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Child Food Poverty i Nutrition deprivation in early childhood

CHILD FOOD

POVERTY

2024 I Child Nutrition Report© United Nations Children’s Fund (UNICEF) June 2024 Permission is required to reproduce any part of this publication. Permissions will be fully granted to educational or non-profit organizations.

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Child Food Poverty. Nutrition Deprivation in Early Childhood. Child Nutrition Report, 2024. UNICEF, New York, June 2024.

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Pirozzi; page 50: © UNICEF/U.S. CDC/Unique Identifier/Florence Goupil; page 52: © UNICEF/UN0307913/ Muellenmeister; page 53: © UNICEF/UNI509882/Iyakaremye; page 54: UNICEF/Frank Dejongh; page 56: © UNICEF/Reuter; page 57: © UNICEF/UN0594274/Htet; page 59: © UNICEF/UN0704755.Child Food Poverty iii CHILD FOOD POVERTY Nutrition deprivation in early childhood 2024 | CHILD NUTRITION REPORTiv Nutrition Deprivation in Early Childhood ACKNOWLEDGEMENTS This publication was prepared by the UNICEF Child Nutrition and Development Programme of the UNICEF Programme Group in collaboration with the Data and Analytics Section of the UNICEF Data, Analytics, Planning and Monitoring Division.

Report team Authors: Harriet Torlesse, Vrinda Mehra, Linda Shaker Berbari, Nita Dalmiya, Chika Hayashi,

Grainne Moloney and Victor Aguayo.

Data analysis: Louise Mwirigi, Joel Conkle and Sebastian Volmer.

Editing and design: Julia D’Aloisio (editing) and Nona Reuter (design).

Internal advisory group (in alphabetical order) Chloe Angood, Maaike Arts, Annalies Borrel, Mauro Brero, Karan Courtney-Haag, Marie-Claude Desilets, Solrun Engilbertsdottir, Yvette Fautsch, Aashima Garg, Roland Kupka, Arnaud Laillou, Alina Michalska, Zivai Murira, Siméon Nanama, Christiane Rudert, Paula Veliz and Amirhossein Yarparvar. External advisory group (in alphabetical order) Richmond Aryeetey, University of Ghana; Kaleab Baye, University of Addis Ababa; Mary Christine

R. Castro, Nutrition Center of the Philippines; Edward A. Frongillo, University of South Carolina;

Yarparvar. External advisory group (in alphabetical order) Richmond Aryeetey, University of Ghana; Kaleab Baye, University of Addis Ababa; Mary Christine

R. Castro, Nutrition Center of the Philippines; Edward A. Frongillo, University of South Carolina; Larry Grummer-Strawn, World Health Organization; Emma Massey, Foreign, Commonwealth & Development Office; Omar Obeid, American University of Beirut; Rafael Perez-Escamilla, Yale School of Public Health; Ellen Piwoz, Independent Adviser, Maternal and Child Nutrition; Vandana Prasad, Public Health Resource Network, India; Alissa Pries, Independent Adviser, Maternal and Child Nutrition; Rahul Rawat, Bill & Melinda Gates Foundation; Juan Rivera, National Institute of Public Health, Mexico; Meera Shekar and Kyoko Shibata, the World Bank; Christine P. Stewart, University of California, Davis; Pattanee Winichagoon, Mahidol University; and Zhenyu Yang, Chinese Center for Disease Control and Prevention.

