Nutrition - Bill & Melinda Gates Foundation
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What We Do

Nutrition

Strategy Overview

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A mother in Bangladesh feeding her child solid food to complement breastfeeding. (Photo © Alive & Thrive/AV Com)

OUR Goal:

To ensure that all women and children have the nutrition they need to live healthy and productive lives.

The Challenge
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At A Glance

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Poor nutrition contributes to nearly half of all child deaths under age 5 and impairs the physical and mental development of millions of children.

More than 1 million child deaths could be averted each year by scaling up proven nutrition interventions.

We work to broaden the use of proven interventions, such as breastfeeding, and we support the development and testing of new solutions.

We work with other teams at the foundation—from Agricultural Development to Discovery & Translational Sciences—to broaden our collective learning and impact.

Our Nutrition strategy is led by interim director Katie Simons and is part of the foundation’s Global Development Division.

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Each year, millions of children die and many more suffer from physical and mental impairments due to poor nutrition during a critical 1,000-day period: from the onset of their mother’s pregnancy to their second birthday. Many children who live in poverty simply don’t get enough food—or the right kind of food—to support normal growth and development. Millions also suffer from illnesses such as diarrhea that sap the nutrients they consume. 

Nutrition-related factors contribute to about 45 percent of child deaths under age 5. Among undernourished children who survive, more than one quarter suffer from stunted growth, which can impair neurological development and learning.

Nutrition has been a neglected area of global health and development, accounting for less than 1 percent of global foreign aid. This is largely due to its underlying and often hidden role in child illnesses and deaths.

The problem starts before pregnancy. Women and girls who are not healthy and well-nourished are more likely to have malnourished children. Because poor nutrition compromises the immune system, children who are malnourished are more vulnerable to life-threatening infectious diseases as well as physical and cognitive impairments. This limits their ability to learn in school and reduces their productivity as adults—creating a vicious cycle that prevents families, communities, and countries from lifting themselves out of poverty.

Most undernourished people live in South Asia and Sub-Saharan Africa. Ten countries in those regions account for two-thirds of deaths attributable to poor nutrition. But even in those countries, most people who are undernourished do not show symptoms of extreme hunger or starvation. This “hidden hunger” is invisible to families, communities, and policymakers, which means that nutrition does not get enough attention and national nutrition programs are often underfunded.

Other challenges that contribute to malnutrition include inconsistent access to safe and affordable nutritious food; lack of awareness and understanding of healthy diets among those most at risk; low agricultural productivity (made worse by climate change); and poor sanitation and hygiene.

The Opportunity
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Over the past decade, research has dramatically expanded our understanding of how to improve nutrition for women and children. We now know, for example, that it is critical to reach children within the 1,000-day period and reach women and adolescent girls before, during, and after pregnancy.

A number of nutrition interventions have been shown to significantly improve child health and survival. They include exclusive breastfeeding during the first 6 months of life, fortifying staple foods such as cereal flours and cooking oil and iodizing salt, breeding crops for improved nutritional content, and providing micronutrient supplements (such as vitamin A and zinc) to children and providing micronutrient supplements to mothers before and during pregnancy and while breastfeeding.

In places where these interventions have been broadly used, the results have been striking. In Brazil, for example, efforts to improve and align nutrition and agriculture interventions reduced stunting by 80 percent within a generation. In Vietnam, rates of exclusive breastfeeding have tripled since 2009 as a result of focused efforts to support mothers. Vitamin A supplementation, which helps reduce blindness and childhood death, is now reaching more than 70 percent of children in high-risk countries.

These tools must be scaled up to reach all mothers and children. At the same time, new solutions are also needed. Evidence suggests that fully scaling up current interventions would address only about half of the burden of malnutrition because of its complex causes.

Our Strategy
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We invest in proven approaches to improving nutrition, such as focusing on the 1,000-day window, immediate and exclusive breastfeeding, complementary feeding, and food fortification and supplementation. We also explore new approaches, such as improving nutrition for women and adolescent girls, increasing advocacy and technical assistance, improving data systems, and strengthening food systems.

A new sweet potato variety that is rich in vitamin A is now widely available in eastern and southern Africa.

Our long-term goal is to ensure all women and children have the nutrition they need to lead healthy and productive lives.

We work closely with governments, the United Nations, bilateral agencies, nongovernmental organizations, and the private sector, and we collaborate with other teams within the foundation—from Agricultural Development to Discovery & Translational Sciences—to broaden our collective learning and impact.

Areas of Focus
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Country Impact

Proper nutrition from birth to age 2 is critical to a child’s growth and development and lifelong health. (Photo © Alive & Thrive/Tina Sanghvi)

The cornerstone of our strategy is our partnerships with several high-burden countries—Bangladesh, Burkina Faso, Ethiopia, India (with a focus on Bihar and Uttar Pradesh), and Nigeria—to demonstrate what can be achieved by expanding the use of proven interventions and developing and introducing new solutions.

In each country, we work with partners to show how these interventions can be introduced and expanded in specific contexts. We also work closely with key partners—including Alive & Thrive, Helen Keller International, HarvestPlus, and the Global Alliance for Improved Nutrition (GAIN)—to apply successful approaches and practices to other countries.

New Solutions

Despite significant research in the past few decades, knowledge about the immediate and underlying causes of unhealthy growth and development remains incomplete. We invest in research to understand the full range of causes of malnutrition, identify the right packages of interventions, and establish the best times to intervene.

We work closely with leading universities—including Cornell University; Johns Hopkins University; Oxford University; University of California, Davis; and University of Colorado—to develop, test, and roll out new solutions and address the obstacles to effective implementation, particularly barriers to reaching women and girls and addressing social and gender norms.

Food Systems

A women’s self-help group in a remote region of Rajasthan, India, produces fortified foods for distribution to mothers and young children. (Photo © Global Alliance for Improved Nutrition)

Despite recent agricultural innovations, the current food system is not capable of delivering good nutrition to all. Improving nutrition and addressing dietary deficiencies requires changes across the entire food chain—from how food is produced to how it is sold and consumed.

We work with national governments—particularly ministries of agriculture and health—to strengthen food systems by increasing collaboration between the agriculture and nutrition sectors; improving production and delivery of nutritious foods; using market-oriented approaches to ensuring the safety and affordability of nutritious foods; and empowering women to expand their control of resources in the home.

Data, Analytics, and Evidence

Better data is needed to define the problem of malnutrition, diagnose its root causes, design interventions, and track progress. In particular, many countries lack the data they need to measure progress against global nutrition targets. We are developing new tools and platforms to enable timely collection of data and improve its analysis and use. We also support global efforts to standardize the collection and monitoring of nutrition data and use evidence to develop effective policies and guidelines.

Policy, Advocacy, and Alignment

Less than 1 percent of global foreign aid is currently directed toward nutrition; national budget allocations in high-burden countries are similarly low. We work to increase domestic and donor resources for nutrition and to improve coordination to achieve long-term impact.

We work with leading organizations—including 1,000 Days, the Global Nutrition Report, Save the Children, Scaling Up Nutrition (SUN), Graça Machel Trust, and Action Against Hunger (Action Contre La Faim)—to generate better nutrition-related evidence, policies, and advocacy efforts at the global level and in high-burden countries. By encouraging greater investment and more effective spending and donor coordination, we aim to build the political will that is needed to reduce malnutrition globally.
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