Health not a destination but a journey

To counter the long-term effects of under-nutrition on fetal growth and development, one has to improve the nutritional status of women around the time of conception and during pregnancy. Under-nutrition is a major cause of stunting. It can lead to consequences such as anaemia, neurological issues, stillbirths in neonate and obesity and nutrition-related non-communicable diseases in adulthood. And while the damage done due to malnutrition is almost always irreversible and reaches far into the future, it is also entirely preventable.

To promote and support good maternal nutrition during pregnancy and lactation, it is important that women should be provided with adequate micronutrients, especially iron, folic acid, calcium, iodine, and vitamin A, through supplementation, fortification and diverse food consumption. Dietary diversification and selection of nutrient-rich foods, fortification or bio-fortification of staple foods, supplementation with multiple micronutrients and use of fortified food products is extremely useful for this target group.

Dietary diversification is an approach that aims to improve the availability, access, and utilisation of foods with a high content of micronutrients throughout the year, including animal-source foods. Such a strategy will lead to a better nutritional status of women and children. This should be the primary long-term goal, but this option requires overcoming barriers posed by restricted access and high cost of such foods. For example, even with a somewhat diverse diet, it may still be difficult to meet iron needs in pregnancy. Thus, other strategies have been considered and implemented to help close the nutrient gaps for pregnant and lactating women.

Another option is multiple micronutrient supplementations rather than iron-folate alone. Micronutrient deficiencies are common among women of reproductive age and women in low- and middle-income countries often have limited intake of animal products, fruits and vegetables resulting in multiple-micronutrient deficiencies. This deficiency can threaten intrauterine growth or development of the fetus and increase the risk of infant morbidity and mortality and later it may also lead to stunted growth, cognitive impairments and poor development of children.

Bio-fortification of staple foods is a relatively new technology and is another way through which increased intake of certain key nutrients such as iron, zinc and vitamin A can be promoted. One example of bio-fortification in Pakistan is the first zinc and iron wheat variety, Zincol-2015, which was released to farmers at the onset of the wheat cropping season during 2015-16. A lot needs to be done in this regard since the development and implementation of bio-fortification food programmes is still in the initial stage.

Yet another option is promotion of fortified food products that are designed for pregnant and lactating women and contain both micronutrients and macronutrients, thus providing essential fatty acids and high quality protein in addition to vitamins and minerals. In Pakistan there is a severe vitamin and mineral deficiency problem. One of the most cost-efficient ways for addressing micronutrient deficiencies and improving health outcomes is food fortification. Since 2006 the Global Alliance for Improved Nutrition has been active in Pakistan. This organisation supports the National Fortification Alliance and works closely with the government at both federal and provincial levels, the private sector and various nutrition development partners. In Pakistan this agency has recently helped to secure new regulation making the fortification of Atta (flour) with iron and folic acid mandatory, as well as develop fortification standards for Atta in Pakistan. The alliance is also working with Unicef and the federal government on a universal salt iodisation programme. There is a need to create mass public awareness about the benefits of fortified food. The same approach can be taken in the case of children, especially under 5 years of age to help reverse micronutrient deficiencies.

Addressing malnutrition in a sustainable fashion in Pakistan must take a lifecycle approach with a special focus on pregnant and lactating women, children under 2 years of age and adolescent girls.

Published in The Express Tribune, May 15^th, 2018.

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