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INTERNATIONAL FOOD POLICY RESEARCH INSTITUTEsustainable solutions for ending hunger and poverty 2.1 The causes of child malnutrition, death, and disability 2.2 Women's status, care for children, and children's birthweights 3.1 Distribution of index of women's relative decisionmaking power 3.2 Distribution of index of societal gender equality 4.1 Percentage of stunted, wasted, and underweight children, by region 4.2 Women's status indexes, by region 4.3 Predicted child nutritional status Z-scores, by indexes of women's status 4.4 Predicted probability of child malnutrition, by indexes of women's status 4.5 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, South Asian countries 4.6 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, Sub-Saharan African countries 4.7 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, Latin American and Caribbean countries 4.8 Effect of societal gender equality on child weight-for-age Z-scores, South Asian countries 4.9 Effect of societal gender equality on child weight-for-age Z-scores, Sub-Saharan African countries 4.10 Effect of societal gender equality on child weight-for-age Z-scores, Latin American and Caribbean countries 5.1 Percentage of nonpregnant women with low and high body mass indexes 5.2 Predicted women's body mass index, by indexes of women's status 5.3 Predicted probability of a woman being malnourished, by indexes of women's status 5.4 Percentage of women who receive any prenatal care and who give birth in a medical facility 5.5 Predicted prenatal care variables, by indexes of women's status vii 5.6 Predicted probability of a woman giving birth in a medical facility, by indexes of women's status 6.1 Predicted breastfeeding variables, by indexes of women's status 6.2 Predicted complementary feeding variables, by indexes of women's status 6.3 Predicted health-seeking variables, by indexes of women's status 6.4 Type of caregiver while woman is working (%) 6.5 Predicted probability of child having an adult caretaker while mother is working, by women's status 7.1 Contribution of level difference in women's status to the child nutritional status gap between South Asia and Sub-Saharan Africa: A hypothetical graphical illustration 7.2 Contribution of effect difference in women's status to the child nutritional status gap between South Asia and Sub-Saharan Africa: A hypothetical graphical illustration B.1 Predicted probability of a woman having "high" status, by indicators of women's relative decisionmaking power B.2 Predicted probability of a woman having "high" status, by index of woman's relative decisionmaking power C.1 Creation of economic status groups: Destitute, poor, middle, and rich viii FIGURES Foreword Many researchers in the international development field have been startled to note that although child malnutrition is rampant in both Sub-Saharan Africa and South Asia, it is much more widespread in South Asia. According to other Millennium Development Goal indicators, chi...

Background Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30–40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain. Methods Using extant longitudinal birth cohorts (n = 19) with data on birth-weight, gestational age and child anthropometry (12–60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth. Results We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5–3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively. Conclusions This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.

Current understanding of biologic processes indicates that women's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and 32 observational studies) that were identified through PubMed and EMBASE database searches and examining review articles. Intervention trials and observational studies show that periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of neural tube defects. Observational studies suggest that preconceptional and periconceptional intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring who are low birthweight and/or small-forgestational age (SGA) and preterm deliveries (PTD). Some studies report that indicators of maternal prepregnancy size, low stature, underweight and overweight are associated with increased risks of PTD and SGA. The available data indicate the importance of women's nutrition prior to and during the first trimester of pregnancy, but there is a need for well-designed prospective studies and controlled trials in developing country settings that examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal mortality. The knowledge gaps that need to be addressed include the evaluation of periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well as the relationship between measures of prepregnancy body size and composition and maternal, neonatal and child health outcomes.

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(34.3 ± 1.8 and 34.3 ± 1.5 cm, respectively) at birth. Offspring of supplemented primigravidae (n = 370) were heavier (difference, 99.4 g; 95% CI, 5.5 to 193.4) and had larger head circumferences (difference, 0.5 cm; 95% CI, 0.1 to 0.9) than controls; the differences in multigravidae

In an analysis of surveillance data from the state of Georgia (US), Saad Omer and colleagues show an association between receipt of influenza vaccination among pregnant women and reduced risk of premature births.

Low birth weight (LBW) remains a significant public health problem in many developing countries, and poor nutrition both before and during pregnancy is recognized as an important cause. Emerging evidence on the role of intergenerational effects in determining maternal preconceptual nutritional status indicates the need for continued investment in strategies that improve women's nutrition and health throughout the life cycle, especially during the early years. Controlled trials have shown that improving food intakes during pregnancy effectively reduces LBW, but programs have been less successful because these interventions are expensive and difficult to manage. Multivitamin-mineral supplements have been viewed as a simpler solution, but 2 of 3 controlled trials conducted to date failed to show that multivitamin-mineral supplements are more effective than are iron-folate supplements, which are already the standard of care during pregnancy. Emerging evidence indicating the benefits of iron supplements in improving birth weight illustrate the need for increased efforts to reduce iron deficiency by improving coverage of antenatal programs and promoting fortification. Other causes of LBW include environmental factors, such as smoking; indoor air pollution; and infections, such as malaria. However, little is known about the interactions between nutrition and infection. Underlying social factors, such as poverty and women's status, are also important, especially in South Asia, where more than one-half of the world's LBW infants are born. In summary, strategies that combine nutrition-based interventions, such as improving food intakes and micronutrient status, especially iron status, with approaches that improve women's status and reproductive health are needed to reduce LBW.