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Editorial

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Welcome to the second issue of Nutrition Exchange (NEX) South Asia. The South Asia region continues to bear the highest burden of child malnutrition in the world with implications on global progress. As with the first issue, this NEX follows on from a regional conference, convened by SAARC (the South Asian Association for Regional Cooperation) and UNICEF (United Nations Children's Fund) on ‘Stop Stunting: Improving Young Children’s Diets in South Asia’ in 2019 in Nepal. Poor complementary feeding practices are associated with high rates of child malnutrition in the South Asia region and it is vital therefore to understand and share learning on how related national policies and programmes are being designed and implemented and share the lessons learned.  

Through a partnership with UNICEF’s Regional Office for South Asia (ROSA), we have worked closely with a range of authors to support the development of nine articles from six countries – Afghanistan, Bangladesh, Bhutan, India, Nepal and Pakistan – as well as an overview from UNICEF ROSA and a regional perspective on tackling the double burden of malnutrition. In keeping with the ethos of NEX, we prioritise the ‘voice’ of national government actors as the primary authors, along with their development partners. 

Each country is a unique context and these articles provide important insights into how the diets of young children are assessed, understood and addressed across diverse settings. Improving complementary feeding is not straightforward and requires taking into account an array of underlying drivers that can reduce availability of and access to adequate and quality diets, including low socio-economic status, food insecurity, and perceptions of appropriate foods and feeding practices. It also needs the enabling policy, programme and financing environment to be effectively mobilised. A standout feature of the South Asia region is how well countries have done in increasing and maintaining high rates of breastfeeding. An enduring challenge is protecting children in the 6-23 months age range from the negative impacts of poor diets on their growth and development.  

As we started work on this edition, the Covid-19 pandemic emerged and exposed the fragilities and inequities in the global and local food systems. As outlined in the overview by the UNICEF regional team, the pandemic is affecting the lives and livelihoods of people across the region. Food-price increases and disruption of key services will add to the challenges already faced by households in feeding their young children. Improving young children’s diets is even more critical to prevent already high levels of child malnutrition from increasing further. 

As highlighted 2019 SAARC/UNICEF conference, it is important for multiple actors across different systems to act in tandem to improve young children’s diets; particularly those engaged in food and health systems; water, sanitation and hygiene (WASH); and social protection. The articles in this issue of NEX South Asia cover all these areas and their impact on complementary feeding.  

Food systems lie at the heart of the solution to improving young children’s diets. From Nepal we learn about promoting homestead food production as a means to help year-round consumption of fresh foods as a key approach to increasing the diversity and quality of diets in a large, multi-sector programme. From Punjab province in Pakistan comes new evidence on the role of cost of diets, food access and perceptions in shaping a multi-sector communications strategy for infant and young child feeding. Health systems provide a key delivery vehicle for different approaches to address complementary feeding. In Bhutan a home-fortification approach aims to reduce high levels of anaemia, while in Bihar state in India a home-based care approach is building the capacity of frontline workers. In Afghanistan a focus on complementary feeding is part of a community-based nutrition programme being scaled up across the country. Other sectors are involved, too: again from Pakistan, an article from Sindh province describes sub-national ownership of a programme linking WASH and nutrition to improved diets and care/feeding practices. In articles from Bangladesh and Nepal the focus is on the role of cash-based social protection systems in supporting affordable and diverse diets among poor and vulnerable families. And another article from India provides rich insights into the integration of complementary food supplements at scale in the country’s national nutrition programme. Finally, in conversation with regional nutrition advisors from the World Health Organization (WHO), we ask what policy shifts will be needed to tackle the double burden of malnutrition in the region, given rising rates of child overweight. 

Looking at the rich learnings from these diverse countries reveals a strong thread running through these articles: the importance of context-specific understanding of the perceptions and realities for families and communities; the need to harness multiple systems and assess, plan and work jointly; and the need for recognition of innovations and adaptations to policy and programmes to overcome blockages along the way. Frontline workers, be they from the agriculture, health, social protection or WASH sectors or from traditional community structures, are vital contact points for families as they nurture their young children and strive to feed them nutritious and diverse foods. 

It has been our privilege to work on NEX Asia 2 and we remain passionate about the importance of hearing the voices of national and sub-national government actors and their partners as they share their learning about what works well and what challenges they need to overcome in nutrition programming and policy. 

Carmel Dolan, Co-editor, NEX
Judith Hodge, Co-editor, NEX

Reference this page

ENN (). Editorial. Nutrition Exchange Asia 2, June 2020. p2. www.ennonline.net/nex/southasia/2/editorial

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