Nutrition Background Paper to inform the …

1 1 Final Version Nutrition Background Paper to inform the preparation of the 7th Five Year Plan This Paper was prepared with significant contributions from Dr. AM Zakir Hussain, Professor MQK Talukder*, Dr. Tahmeed Ahmed in close consultations with representatives of the Institute of Public Health Nutrition , the Ministry of Health and Family Welfare, the Food Planning and Monitoring Unit of the Ministry of Food, development partner representatives including the Canadian Department of Foreign Affairs, Trade and Development (DFTD), the Delegation of the European Union (EU), the United Kingdom Department of International Development (DFID), the United States Agency for International Development (USAID)

2 , the World Bank, and the United Nations Renewed Efforts Against Child Hunger and Undernutrition (UN REACH) agencies FAO, Unicef, WFP and WHO. February 2015 * Note: Professor MQK Talukder insisted that the private sector be excluded from Nutrition policy formulation and programmes. 2 CONTENTS Page Acronyms 3 Executive Summary 5 CHAPTER 1: INTRODUCTION 8 Why Nutrition is important 8 National and international commitments to scale up Nutrition 9 A conceptual framework for Nutrition 10 CHAPTER 2.

3 CURRENT Nutrition SCENARIO 12 Under 5 children nutritional status and early childhood development 12 Nutritional status of girls and women, and links to gender inequality 13 Micronutrient deficiencies 14 Overweight, obesity and Nutrition related NCDs 14 Food diversity and dietary habits as determinants of Nutrition 15 IYCF and care practices as determinants of Nutrition and early childhood development 16 Access to health services as determinant of Nutrition 17 Access to clean environment as determinant of Nutrition 17 Poverty, and other inequities, related to Nutrition 18 Stewardship for Nutrition policy, plans and governance 20 CHAPTER 3.

4 Nutrition IN THE 6th FIVE YEAR PLAN 24 Nutrition -specific mechanisms and interventions 24 Nutrition -sensitive mechanisms and interventions 26 The broader context for Nutrition under the 6th Five Year Plan 27 CHAPTER 4: ISSUES AND CHALLENGES 28 Institutions, coordination and capacity for Nutrition 28 Nutrition -specific solutions 29 Nutrition -sensitive solutions 31 CHAPTER 5: DEVELOPMENT VISION FOR Nutrition IN 7th FYP 33 Vision, goals and objectives 33 Strategies 33 CHAPTER 6: RECOMMENDATIONS 44 References 51 Tables 1. Prevalence of micronutrient deficiencies 2.

5 Trends in food consumption, 1991-2010 3. Existing coordination mechanisms for Nutrition in the health and food sectors 4. Proposed organogram for Multisectoral and Multitakeholder Nutrition Coordination and Governance Mechanism (BNNC) 14 15 23 34 Figures 1. Conceptual framework for Nutrition 2. Trends in prevalence of child (0-59 months) undernutrition: 1986-2013 3. Trends in overweight and underweight in women 4. Trends in breastfeeding indicators, 1993-2013 5. Map showing stunting rates by upazila 11 11 13 16 19 6. Proposed multistakeholder Nutrition coordination and governance mechanism 44 7 Proposed management structure for MoHFW and NNS 46 8.

6 Multisectoral Nutrition governance at different levels 47 Annex National Nutrition Situation Analysis 2014 (compiled by UN REACH) 3 ACRONYMS ADP Annual Development Programme ICN International Conference on Nutrition AHI Assistant Health Inspector IDD Iodine Deficiency Disorder APR Annual Programme Review IEC Information Education and Communication APIR Annual Programme Implementation Report IEDCR Institute of Epidemiology Disease Control & Research APSU Agriculture Policy Support Unit IFAD Institute of Food and Agriculture Development BADC Bangladesh Agricultural Development Corporation IFPRI International Food Policy Research Institute BANHRDB Bangladesh Applied

7 Nutrition & Human Resource Development Board IPH Institute of Public Health BARC Bangladesh Agricultural Research Council IPHN Institute of Public Health and Nutrition BARI Bangladesh Agriculture Research Institute ILO International Labour Organization BBF Bangladesh Breastfeeding Foundation IMCI Integrated Management of Childhood Infection BBS Bangladesh Bureau of Statistics IMED Implementation Monitoring and Evaluation Division BCC Behaviour Change Communication IFNS Institute of Food and Nutrition Science BDHS Bangladesh Demographic and Health Survey INGO International Non-Government Organization MEAN Building Equity in Agriculture and Markets IT Information Technology BHE Bureau of Health Education IYCF Infant and Young Child Feeding BIDS Bangladesh Institute of Development Studies KAP Knowledge Attitude and Practice BINP Bangladesh Integrated Nutrition Project Kcal Kilo Calorie BIRDEM Bangladesh Institute of Research on Diabetic & Endocrine Metabolism LBW Low Birth Weight BIRTAN Bangladesh Institute of Research and Training on Applied Nutrition LD Line Director BNNC

8 Bangladesh National Nutrition Council LGD Local Government Division BMI Body Mass Index LMIC Low and Middle Income Country BMS Breast Milk Substitutes MAD Minimum Acceptable Diet BRAC Bangladesh Rural Advancement Committee MAM Moderate Acute Malnutrition BRRI Bangladesh Rice Research Institute MCH Maternal and Child Health CARE Cooperative for American Relief Everywhere MDG Millennium Development Goal CBHC Community Based Health Care MICS Multiple Indicator Cluster Survey CBO Community Based Organization MMT Million metric tons CC Community Clinics MMR Maternal Mortality Rate CDC Centre for Disease Control and Prevention MN Micronutrient CG Community Support Group MNP Micro-nutrient Promotion CIP Country Investment Plan.

9 MNCAH Maternal Neonatal Child and Adult Health CMAM Community Managed Acute Malnutrition MoAg Ministry of Agriculture CNP Community Nutrition Promoter MoHFW Ministry of Health and Family Welfare CO2 Carbon-di-oxide MoLGRD&C Ministry of Local Government Rural Development & Cooperatives CRF Common Results Framework MoWCA Ministry of Women and Children Affairs CS Civil Surgeon MoSocWel Ministry of Social Welfare CSG Community Support Group MTR Mid-term Review C-section Caesarean Section MUAC Mid Upper Arm Circumference CSO Civil Society Organizations NAEP National Agricultural Extension Policy 4 DC Disease Control NCHS National Centre for Health Statistics DDT Dichlorodiphenyltrichloroethane NFP National Food Policy DfID Department for International Development (UK)

10 NFP PoA National Food Policy Plan of Action DGFP Directorate General of Family Planning NGOs Non-Governmental Organizations DGHS Directorate General of Health Services NICC Nutrition Implementation Coordination Committee DP Development Partners NIPU Nutrition Information and Planning Unit DPE Department of Primary Education NPNL Non Pregnant Non Lactating DPM Deputy Programme Manager NNP National Nutrition Programme EBR Exclusive Breastfeeding Rate NNS National Nutrition Services EC Executive Summary NSSS National Social Safety (Protection)