Special thanks to UNICEF colleagues in Bangladesh, Burkina Faso, Chad, the Democratic Republic of the Congo, Kenya, Lebanon, Madagascar, Mali, Pakistan, Somalia and the Syrian Arab Republic for conducting rapid assessments on child food poverty in communities affected by the food and nutrition crisis. UNICEF colleagues in the State of Palestine for providing data and information on severe child food poverty in the Gaza Strip. UNICEF colleagues in Burkina Faso, Kenya, Nepal, Peru and Rwanda for providing analysis and information on trends in severe child food poverty.Child Food Poverty v CONTENTS Foreword vii Executive summary 1 1 | Our research : Understanding child food poverty 8 What is child food poverty? 10 Child food poverty carries a huge human cost 11 Multiple facets of child food poverty 12 What does the report aim to contribute? 13 2 | Our findings: The crisis of severe child food poverty 16 Finding 1: Globally, one in four children (27 per cent) are living in severe child food poverty in early

Child food poverty carries a huge human cost 11 Multiple facets of child food poverty 12 What does the report aim to contribute? 13 2 | Our findings: The crisis of severe child food poverty 16 Finding 1: Globally, one in four children (27 per cent) are living in severe child food poverty in early childhood, amounting to 181 million children under 5 years of age 17 Finding 2: Globally, progress towards ending severe child food poverty is slow, but some regions and countries are proving that progress is possible and is happening 21 Finding 3: Severe child food poverty is experienced by children belonging to poor and non-poor households, indicating that household income is not the only driver of child food poverty 22 Finding 4: Children living in severe child food poverty are missing out on many nutrient-rich foods, while unhealthy foods are becoming entrenched in the diets of these children 27 Finding 5: The global food and nutrition crisis and localized conflicts and climatic shocks are intensifying severe child food poverty, especially in fragile and humanitarian settings 31 Finding 6: Severe child food poverty is driving child undernutrition: the percentage of children living in severe child food poverty is three times higher in countries with a high prevalence of stunting 38 3 | Our analysis: The forces driving severe child food poverty 40 Severe child food poverty is driven by poor food environments, poor feeding practices and household income poverty 41 Severe child food poverty is the result of systems that are failing, not families that are failing 44 Progress is possible when action is taken to transform food, health and social protection systems for children 47 4 | Our recommendations : Ending severe child food poverty 56 A systems approach to ending severe child food poverty 57 Galvanizing commitment, action and accountability 59 Annex 1: Regional profiles on child food poverty 61 Annex 2: Notes on figures 76 Endnotes 7 9vi Nutrition Deprivation in Early Childhood Israa, a 3-year-old, eats a piece of bread while standing in front of her family’s tent in Khan Younis city, south of the Gaza Strip in

Annex 2: Notes on figures 76 Endnotes 7 9vi Nutrition Deprivation in Early Childhood Israa, a 3-year-old, eats a piece of bread while standing in front of her family’s tent in Khan Younis city, south of the Gaza Strip in December 2023.Child Food Poverty vii One in four children today is living in severe food poverty. This means that they are surviving on one or two food groups a day, and on some days even less. The scale of this deprivation is alarming, and the overall slow progress to address this crisis hides deep inequalities at both global and regional levels. To put it into stark numbers, this means that 181 million children are not having the equal opportunity to grow, develop, and learn to their full potential. They risk falling into a cycle of malnutrition and poverty that will have consequences for them today and into the future; for their children and for generations to come. This report analyses the drivers of food poverty in early childhood. We found that household income is not the sole determinant of protecting children from food poverty. In fact, while almost half of children experiencing severe child food poverty live in poor households, more than half belong to households where factors other than income drive child food poverty. This means that in addition to working to lift families out of poverty, we must address poor food environments and poor child feeding practices. These challenges, in addition to household income, are denying millions of young children the nutritious and diverse foods they need to grow and develop to their full potential. But we can change this. Ending child food poverty is a policy choice, and the solutions are well known. Drawing from concrete and recent examples we outline a path towards tackling the problem, including actions to transform food systems, leverage health systems, and activate social protection systems in ways that put children’s right to food and nutrition in early childhood at the centre. Children living in food poverty are denied the

