The First 1,000 Days: Development Aid Programs to Bolster Health and Nutrition

Thank you, Mr. Chairman, Ranking Member Bass, and Members of the Subcommittee, for having me here today. I am delighted to be here to talk about the nutrition efforts of the U.S. Agency for International Development (USAID).

First, I want to recognize Congress for the strong leadership it has demonstrated in addressing the challenge of global child and maternal nutrition. As you may know, at least 165 million children worldwide are stunted, or have short stature resulting from chronic under-nutrition. New evidence shows that the effects of stunting are even more far reaching than we realized, with implications on many aspects of the lives of individual survivors and the countries they live in. Stunting leads to irreversible cognitive impairment and poor health over the lifespan. Each year, under-nutrition in all forms is the underlying cause of 3.1 million child deaths or 45% of all child deaths worldwide. It leads to higher health care costs, increased mortality and lower productivity. On a national scale, widespread under-nutrition undermines economic development, costing low and middle income countries up to 8% of economic growth potential. Our goals of reducing extreme poverty and hunger as well as ending preventable child and maternal deaths cannot be met without addressing nutrition, especially during the critical 1,000 day window, from a mother’s pregnancy to -her child's second birthday. We also strive to reach women with nutrition interventions even before they become pregnant.

This is a unique time for nutrition, and in the last few years, global nutrition has received unprecedented attention as new research and evidence have contributed to a better understanding by the international development community of the importance of good nutrition in early life for forming the basis for healthy individuals and productive societies. A few major recent developments in particular are fueling momentum for nutrition:

• The Scaling Up Nutrition Movement (or SUN) was launched in 2010 as a platform for partnership between the UN, civil society, the private sector, donors and developing country governments to support country-led efforts to reduce under-nutrition, especially during the 1,000 days window. Today, 47 countries have joined the SUN Movement, indicating their commitment to improving the nutrition and health of their citizens. USAID is a strong supporter of the SUN Movement, serving as a donor-convener in 6 countries and providing both financial and technical support and playing a leadership role at the global level.
• In 2010, former Secretary of State Hillary Rodham Clinton and former Irish Foreign Minister Micheál Martin launched the 1,000 Days Partnership, which brings together governments, civil society and the private sector to promote targeted action and investment to improve nutrition for mothers and children during the 1,000 day window. The efforts of the 1,000 Days Partnership also support SUN.
• The World Health Assembly set nutrition targets for reducing under-nutrition by 2025 for women and children, including a 40% reduction in stunting. In June 2013, a nutrition summit in London culminated in the Nutrition for Growth Compact, which led to increased nutrition funding commitments from G8 donor governments and civil society. At the summit- the U.S. government announced that, from 2012 to 2014, we anticipated providing more than $1 billion for direct nutrition interventions and $9 billion worth of attributed nutrition-sensitive investments. Together we estimate that these investments will result in 2 million fewer stunted children.
• In June 2013, the new Lancet Series on Maternal and Child Nutrition provided updated research and analyses and made recommendations for nutrition interventions and approaches. New information from this series, particularly on how interventions in other sectors can have an impact on nutrition, is already helping to inform and improve USAID programming.

USAID is taking a strong leadership role in these international efforts, both within the U.S. Government and at the global level.

USAID promotes nutrition through the Feed the Future and Global Health interagency initiatives, the Food for Peace Development and Emergency programs, and through our humanitarian assistance efforts. Our goals are to reduce stunting by 20% in Feed the Future zones of influence and Food for Peace Development programs and, where possible, to maintain global acute malnutrition rates below 15% in times of crisis through humanitarian programs.

To reinforce these efforts, USAID is in the final stages of developing a multi-sector nutrition strategy which will improve the integration and effectiveness of nutrition programming across all our bureaus and missions. Under our strategy, USAID will address nutrition with more discipline than ever before, developing country nutrition frameworks (based on national plans), setting country-specific targets, and tracking and reporting on nutrition progress. Nutrition programs will be integrated across humanitarian and development contexts and coordinated with those of other U.S. government agencies active overseas. The USAID nutrition strategy addresses the underlying causes of poor nutrition during the first 1,000 days by promoting the scale-up of proven, cost-effective nutrition interventions. These include both nutrition-specific (those that directly address under-nutrition) and nutrition-sensitive (such as hygiene, that indirectly affect nutrition outcomes) activities. USAID nutrition investments link programs in agriculture and food security, health, and water, sanitation and hygiene in a more integrated manner. Nutrition is also an integral part of USAID’s resilience strategy.

