Explaining why nutrition has been much maligned, head of growth, equity and livelihoods at Save the Children, David McNair said: "Nutrition has been the Cinderella issue of development. It's been a hidden problem because it doesn't show up on death certificates."
In 2013 medical journal, the Lancet, confirmed that malnutrition is the underlying cause behind 45% of child deaths under five. The figure is even higher in Sierra Leone where 57% of deaths of children under five are attributable to malnutrition. A Unicef's 2010 survey also found that 44% of children in this small west African nation were stunted – a symptom of lack of adequate nutrients.
But the government is showing it has the political will to address the problem, having signed up to the Nutrition for Growth agreement and joined the Scaling Up Nutrition (Sun) movement, a collective effort from governments, civil society, the UN, donors, businesses and researchers. It's involvement in Sun is being led by the vice-president's office.
"It's come to the point where everybody knows it's not just health related, you need to have all the players on board to tackle malnutrition," says Aminata Shamit Koroma, director of food and nutrition at Sierra Leone's the ministry of health.
As the country moves from post-conflict (the civil war ended in 2002) to emerging market (GDP growth was 15% in 2012), the government realises that it must shift from treatment of malnutrition to prevention. Agriculture, education, gender equality and sanitation all have a role to play in this.
"We've seen that women with a higher educational level are less likely to have malnourished children. You need good sanitation. You need food to be affordable, accessible for people to be able to purchase and feed themselves," says Koroma, who was in London for the launch of the Generation Nutrition campaign in which 30 NGOs are pledging to end child malnutrition with this generation.
In Sierra Leone, Koroma focuses on promoting breastfeeding as a key policy for reducing stunting and malnutrition among younger generations. The message that babies should be exclusively breastfed for the first six months of their lives is broadcast over the radio, during awareness weeks and via mother-to-mother support groups.
"Experienced mothers counsel young mothers," she says. "We've found that the barrier to exclusive breastfeeding is tradition. Grandmothers tell mothers they need to give the baby water because it's thirsty. We use this same medium [grandmothers] to go back to the mothers and say, you don't have to give the baby water. Breast milk has everything the child needs for the first six months." The mother-to-mother initiative started with three support groups of 20 mothers each and has grown to 3,000 support groups across the country.
As well as grandmothers, the Sierra Leone National Food and Nutrition Security Policy 2012-2016, targets fathers. "We've found that once they get to know about the benefits of breastfeeding they support their wives," says Koroma. "One myth is that if you are sexually active during breastfeeding the child will get ill. So we tell them that this is not true, in fact it will help you, because for the first six months if you actively exclusively breastfeed it helps to stop getting pregnant."
Another motivating factor for fathers is that if their babies are breastfed they don't have to buy food for them for their first six months of life. "When they find out, some fathers will really push their partners to breastfeed because this is money in their pocket," says Koroma.
The nutrition policy also recommends the establishment of a code of conduct for the marketing of breast milk substitutes. The code has yet to be drafted but Koroma says it's on the agenda for this year. A report from Save the Children released last year found that companies that produce breast milk substitutes are still putting children at risk by promoting their product as superior to a mother's milk.
"Many people feel that this is an issue that was dealt with in the 1980s and 1990s," says McNair. "But we remain concerned by the role of large companies in trying to influence and weaken legislation around ensuring code compliance at a country level."
Although Koroma is realistic that Sierra Leone will not meet the millenium development goal of eradicating hunger by 2015, she is optimistic that the country can achieve this by 2020. "We've seen now that nutrition is on the development agenda of the government," she says. "When the president of Sierra Leone talks about what he hopes to do, now he mentions nutrition."
Read more stories like this:
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