Drawing from concrete and recent examples we outline a path towards tackling the problem, including actions to transform food systems, leverage health systems, and activate social protection systems in ways that put children’s right to food and nutrition in early childhood at the centre. Children living in food poverty are denied the power of good nutrition during the time in their lives when it matters the most. Let us mobilize the commitment and resources of governments, development and humanitarian organizations, civil society and academia, and the food industry to address this moral imperative. Catherine Russell UNICEF Executive Director FOREWORDviii Nutrition Deprivation in Early ChildhoodChild Food Poverty 1 Across the world, millions of parents and families are struggling to provide the nutritious and diverse foods that young children need to grow, develop and learn to their full potential. Growing inequities, conflict and climate crises, combined with rising food prices, the overabundance of unhealthy foods, harmful food marketing strategies and poor child feeding practices, are condemning millions of children to child food poverty. UNICEF has introduced the concept of child food poverty to bring dietary deprivation and poor quality diets in early childhood to the forefront of global efforts to achieve the nutrition targets of the Sustainable Development Goals. UNICEF defines child food poverty as children’s inability to access and consume a nutritious and diverse diet in early childhood (i.e., the first five years of life). Child food poverty harms all children, but it is particularly damaging in early childhood, when insufficient dietary intake of essential nutrients can cause the greatest harm to child survival, physical growth and cognitive development. The consequences can last a lifetime: children deprived of good nutrition in early childhood do less well at school and have lower earning capacity in adulthood, trapping them and their families in a cycle of poverty and deprivation. OUR RESEARCH Understanding child food poverty This global report examines the status, trends, inequities and drivers of child food poverty in early childhood, including the impact of global and local

adulthood, trapping them and their families in a cycle of poverty and deprivation. OUR RESEARCH Understanding child food poverty This global report examines the status, trends, inequities and drivers of child food poverty in early childhood, including the impact of global and local food and nutrition crises. The report focuses on lowand middle-income countries, where most children living in child food poverty reside, and on the implications of child food poverty for undernutrition and poor development. The analyses used data from the UNICEF Global Database on Infant and Young Child Feeding, comprising data from 670 nationally representative surveys conducted in 137 countries and territories, and representing more than 90 per cent of all young children globally. We also analysed national survey data to identify determinants of severe child food poverty, and the extent to which severe child food poverty predicts child undernutrition. In addition, we analysed data from rapid assessments conducted in lowand middle-income countries to examine the barriers experienced by parents and families in feeding young children in communities affected by food and nutrition crises. EXECUTIVE SUMMARY Child food poverty is measured using the UNICEF and World Health Organization (WHO) dietary diversity score. To meet the minimum dietary diversity for healthy growth and development, children need to consume foods from at least five out of the eight defined food groups.

If children are fed: 0–2 food groups/day they are living in severe child food poverty 3–4 food groups/day they are living in moderate child food poverty 5 or more food groups/day they are not living in child food poverty Pulses, nuts and seeds Eggs Other fruits and vegetables Dairy products

Breastmilk Flesh foods (meat, poultry and fish) Vitamin A-rich fruits and vegetables Grains, roots, tubers and plantains2 Nutrition Deprivation in Early Childhood

OUR FINDINGS

Eggs Other fruits and vegetables Dairy products Breastmilk Flesh foods (meat, poultry and fish) Vitamin A-rich fruits and vegetables Grains, roots, tubers and plantains2 Nutrition Deprivation in Early Childhood OUR FINDINGS The crisis of child food poverty Our six key findings uncover the scale of severe child food poverty in early childhood globally, the slow progress in lowering severe child food poverty, the presence of severe child food poverty in children living in poor and non-poor households, and how children living in severe child food poverty are missing out on many nutritious foods that are essential to survival, growth and development. Finding 1. Globally, one in four children (27 per cent) are living in severe child food poverty in early childhood, amounting to 181 million children under 5 years of age. Severe child food poverty affects all regions of the world, but not equally: South Asia and sub-Saharan Africa are home to more than two-thirds (68 per cent) of the 181 million children living in severe child food poverty. Twenty countries account for almost two-thirds (65 per cent) of the total number of children living in severe child food poverty: Afghanistan, Bangladesh, China, Côte d’Ivoire, the Democratic Republic of the Congo, Egypt, Ethiopia, Ghana, India, Indonesia, Myanmar, the Niger, Nigeria, Pakistan, the Philippines, Somalia, South Africa, Uganda, the United Republic of Tanzania and Yemen. Finding 2. Globally, progress towards ending severe child food poverty is slow, but some regions and countries are proving that progress is possible and is happening. In the subset of 64 countries with trend data, there was minimal change in the percentage of children living in severe child food poverty during the last decade (34 per cent in 2012 to 31 per cent in 2022); the prevalence did not change in 32 countries and increased in 11 countries.

