What We Do

Nutrition

Strategy Overview

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A mother in Bangladesh feeding her child solid food to complement breastfeeding. (Photo © Alive & Thrive/AV Com)

OUR Goal:

to ensure that all children have the nutrition they need for a healthy start in life.

The Challenge

At A Glance

Millions of children, mostly in developing countries, die each year or suffer permanent physical or mental impairments because they lack good nutrition during the critical 1,000-day period between conception and age 2.

One in four child deaths could be prevented by scaling up proven nutrition interventions.

Our Nutrition program focuses on delivering proven interventions and creating new tools and strategies to ensure that pregnant women and young children receive the nutrition they need for healthy growth and development.

We work closely with the foundation’s Agricultural Development team to improve the nutritional impact of agricultural programs and advocate for policies that benefit smallholder farmers, their families, and communities in developing countries.

Our Nutrition strategy, updated in 2011, is led by director Shawn Baker, and is part of the foundation’s Global Development Division.

Millions of children in the developing world suffer from a range of health problems with a common root cause: undernutrition. Many children who live in poverty don’t get enough food—or the right kind of food—to support normal growth and development. Millions also frequently suffer from illnesses such as diarrhea that sap the nutrients they consume.

Nutrition-related factors account for about 35 percent of the deaths of children under age 5. Among undernourished children who survive, about one-third suffer from stunted growth, which often impedes neurodevelopment and learning, and ultimately the ability to work and earn a living.

In pregnant women, undernutrition increases the chances of dying due to pregnancy complications and of delivering an underweight baby. Children who are born underweight are at risk of suffering from acute infectious diseases as well as chronic diseases and physical and cognitive impairments. The result is a vicious cycle in which succeeding generations of poor people are vulnerable to death, disease, cognitive impairment, reduced productivity due to undernutrition, and continuing poverty.

Most undernourished people live in South Asia and Sub-Saharan Africa. Ten countries in those regions account for two-thirds of the world’s growth-stunted children. But even in those countries, most of the people affected by undernutrition do not show symptoms of extreme hunger or starvation. This crisis of “hidden hunger” is invisible to some policymakers, which means that national nutrition programs are often underfunded.

Other challenges that contribute to undernutrition include inconsistent access to sufficient, safe, nutritious food; low agricultural productivity; effects of climate change; poor sanitation and hygiene, and lack of awareness and understanding of healthy diets among those most at risk of undernutrition.

The Opportunity

Promoting better breastfeeding practices, expanding access to nutritious foods for children from 6 to 24 months of age, and ensuring that women and children get sufficient amounts of key vitamins and minerals are proven strategies that can substantially reduce child mortality and nutrition-related problems. In recent years, nutrition programs have produced significant increases in the global intake of vitamin A and iodine, for example, resulting in improved maternal and child health.

Achieving improved nutrition on a broad scale requires further research to understand the factors that influence the nutritional status of women as well as the conditions that affect fetal growth and the growth and development of young children. Also needed are better ways to reach target populations, better tools to identify nutrient deficiencies and the impact of nutrition interventions, and increased funding and delivery capacity.

Our Strategy

At the Bill & Melinda Gates Foundation, our nutrition efforts focus on delivering proven interventions and developing better tools and strategies for providing pregnant women and young children with the foods and nutrients they need.

We are particularly interested in new approaches to improving nutrition for women before and during pregnancy and for children from birth to age 2—when nutrition is most critical to growth and development and lifelong health. This includes new approaches to ensuring immediate and exclusive breastfeeding for the first 6 months of a child’s life, followed by a transition to healthy complementary feeding from 6 to 24 months of age.

We focus on regions of Sub-Saharan Africa and South Asia where the burden of undernutrition is greatest. We rely on partners to deliver proven nutrition interventions, and we gather and disseminate information on intervention models that can be affordably replicated. We also advocate for funding and policies that support evidence-based nutrition efforts.

A new sweet potato variety that is rich in vitamin A is now widely available in eastern and southern Africa.

