On World Food Day, MCHIP stands with others around the world to combat global hunger and malnutrition. Undernutrition is the underlying cause for 35 percent of deaths in children under five. Severe malnutrition kills, but even less severe cases increase susceptibility to and mortality from diarrhea, pneumonia, malaria, TB, and other infectious diseases. Because so many children are mildly to moderately malnourished in developing countries, more deaths are associated with these forms of malnutrition than severe malnutrition. Studies have shown that couples who wait at least two years after the birth of their last child before conceiving again are most likely to have healthy term pregnancies, infants and children who will survive. MCHIP is supporting the integration of family planning and infant and young child nutrition counseling as a way to help women protect their health and that of their infants. How?

Mothers who exclusively breastfeed their babies during the first six months, following three simple criteria, are providing the perfect/best nutrition for their infants AND also using an effective method of contraception called Lactational Amenorrhea Method (LAM). LAM has other benefits aside from preventing infection and malnutrition. Exclusive breastfeeding and using LAM is also more that 98 percent effective in preventing pregnancy. Another pregnancy during this vulnerable initial six months may put the mother and her infant at more than four times the risk of dying. Stunting in children also increases when births are too closely spaced. Exclusive breastfeeding during the initial six months and then giving optimal complementary foods after six months while continuing to breastfeed through two years can help reduce undernutrition in infants and young children. However, mothers need to transition to other forms of family planning when they start offering complementary feeding since they are at risk of another pregnancy while continuing to breastfeed. Women should continue to breastfeed their child to age two, as is recommended by WHO and UNICEF. There are significant opportunities for nutritional messages to include the need for family planning, but also for family planning counseling to provide information about optimal infant and young child feeding practices during the 6-23 month period. In this way both programs can contribute to reducing child malnutrition. Mothers would provide optimal feeding behavior to their infants and prevent another pregnancy while their young child still benefits from breastfeeding.

In an effort to better understand the potential synergies existing between maternal, infant and young child nutrition (MIYCN) and family planning (FP) MCHIP organized a meeting in Washington DC recently to capitalize on opportunities for integration. More than 55 participants from 31 global health organizations were brought together to participate in the all-day event. Public health experts from the World Health Organization (WHO), UNICEF, U. S. Agency for International Development (USAID) bilateral organizations, World Bank, the Bill and Melinda Gates Foundation and universities presented both research evidence and programmatic findings on pregnancy spacing and the benefits to infant, child and maternal health and nutritional status.

Participants explored how to harmonize efforts through the continuum of pregnancy through the first year postpartum, in the following key areas: birth to pregnancy intervals and related pregnancy outcomes, prevention of unintended pregnancy, maternal nutrition and health, as well as infant and young child nutrition. Integrating family planning and infant and young child nutrition counseling has the potential to increase coverage for both programs, and save the lives of mothers and their babies.

Additionally, the nutritional health status of a mother is at risk during pregnancy and lactation. Maternal anemia, even moderate cases, increases the risk of dying during delivery. The recent Lancet series on maternal and child under-nutrition estimated that 20% of maternal deaths are due to maternal iron-deficiency anemia and stunting in women, thus adding 115,000 deaths to the total maternal deaths from obstetric complications annually. To improve programming in these areas, MCHIP uses innovative strategies to solve supply and demand barriers to successful programs. MCHIP is investigating such schemes as pay-for-performance to increase the number of women receiving iron-folic acid supplements from health workers, and using cell phones to remind women to take their iron/folic acid supplements. Integrating family planning and nutrition messages has the potential to increase birth intervals which will decrease preterm births, small for gestational age babies, and anemia in women.

MCHIP is working to offer a package of interventions that maximize maternal and child survival and improve nutritional status. We have an opportunity to capitalize on existing momentum, synergies between infant nutrition and family planning. The challenge is how to best enhance collaboration to maximize the potential impacts of both areas of intervention for the benefit of the mother, infant and child.