minimal change in the percentage of children living in severe child food poverty during the last decade (34 per cent in 2012 to 31 per cent in 2022); the prevalence did not change in 32 countries and increased in 11 countries. However, in West and Central Africa, severe child food poverty fell by one quarter (42 per cent to 32 per cent). Twenty-one countries – about one in three of the 64 countries with trend data – achieved a significant reduction in severe child food poverty. Finding 3. Severe child food poverty is experienced by children belonging to poor and non-poor households, indicating that household income is not the only driver of child food poverty. Of the 181 million children living in severe child food poverty, about half (84 million, or 46 per cent) belong to households in the two poorest wealth quintiles, among whom limited household income is likely to be a major driver of severe child food poverty. The remaining 97 million children (54 per cent) living in severe child food poverty belong to households in the middle and two upper wealth quintiles, among whom factors other than income poverty are driving the problem. Finding 4. Children living in severe child food poverty are missing out on many nutrient-rich foods, while unhealthy foods are becoming entrenched in their diets. Among children living in severe child food poverty, four out of five are fed only breastmilk and/or dairy products and/or a starchy staple, such as rice, maize or wheat. Less than 10 per cent are fed fruits and vegetables and less than 5 per cent are fed eggs, or meat, poultry and fish. Meanwhile, unhealthy foods and beverages are consumed by an alarming proportion of children living in severe child food poverty, displacing more nutritious foods from their diets. In Nepal, for example, 42 per cent of children living in severe child food poverty consume foods high in sugar, salt and/or fat, and 17 per cent consume sweet beverages.

consumed by an alarming proportion of children living in severe child food poverty, displacing more nutritious foods from their diets. In Nepal, for example, 42 per cent of children living in severe child food poverty consume foods high in sugar, salt and/or fat, and 17 per cent consume sweet beverages. Finding 5. The global food and nutrition crisis and localized conflicts and climatic shocks are intensifying severe child food poverty, especially in fragile and humanitarian settings. Since 2020, the economic fall-out of the COVID-19 pandemic, the war in Ukraine and localized conflicts and climatic shocks have exacerbated the challenges that parents and families face in feeding their children. In vulnerable communities in the Democratic Republic of the Congo and Somalia, more than 80 per cent of parents reported that their child had been unable to eat for an entire day because of a lack of money or other resources.Child Food Poverty 3 One in three children in fragile countries are living in severe child food poverty. For children in extremely fragile contexts, the percentage affected by severe child food poverty can soar to exceptionally high levels, such as in Afghanistan (49 per cent), Somalia (63 per cent), and most recently in the Gaza Strip in the State of Palestine (nine in ten children living in severe child food poverty between December 2023 and April 2024). Finding 6. Severe child food poverty is driving child undernutrition: the percentage of children living in severe child food poverty is three times higher in countries with a high prevalence of stunting. Severe child food poverty is associated with child undernutrition. One in three children (32 per cent) experience severe child food poverty in countries with a high prevalence of stunting, compared to 11 per cent in countries with a low prevalence; and the odds of stunting are 34 per cent higher in children affected by severe child food poverty compared to children who are not affected. Similarly, the percentage of children living in severe child food poverty is more than double in countries with

