The global COVID-19 health crisis is unprecedented, in both its global scope and devastating impacts. What started as a novel virus soon resulted in global economic shutdown that is creating a malnutrition crisis felt the world over – especially by the world’s poor. For those on the margins, including so many of world’s women and girls, COVID-19 represents a triple threat – to the hard-won development and gender equality gains to date, to the survival of women and children whose health and nutrition needs can’t wait, and to the future potential of every child growing up in this catastrophe.

The compounding effects of job loss, economic uncertainty, supply chain disruptions, price hikes, weakened or overwhelmed health systems, and fear of contracting the virus by accessing health services all mean that access to nutritious food and nutrition services are plummeting, with further reductions in services on the horizon. Already, leading health officials have recommended temporarily suspending preventative nutrition measures that stave off mass malnutrition including vitamin A supplementation. Conflicting national guidance and exploitative messaging from breastmilk substitute manufacturing companies have caused many mothers to avoid breastfeeding, even though there is no evidence of transmission danger.

Women, already 50% more likely to face malnutrition than men and boys, will bear the brunt of this crisis. Not only are they less likely to have the economic means to purchase nutritious foods, they are also often the first members of the household to go without nutritious food so that the rest of the family can eat, especially during times of food insecurity.

The coming malnutrition crisis is particularly dangerous because:

1. Malnutrition increases susceptibility to infection and illness including COVID-19, which puts the world at risk of further outbreaks.
   Undernutrition has long been shown to increase susceptibility to and severity of illness and infection, including respiratory infections such as pneumonia, and is “the primary cause of immunodeficiency worldwide.” Women and children who are undernourished will likely suffer from more serious cases of COVID-19. Similarly, emerging research is suggesting that obesity itself − not just the non-communicable diseases associated with obesity − acts as a comorbidity increasing the deadliness of COVID-19 symptoms.
2. Malnutrition heightens existing risks to women’s health, especially pregnancy and childbirth, to which overburdened health systems have less capacity to respond.
   Evidence from previous epidemics suggests that COVID-19 will result in a large increase in maternal mortality as quarantine measures, overcrowded healthcare facilities, and fear of infection can cause many women to forego routine antenatal checkups and opt to give birth at home instead of in a health facility. Malnourished mothers are already more likely to die than those who are well-nourished due to complications caused by conditions such as iron deficiency anaemia and the short stature associated with chronic hunger. They are also 30% more likely to give birth to low birthweight babies who are, in turn, much more susceptible to malnutrition and death. The coming increase in home births and decrease in antenatal care will be even more fatal if combined with increased maternal malnutrition.
3. Malnutrition in the first 1,000 days, even for a short time, can have devastating lifelong physical and cognitive effects.
   During the 1,000 days between a woman’s pregnancy and her child’s 2nd birthday, the child’s brain begins to grow and develop and their bodies set foundations for health throughout their lives. Malnutrition in this period is especially dangerous, resulting in irreversible setbacks including stunted growth, reduced cognitive development, and a predisposition for obesity and non-communicable diseases later in life. Even a short period of malnutrition in this critical time frame can have lifelong consequences that are especially challenging for girls and women who often have fewer opportunities to overcome these setbacks than their male counterparts. The coming malnutrition crisis could put a whole generation at risk.

We cannot allow the tremendous risk malnutrition poses to take a back seat to other COVID-19 response priorities. There are concrete actions we can take today to limit women’s vulnerability to the malnutrition crisis and build resilience against future COVID-19 waves or new pandemics, specifically:

1. Prioritize good nutrition for pregnant women and young children
   Since the 1,000 day window is such a critical time for the life-long wellbeing of both mothers and children, they will need modified packages of services which include additional supplements and nutritional counselling, especially if the quality of their diets decreases. Once it is safe to gather in person again, intensified catch-up child health days and strengthened routine delivery will be key to ensuring distribution of critical health and nutrition services, including vitamin A supplementation and other Power 4 interventions.
2. Support good nutrition through food security programs
   As the coming hunger crisis becomes more apparent, food security and food aid have been identified as key needs around the world. As countries respond to this need, it is imperative to ensure that all food security and social protection programs make access to adequate nutrition a key program outcome. This can be achieved by including nutrition-related messages where cash is distributed to support household purchasing power and supporting measures to maintain uninterrupted staple food fortification.
3. Advance good nutrition through immunization programs
   When immunization campaigns resume, it will be important to ensure vitamin A supplementation is delivered as part of a likely ramp-up of polio and measles vaccine campaigns and future COVID-19 vaccination campaigns. Additionally, vaccine delivery should be used to screen for malnutrition and refer moderate or severe cases.

Implementing these preventative measures will only be possible if countries have the data, analytics, and technical assistance they need to make informed nutrition risk reduction plans and resource allocation decisions. Investing in informed decision making, building evidence, and developing and providing good guidance will help ensure that the allocations made today are based on good practices. For the sake of everyone, but especially for the women and children who will be hit hardest, it is imperative that we prioritize and fund nutrition in COVID-19 response plans today and recovery plans in the future.

This blog was originally shared on the 1,000 Days website.

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