Covid undermines Nepal's mother-child gains

Despite periods of political and economic instability, Nepal achieved dramatic progress in maternal and child health in the early 2000s becoming an international model.

It took great strides in reducing childhood malnutrition, in particular, reducing stunting from 57% in 1996 to 33% in 2016. Maternal and Infant mortality rates also similarly declined, only for much of these successes to stall in the recent years. And this trend has been made worse by the Covid-19 pandemic, states a new UNICEF report.

Titled “Nutrition in Nepal: Three decades of progress for children and women”, the report brings together a set of nine original articles that examine the drivers of success and identify where greater policy and programmatic action is needed to achieve the Sustainable Development Goal (SDG) nutrition targets.

“Optimal maternal and child nutrition is the basis for developing a resilient society,” says EU Ambassador to Nepal, H.E. Nona Deprez. “The decline in the number of malnourished children, improvements in health facilities and services, and the multisectoral approach used in Nepal over the past three decades are a testament to the Government of Nepal’s commitment to reducing all forms of malnutrition.”

A special supplement of the Maternal and Child Nutrition Journal published on Thursday lists some of Nepal’s biggest nutritional achievements. Between 1996-2016, the early initiation of breastfeeding saw an increase from 18% to 56%, and complementary feeding increased from 54% to 77%.

During the same period, women taking sufficient iron and folic acid supplements during their pregnancy rose from 6% to 71%. This was combined with earlier and more frequent antenatal care visits.

Consistent administering of Vitamin A has saved the lives of an estimated 45,000 Nepali children under the age of five, between 2002 and 2015. Similarly, households using adequately iodised salt doubled from 35% to 77% from 1998 to 2016.

Much of this progress can be credited to improvements in household wealth, parental education, and sanitation. But equally important was increased coverage of health and nutrition services undertaken by successive governments.

Nepal Government utilised ground-breaking research to test interventions and overcome challenges, it is also committed to enforcing mandatory legislation such as salt iodisation, writes the journal supplement.

Mobilisation of Female Community Health Volunteers (FCHVs) across Nepal villages and towns have improved the health of mother and children, so has an investment in sectoral programs including education and sanitation.

But there are now new challenges to achieving national and global targets on nutrition, which also threatens to undermine past gains.

“The learning from the past 25 years that are incorporated in the supplement will inform and contribute to future improvements. However, we must act now, given the impact that the pandemic has had on the nutritional health of mothers and their children,” says Elke Wisch, UNICEF Representative to Nepal.

During the pandemic, most households experienced job losses or reduced income. With the Omicron-led third wave spreading across Nepal, the pandemic’s ensuing socioeconomic crisis is long from over.

This means reduced dietary intake among children and mothers. School closures will deprive many children of getting one decent meal a day. All this will add to childhood malnutrition which continues to be a major cause of death and retarded mental and physical development among younger populations

As such, UNICEF has recommended the government to improve the general public’s access to nutritious, safe, affordable, and sustainable diets. It also suggests integrating essential nutrition services into the existing service delivery platforms like family planning, antenatal, delivery and post-natal care and well-child and sick-child care and continuing to mobilise FCHVs to reach more women and children.

To disseminate factual information, advice and counselling on infant and young child feeding, healthcare workers can also use multiple communication channels such as radio, TV or social media.

But perhaps equally if not more important is strengthening local levels so that they can plan, implement and monitor nutrition programs and services, and maintain Nepal's commitment to generating data, information, and evidence to assess progress and inform decisions.