in countries with a low prevalence; and the odds of stunting are 34 per cent higher in children affected by severe child food poverty compared to children who are not affected. Similarly, the percentage of children living in severe child food poverty is more than double in countries with a high compared to low prevalence of wasting (35 per cent versus 14 per cent), and the odds of wasting are 50 per cent higher if a child is affected by severe child food poverty. OUR ANALYSIS The forces driving severe child food poverty Our analysis identifies three major drivers of severe child food poverty: poor food environments for children, poor feeding practices i n early childhood, and household income poverty affecting children and their families. We find that the food, health and social protection systems are failing children’s right to good food and nutrition. However, progress in reducing severe child food poverty is possible when action is taken to activate these systems. Severe child food poverty is driven by poor food environments, poor feeding practices and household income poverty Poor food environments are disrupting access to nutritious and diverse diets. In rural, remote and fragile settings, adverse weather, climatic shocks, insecurity or poor roads can disrupt food production and/or physical access to affordable nutritious foods. Meanwhile, the overabundance of nutrient-poor ultraprocessed foods in shops and markets is an evergrowing challenge for families throughout the world, particularly in – but not limited to – urban areas.4 Nutrition Deprivation in Early Childhood These foods are low in essential nutrients and high in sugar, salt and unhealthy fats; they are often cheaper than healthier, nutritious options and made more desirable by aggressive marketing strategies. Poor feeding and care practices are undermining young children’s diets. Poor practices and beliefs concerning the foods that young children should be fed and the types and amounts of foods that children can safely consume and digest are passed from one generation to the next and between peers. This occurs particularly when there is a lack of accurate information and effective counselling and support

concerning the foods that young children should be fed and the types and amounts of foods that children can safely consume and digest are passed from one generation to the next and between peers. This occurs particularly when there is a lack of accurate information and effective counselling and support on child feeding for parents and families. In addition, discriminatory gender and patriarchal norms persist in some countries, impeding women’s access to information and education, limiting women’s incomeearning opportunities, and denying mothers the autonomy to make food purchase decisions for their young children. Household income poverty means that families cannot afford nutritious and diverse diets for their children. Families living in extreme income poverty struggle to afford nutritious foods, particularly animal-source foods (eggs, meat, poultry, fish and dairy) and fruits and vegetables. Nutritious foods cost much more per calorie than staple foods, especially in lower-income countries, and food inflation is pushing these foods further out of reach for parents, families and their young children. In these contexts, full stomachs – not nutritious food – tend to be a priority for income-poor families. Severe child food poverty is the result of systems that are failing, not families that are failing Parents and families have a responsibility to feed and care for their young children, but the forces that lead to severe child food poverty – poor food environments, poor feeding practices and household income poverty – are beyond their full control. These forces persist because the food, health and social protection systems are failing to improve physical and financial access to affordable nutritious and diverse foods and are failing to equip parents and families with the knowledge, skills and support they need to feed these foods to their children. And these systems are ill-equipped to cope with the global and local impacts of conflict, climatic shocks and economic crises.Child Food Poverty 5 Food systems are failing to provide children with the diets they need for healthy growth and development. Food systems are not providing millions of families and young children with adequate access to

