Maternal and Adolescent Nutrition and SDG 2.

2 Discussion Document
By Pat Mc Mahon BSc Adult Nursing,
Nutrition Field worker,
Nutrition Advocate.
12th December 2017

Premise:
'Undernourished girls have a greater likelihood of becoming undernourished mothers who in
turn have a greater chance of giving birth to low birth weight babies, perpetuating an
intergenerational cycle' UNICEF 2017
Sustainable Development Goal (SDG) 2.2 asks us to end all forms of malnutrition. It carries
us though every significant life stage from children, adolescents, adults and older people. It
refers to addressing the 'nutritional needs of adolescent girls and pregnant and lactating
women.'
In the WHO Monitoring Framework For Nutrition 2014, Body Mass Index (BMI) <18·5
kg/m2 is referenced as maternal malnutrition. However currently when low BMI is reported
< 18.5, terminology used may be misleading i.e. the wording used often refers to thinness or
undernourished and rarely Malnutrition. Considering the SDGs use the word malnutrition it
would provide consistency and clarity to align this terminology to reporting frameworks and
literature reports.

Scale of Maternal Malnutrition:

Trends in Adult Body Mass Index Lancet 2016
When using the WHO indicator BMI <18·5 kg/m2 as a reference point for maternal
malnutrition the Lancet states in the year 2014 maternal malnutrition 'affected 12% of women
in central and east Africa and over 25% of women in Bangladesh and India.' According to
the report 'Underweight remains a public health problem in south Asia and central and east
Africa'. The publication came up with a stark conclusion that ‘the global focus on obesity is
overshadowing the persistent underweight problem’. This would seem to be the case when
we look at global targets and monitoring frameworks for nutrition.

Global Targets:
We have globally agreed targets for Maternal, Infant and Young Child Nutrition (MIYCN)
and the Non-Communicable diseases (NCD) monitoring framework. Of these global targets
only two are found to be directly relevant to adolescent girls and pregnant and lactating
women's nutritional status. They are anaemia, overweight and obesity. This means that there
are no global nutrition targets on maternal nutrition as a stand-alone issue.

SDG 2.2 indicators:

'An indicator gives an "indication" that is intended to reflect a particular situation or an
underlying reality, usually by providing an order of magnitude, which means that it is
difficult to meet the criteria directly' Indicators are variables that attempt to measure or
objectify a quantitative or qualitative collective (especially biodemographic) event in order
to support political action and evaluate achievements and goals'
The Review of Health and Nutrition Indicators in Early Childhood UNESCO 2012

In the Metadata compilation for Goal 2- as of March 29, 2016 under SDG Resources. We
found only one Indictor for SDG 2.2 and that pertains to childhood wasting and overweight.
This is surprising considering maternal malnutrition is directly relevant to two of the World
Health Assembly targets of low birth weight and child mortality.
'Maternal malnutrition is a key contributor to poor fetal growth, low birth weight (LBW) as
well as short and long-term infant morbidity and mortality', (Bhutta et al 2014). There is also
a wealth of emerging evidence that low birth weight and poor nutrition in the first 1000 days
from pregnancy to the second birthday are linked to stunting, wasting and later in life obesity,
diabetes and cardiovascular diseases.

Moreover, much of a child’s future is determined by their development in the first 1000 days
from pregnancy to the second birthday. The only direct nutrition intervention for the first 450
days that is available to us is Pharmaceutical in nature. Given the scale of the problem of
maternal malnutrition and its generational consequences we need urgent scaling up of
nutrition interventions to prevent adolescent girls and pregnant and lactating mothers
suffering from malnutrition.

This discussion document agrees with the Lancet conclusion regarding ‘the global focus on
obesity is overshadowing the persistent underweight problem’

Conclusions and recommendations:

The intergenerational cycle of malnutrition begins with the malnourished adolescent girl and
mother. This creates a new trajectory of fetal malnutrition, low birth weight and its well
documented consequences. Malnutrition does not contain itself in silos but is a life
continuum. Yet we have found maternal nutrition is given a low priority or even non-existent
in treatment programs. Apart from anaemia and obesity we have no global targets or
monitoring systems that expressly monitor maternal malnutrition. Ending malnutrition in all
its’ forms can only be achieved when it is clearly referenced and identified. Part of that
identifying includes a consistency in words we use when describing malnutrition.

We are a small field based organization working for almost 15 years in India providing
targeted nutrition to malnourished adolescent girls, pregnant and lactating mothers and
children. It is our firm belief that a better nourished world cannot happen until we began
nourishing women and girls as a priority.

We started this paper with a quote from UNICEF and we will end it in the same way.
'Babies born to a malnourished mother are much more likely to have low birth weights
(LBW). LBW is one of the strongest predictors of whether a child will die before his or her
fifth birthday'(UNICEF, 2014).

1 Urgent indictors are required to end all forms of malnutrition in each of the life stages that
it occurs in.
2 Align and be consistent with the terminology used to describe malnutrition.
3 Prioritise targeted nutrition programs for adolescent girls and pregnant and lactating
mothers
4 2018 to be declared the year of the mother.