Child Health
Poverty, urbanisation, climate change and poor eating choices are driving unhealthy diets, according to the UNICEF's latest report.
Arjan De Wagt, Chief, Nutrition, UNICEF India; Shariqua Yunus, Chief of Nutrition, World Food Programme launching the SOWC 2019 Report

An alarmingly high number of children are suffering the consequences of poor diets and a food system that is failing them, the UNICEF warned on Thursday in a new report on children, food and nutrition. 

The State of the World’s Children 2019: Children, food and nutrition (SOWC) finds that at least 1 in 3 children under five – or 200 million – is either undernourished or overweight. Almost 2 in 3 children between six months and two years of age are not fed food that supports their rapidly growing bodies and brains. This puts them at risk of poor brain development, weak learning, low immunity, increased infections and, in many cases, death. 

“Despite all the technological, cultural and social advances of the last few decades, we have lost sight of this most basic fact: If children eat poorly, they live poorly,” said Henrietta Fore, UNICEF Executive Director. “Millions of children subsist on an unhealthy diet because they simply do not have a better choice. The way we understand and respond to malnutrition needs to change: It is not just about getting children enough to eat; it is above all about getting them the right food to eat. That is our common challenge today.”

The report provides the most comprehensive assessment yet of 21st century child malnutrition in all its forms. It describes a triple burden of malnutrition: Undernutrition, hidden hunger caused by a lack of essential nutrients, and overweight among children under the age of five, noting that around the world:

· 149 million children are stunted, or too short for their age,

· 50 million children are wasted, or too thin for their height,

· 340 million children – or 1 in 2 – suffer from deficiencies in essential vitamins and nutrients such as vitamin A and iron,

· 40 million children are overweight or obese.

The report warns that poor eating and feeding practices start from the earliest days of a child’s life. Though breastfeeding can save lives, for example, only 42 per cent of children under six months of age are exclusively breastfed and an increasing number of children are fed infant formula. Sales of milk-based formula grew by 72 per cent between 2008 and 2013 in upper middle-income countries such as Brazil, China and Turkey, largely due to inappropriate marketing and weak policies and programmes to protect, promote and support breastfeeding.

As children begin transitioning to soft or solid foods around the six-month mark, too many are introduced to the wrong kind of diet, according to the report. Worldwide, close to 45 per cent of children between six months and two years of age are not fed any fruits or vegetables. Nearly 60 per cent do not eat any eggs, dairy, fish or meat.

As children grow older, their exposure to unhealthy food becomes alarming, driven largely by inappropriate marketing and advertising, the abundance of ultra-processed foods in cities but also in remote areas, and increasing access to fast food and highly sweetened beverages.

For example, the report shows that 42 per cent of school-going adolescents in low- and middle-income countries consume carbonated sugary soft drinks at least once a day and 46 per cent eat fast food at least once a week. Those rates go up to 62 per cent and 49 per cent, respectively, for adolescents in high-income countries.

As a result, overweight and obesity levels in childhood and adolescence are increasing worldwide. From 2000 to 2016, the proportion of overweight children between 5 and 19 years of age doubled from 1 in 10 to almost 1 in 5. Ten times more girls and 12 times more boys in this age group suffer from obesity today than in 1975.

The greatest burden of malnutrition in all its forms is shouldered by children and adolescents from the poorest and most marginalised communities, the report notes. Only 1 in 5 children aged six months to two years from the poorest households eats a sufficiently diverse diet for healthy growth. Even in high-income countries such as the UK, the prevalence of overweight is more than twice as high in the poorest areas as in the richest areas.

The report also notes that climate-related disasters cause severe food crises. Drought, for example, is responsible for 80 per cent of damage and losses in agriculture, dramatically altering what food is available to children and families, as well as the quality and price of that food.

To address this growing malnutrition crisis in all its forms, UNICEF is issuing an urgent appeal to governments, the private sector, donors, parents, families and businesses to help children grow healthy by:

1. Empowering families, children and young people to demand nutritious food, including by improving nutrition education and using proven legislation – such as sugar taxes – to reduce demand for unhealthy foods.

2. Driving food suppliers to do the right thing for children, by incentivising the provision of healthy, convenient and affordable foods. 

3. Building healthy food environments for children and adolescents by using proven approaches, such as accurate and easy-to-understand labelling and stronger controls on the marketing of unhealthy foods.

4. Mobilising supportive systems – health, water and sanitation, education and social protection – to scale up nutrition results for all children.

5. Collecting, analysing and using good-quality data and evidence to guide action and track progress.

“We are losing ground in the fight for healthy diets,” said Fore. “This is not a battle we can win on our own. We need governments, the private sector and civil society to prioritise child nutrition and work together to address the causes of unhealthy eating in all its forms.”

State of children in India

In India, the recently released Comprehensive National Nutrition Survey (CNNS) conducted by the Health Ministry in partnership with UNICEF shows that 35 per cent of children under five are stunted, 17 per cent are wasted and 33 per cent are underweight. Only 42 per cent of children (6 to 23 months) are fed at adequate frequency and only 21 per cent are fed an adequately diverse diet. Timely complementary feeding is initiated for only 53 per cent of infants aged 6-8 months.

At the same time, the survey highlights that overweight and obesity increasingly begin in childhood with a growing threat of non-communicable diseases like diabetes (10 per cent) in school-aged children and adolescents. Urban India is moving into an unhealthy food snacking environment, which is influencing children’s food choices and this is spreading to rural areas. 

Food consumption patterns in India reveal that child diets are largely starved of proteins and micronutrients and are influenced by household (adult) food choices. Over the decades, despite growing incomes, protein-based calories remain low and unchanged, and the calorific share of fruits and vegetables has declined.

The CNNS survey does show some progress in the reduction of malnutrition. It also reflects effective reach of government programmes to prevent Vitamin A and iodine deficiency in children aged 1-4 years.

“When healthy options are available and these are affordable and desirable, then children and families make better food choices.  As the SOWC report highlights this year, children’s nutrition will improve significantly if there is an increase in the production and processing of healthy foods to deliver nutritious, safe, affordable and sustainable diets for all children,” said Dr. Yasmin Ali Haque, UNICEF Representative in India.

In India, the POSHAN Abhiyaan or the National Nutrition Mission is playing a major role in improving nutrition indicators across India. The Government of India’s Anaemia Mukt Bharat programme to fight anaemia prevalence has been recognised as one of the best programmes implemented by Governments across the world to address malnutrition. The 6X6X6 strategy (six target beneficiary groups, six interventions and six institutional mechanisms) of the programme has been highlighted for using anaemia testing and treatment as the entry point to provide information on healthy diets.