systems are ill-equipped to cope with the global and local impacts of conflict, climatic shocks and economic crises.Child Food Poverty 5 Food systems are failing to provide children with the diets they need for healthy growth and development. Food systems are not providing millions of families and young children with adequate access to affordable, nutritious and diverse foods, including eggs, meat, poultry, fish, milk, fruits, pulses and vegetables. At the same time, shops and markets are flooded with an overabundance of aggressively marketed ultraprocessed foods and sugar-sweetened beverages that are low in essential nutrients for children’s growth and development and high in sugar, salt and unhealthy fats. Health systems are failing to provide families with the essential nutrition services young children need. In particular, parents, families and communities have insufficient access to timely and quality information, counselling and support on child feeding. Health and nutrition workers in primary health care facilities and in communities are insufficient in numbers and often have inadequate training, supportive supervision, remuneration and clear accountabilities for delivering information, counselling and support services on child feeding to parents and families. Social protection systems are failing to protect vulnerable children against malnutrition in early childhood. Three out of four children worldwide (74 per cent) do not have any form of social protection, leaving them exposed to economic hardship, social exclusion and severe child food poverty. Where social protection programmes are available, they are often fragmented in scope, inadequate in coverage and benefit size, inflexible to changing needs and disconnected from nutrition services, limiting the potential to prevent severe child food poverty. Progress is possible when action is taken to transform food, health and social protection systems for children Positive change towards ending child food poverty is happening today, across countries and continents. For example, over the last decade Burkina Faso and Nepal have reduced the prevalence of severe child food poverty by half and Rwanda has reduced the prevalence by one third, while Peru has maintained the

Positive change towards ending child food poverty is happening today, across countries and continents. For example, over the last decade Burkina Faso and Nepal have reduced the prevalence of severe child food poverty by half and Rwanda has reduced the prevalence by one third, while Peru has maintained the prevalence below 5 per cent since 2014 – despite the considerable challenges caused by the global food and nutrition crisis. A combination of actions across the food, health and social protection systems makes progress possible. Countries that have reduced severe child food poverty have several success factors in common: they have improved the supply of nutritious foods and strengthened food environments (food system); expanded the coverage and quality of nutrition services for young children, including child feeding counselling at community level (health system); and protected poor households from income poverty (social protection system). They also share strong political commitment to child nutrition and nutrition governance – including through multisector plans, multisector coordination, results-based budgeting, and robust progress monitoring. OUR RECOMMENDATIONS Ending severe child food poverty Growing inequities, conflict and climate crises, household income poverty, the overabundance of unhealthy foods, harmful food marketing strategies, and poor child feeding practices are condemning millions of children to severe food poverty in early childhood. The scale of severe child food poverty, the slow progress over the past decade, and the escalating threats to young children’s diets – combined with the impacts of severe child food poverty on child survival, growth and development – demand a step change in commitment, actions and accountability. While contexts vary, the core agenda to end severe child food poverty includes coordinated and synergistic actions in development and humanitarian contexts to:

1. Position child food poverty elimination as a policy imperative and child food poverty reduction as a metric of success towards achieving global and national nutrition and development goals, with time-bound targets and results in relevant sectoral and multisectoral plans.

2. Transform food systems by ensuring food

1. Position child food poverty elimination as a policy imperative and child food poverty reduction as a metric of success towards achieving global and national nutrition and development goals, with time-bound targets and results in relevant sectoral and multisectoral plans.

2. Transform food systems by ensuring food environments make nutritious, diverse and healthy foods the most accessible, affordable and desirable option for feeding young children, and the food and beverage industry complies with policies and regulations to protect children from unhealthy foods and beverages.

3. Leverage health systems to deliver essential nutrition services to prevent and treat child malnutrition – including community-based counselling, support and services to improve feeding and care practices in early childhood – prioritizing the most vulnerable children.6 Nutrition Deprivation in Early Childhood

4. Activate social protection systems to address income poverty in ways that are responsive to the food and nutrition needs of vulnerable young children and their families, including social transfers

(cash, vouchers and food) to protect children at highest risk of child food poverty.

5. Strengthen data systems to assess the prevalence and severity of child food poverty and identify its drivers; detect increases in child food poverty early, including in fragile and humanitarian contexts; and track national and global progress in reducing severe child food poverty.

To make freedom from severe child food poverty a reality for all children – including the most vulnerable – governments, together with development and humanitarian organizations, civil society and media, academic and research organizations, and the food and beverage industry, must urgently commit to a bold and broad response. Crucially, these stakeholders must hold themselves and each other accountable for delivering on commitments to transform, leverage and activate the food, health and social protection systems. Governments • Ensure po