Within the foundation, our Nutrition program collaborates closely with other program teams. In particular, we work closely with the Agricultural Development team to improve the nutritional impact of agricultural practices, programs, and policies for smallholder farmers in developing countries. Common areas of focus include biofortification of staple foods, nutrition education, control of mycotoxins, policy and advocacy, and research.

We work also with the foundation’s Discovery & Translational Sciences program to better understand the biological determinants of healthy growth and find new ways to measure micronutrient deficiencies and the nutritional status of populations.

We work to encourage effective practices in maternal nutrition and breastfeeding in cooperation with the foundation’s Maternal, Newborn & Child Health program. We also collaborate with the Enteric and Diarrheal Diseases program and the Water, Sanitation & Hygiene program to better understand how clean water, good sanitation, and a healthy digestive system can improve children’s nutrition.

Areas of Focus

Promoting Healthy Growth

Proper nutrition from birth to age 2 is critical to a child’s growth and development and lifelong health. (Photo © Alive & Thrive/Tina Sanghvi)

Quality tools and standards for measuring healthy growth—including those based on the World Health Organization’s Child Growth Standards—are available; however, further work is needed to understand the biological basis of faltering growth in fetuses and young children and the effectiveness of specific nutritional products and interventions to improve growth and neurodevelopment. To help fill this gap, we invest in the development of additional global standards to assess healthy fetal and child growth. We also support research to understand the interplay between maternal nutrition and fetal development, birth outcomes, and child development and health.

In addition, we invest in developing and testing new low-cost tools, products, and interventions that promote healthy growth in children from conception to age 2 and that can be deployed on a broad scale.

Improving Breastfeeding Practices

One of the most effective ways to improve the health of infants is for mothers to breastfeed exclusively from birth to age 6 months and to continue breastfeeding through age 2, supplementing with other appropriate (complementary) foods.

A woman breastfeeding her baby in Dowa, Malawi.

Most women in developing countries breastfeed their infants, but few do so optimally due to work commitments, cultural beliefs, lack of social support, or other barriers. More than a half-million child deaths each year are attributable to inadequate breastfeeding. We invest in research to test and evaluate ways to encourage more effective breastfeeding practices through mass media, social networks, maternity and marketing policies, innovative service delivery models, and by enhancing the knowledge and skills of frontline health workers.

Addressing Micronutrient Deficiencies

Diets that are deficient in key micronutrients can affect brain and cognitive development, stunt growth, and lead to death among women and children. In Sub-Saharan Africa and Asia, many children suffer from severe infections, chronic medical problems, and permanent neurodevelopmental impairments due to lack of vitamin A, iron, folic acid, iodine, zinc, and other essential nutrients.

A women’s self-help group in a remote region of Rajasthan, India, produces fortified foods for distribution to mothers and young children. (Photo © Global Alliance for Improved Nutrition)

Nutritional intake can be significantly improved by fortifying local foods with micronutrients and enhancing the nutritional quality of staple crops through selective breeding. We work with a diverse range of public- and private-sector partners to increase access to fortified and biofortified foods among vulnerable populations. This work has already improved access to micronutrients for hundreds of millions of people. Efforts have included development of a sweet potato variety that is rich in vitamin A—the first biofortified food widely and commercially available in eastern and southern Africa.

Our efforts to develop and test better tools for measuring micronutrient deficiencies will help policymakers better target and evaluate micronutrient programs.

Advocating for Better Nutrition Funding and Policies

Scaling up effective nutrition solutions will cost an estimated US$11 billion annually, according to the World Bank. This includes US$6 billion annually for high-quality food to treat malnourished children. Donor and developing-country commitments to nutrition programs currently fall far short of this mark, but the global community is coming together in the Scaling Up Nutrition (SUN) movement to raise awareness, increase resources, and improve the capacity and accountability of programs.

In developing and donor countries, we work to encourage decision makers to not only spend more on improving nutrition but also to spend more wisely. Our efforts include gathering and disseminating information on the causes and consequences of undernutrition and effective ways to address it; advocating for policies and regulations that support improved nutrition; and mobilizing the public and private sectors to invest in nutrition. We also support efforts to make nutrition a priority in agricultural investments.

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