The USAID strategy is informing a broader U.S. Government-wide nutrition coordination plan, which is currently being developed. For the first time, the U.S. Nutrition Coordination Plan will bring together all the U.S. government agencies working in global nutrition with the purpose of maximizing impact through better coordination of U.S. Government global nutrition investments.

USAID leads Feed the Future, the President’s global hunger and food security initiative. This is the first Presidential Initiative to address nutrition at the goal level. Feed the Future reduces under-nutrition during the first 1,000 days window and hunger by improving access to nutrition services, clean water and support for agriculture value chain activities that include nutrient-dense crops.

USAID’s integrated, multi-sectoral approach has led to tangible results:

To address water and hygiene-related factors associated with stunting, USAID has helped install more than 155,000 “tippy taps” (water-saving, hand washing device that makes clean water available at the household level) throughout Bangladesh. They help reduce diarrhea and other waterborne illnesses among young children, which in turn help promote healthy nutrition. At the same time, USAID has also supported nearly 91,000 women farmers in homestead gardening, which means improved access to nutrient-dense foods and increased income for Bangladeshi women and their children.

In Tanzania, we take a three-pronged approach to help resolve common micronutrient deficiencies that contribute to stunting. USAID trained flour millers to fortify their products with vitamins and minerals, and strengthened the capacity of 405 small and medium-scale maize millers and processing plants to safely fortify maize flour. To complement these efforts, USAID provided 1.6 million micronutrient powder sachets to help prevent stunting and micronutrient deficiencies among children 6-24 months old. USAID also promotes bio-fortified crops like the orange-fleshed sweet potato, green leafy vegetables and small livestock. Moreover, to further strengthen results like these, through Feed the Future’s nutrition innovation labs, USAID supports research on nutrition-sensitive agriculture and their work is informing a growing number of Feed the Future programs. Feed the Future also works with the private sector to increase the level of responsible nutrition investments. In 2013 alone, the US government, through Feed the Future in collaboration with the Global Health Initiative reached 12.5 million children with nutrition interventions.

USAID supports the Global Alliance for Improved Nutrition in its Marketplace for Nutritious Foods program, which increases private sector investment and marketing of nutrient-dense foods. In Mozambique, for example, the Marketplace has been working with producers and food processors on a locally made peanut butter to support market development as well as food safety and quality control.

Beyond Feed the Future, to help maintain global acute malnutrition rates below 15% in times of crisis and to support nutrition in humanitarian settings and among the most vulnerable populations, especially during the 1,000 days window, USAID is seeking to reform the way it delivers food aid. In certain emergencies and under certain circumstances, USAID now provides cash to purchase local and regional food near food crises, which is on average much timelier and cheaper than in-kind food aid and also stimulate economic growth in developing countries. By enacting the food aid reform that we have requested in the 2015 Budget to allow 25 percent of Title II food aid funding to be used for flexible emergency responses, USAID programs will be able to help about 2 million more men, women and children in emergency crises without additional resources. These reforms will allow USAID to expand the use of local and regional purchase as well as innovative approaches, such as food vouchers, that are often cheaper than in-kind food aid and also allow beneficiaries to select their own food in local markets. In addition USAID continues to support research on various types of specialized foods as well as work on updating and improving existing products based on evolving nutritional evidence.

Through USAID’s continued efforts to coordinate and integrate multi-sectoral programs across USAID offices and bureaus and strengthen program quality using new findings, we are better addressing the complex underlying causes of stunting. We are also making meaningful contributions toward achieving the World Health Assembly 2025 nutrition targets and reducing under-nutrition during the first 1,000 days worldwide.

I would like to thank Congress again for the leadership you are showing on this issue. We look forward to working with you to make progress on ending child and maternal malnutrition.