabad, Telangana, India. The organization started in New Zealand but has spread to many countries around the world.

Recent attempts at normalization in mainstream media have begun to manifest themselves as well. Indian cinema has begun to prominently display breastfeeding such as in the recent blockbuster movie Baahubali. The highly anticipated film cost $40 million and is the most expensive movie in Indian history. Whether purposeful or not, the display of breastfeeding in such a popular film shows marked progress towards shifting attitudes of the viewers.

The Borgen Project

Sources: India Times, Jantaka Reporter, IBN Live
Photo: Flickr

It has been proven that the first 6 months of a child’s life are amongst the most crucial for establishing their longstanding health immunities and development of antibodies. However, in the rural areas of northern India, UNICEF estimates that only 46 percent of infants are exclusively breastfed during this time. Furthermore, it is believed that approximately 2 million Indian children die each year before the age of 5.

A 2009 study was conducted at the Pravara Rural Hospital in Loni, Uttar Pradesh. Three hundred mothers of children between ages 0 and 5 were surveyed regarding socio-demographics, religious affiliations and breastfeeding practices. In like manner, the children themselves were clinically examined to determine the severity, if any, of their malnutrition.

These data sets were examined, compared and analyzed to determine any patterns or similarities. Male and female children surveyed were split approximately 60 percent to 40 percent, respectively, but there were no indications implying the biological sex was a factor in nourishment.

The data did not reveal a correlation regarding religion, which would imply that the various faith teachings did not object to breastfeeding. It was found that socio-economic and educational status were the primary indicators of malnourishment. Ninety-seven percent of the mothers surveyed were under the age of 30. Additionally, of the 300 mothers, 147 had completed high school or less and had malnourished children.

While the sample size is very small, it is certainly representative of rural breastfeeding habits and conditions during the first few months. Children of young, uneducated mothers in rural areas appear to be at most risk. Initially, this would indicate a lack of understanding regarding the benefits of breastfeeding. Although there appeared to be a common understanding of necessary benefits, the prevalence of this knowledge does not correlate to perfect practice in reality.

Responses revealed an absence of any scheduled patterns for breastfeeding other than as a means to stop the child’s crying. The lack of an organized routine and the late start for breastfeeding practices are central contributors to malnutrition in rural India.

In rural communities, there is also a belief that colostrum, the nutrient milk produced directly after delivery, is unhealthy for children. In many communities, goat’s milk is traditionally provided as a substitute. For these reasons, 80 percent of the mothers surveyed began periodically breastfeeding their children between 4 and 8 months old.

In an effort to encourage earlier, more consistent breastfeeding habits, UNICEF has partnered with local organizations in the northern states to provide home visits to encourage earlier breastfeeding and to dispel any false notions. Durowpadi Bedia, a health worker in the Northern state of Assam says, “Whenever we go on home visits, we talk to all members of the family – the parents, the grandparents, adolescent girls…They have faith in what I am saying.”

“When they come and talk in our own language, I understand better. I feel comfortable with them,” said Monika Bedi, a young mother. Home visits are scheduled with expectant mothers 3 to 4 times per month in the third trimester of their pregnancy. Jeroo Master, UNICEF’s Chief of Field Officer in Assam states, “Now mothers understand how vital breast milk is to the health of their babies…having health and nutrition workers actively promoting breastfeeding at the village level will ensure each child has the best start possible in life.”

Dr. Victor Aguayo, UNICEF India’s Chief of Child Nutrition and Development states, “Unquestionable global evidence demonstrates that breastfeeding counseling and support is the most important child-survival intervention.”

The Borgen Project

Sources: Research Gate, UNICEF, NIC
Photo: Baby Center

Health experts and activists are calling for the government in the Indian state of Assam to create public breastfeeding areas in India.

Assam, a state in northeast India, has a bad record when it comes to maternal and infant mortality rates.

With Aug. 1-7 being World Breastfeeding Week, the spotlight has shifted to Assam, where there are no public facilities available for women to breastfeed. As a result, mothers who are lactating often have a difficult time comfortably attending to their infants.

The difficulty is greater for mothers in rural areas, where malnutrition rates in infants are higher. Additionally, mothers who are working do not have the ability to meet their babies’ needs in a timely matter.

To avoid malnutrition, the need for public breastfeeding areas in India, specifically Assam, is high. Creating designated areas, such as in buses and railway stations, would help avoid malnutrition.

Those engaged in World Breastfeeding Week are also asking for uniformity when it comes to maternity leave. Organizations such as the Association of Promotion of Child Nutrition (APCN) and Breastfeeding Promotion Network of India (BPNI) are calling on the state government to implement consistent leave in both the public and private sectors for working mothers.

Currently, women working in the public sector are granted a leave of six months, but most are unaware they can take a leave to care for their babies, as the parameter is not implemented uniformly in the sector.

While women are granted a leave of between three and four and a half months in the private sector, most workplaces in the public and private sectors lack the proper facilities to allow women to breastfeed, leading to problems for mothers.

Matt Wotus

Sources: Encyclopedia Britannica, The Times of India, World Breastfeeding Week
Photo: Healthy Newborn Network

In Brazil, Breastfeeding Positively Correlates with Education Level
What do breastfeeding, IQ range, education, and income all have to do with each other?

In Pelotas, Brazil, a recent study reveals the long-term benefits of breastfeeding. While the short term health and nutrition benefits have been widely acknowledged, this study has discovered new and exciting benefits to breastfeeding.

Here are the two key findings:

1. Duration and predominance of breastfeeding are positively associated with IQ, educational attainment, and income.

2. There is a dose-response association with breastfeeding duration for IQ and educational attainment.

The study was implemented with a population-based birth cohort from 1982. Information about breastfeeding patterns was recorded in early childhood. 30 years later, information related to IQ, levels of education, and income was collected.

Participants who were breastfed for at least 12 months had higher IQ scores, more years of education, and even higher monthly incomes compared to those participants who were breastfed for less than one month.

These results could have important implications for developing countries and the reduction of poverty. It is critical that mothers are supported in breastfeeding. It is recognized that there is not a direct causal link. However, the long-term results from this study could imply that children who are breastfed are more likely to achieve the education that will help them provide for their families. This offers them the opportunity to draw their communities out of poverty.

While breastfeeding is not the only factor related to potential education attainment and income, this study demonstrates that it is an important one. Further evaluation is needed to understand how programs can disseminate information about the long-term benefits of breastfeeding and support parents in this decision.

Iliana Lang

Sources: The Lancet