Mason John B, Shrimpton Roger, Saldanha Lisa S, Ramakrishnan Usha, Victora Cesar G, Girard Amy Webb, McFarland Deborah A, Martorell Reynaldo
Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA;
Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Glob Health Action. 2014 Jun 6;7:23623. doi: 10.3402/gha.v7.23623. eCollection 2014.
From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months--about 500 days--is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here.
This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers.
The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron-folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries.
This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay.
从受孕到6个月大，婴儿的营养完全依赖母亲：最初通过胎盘，之后理想的方式是纯母乳喂养。这15个月——约500天——是儿童生命中最重要且最脆弱的时期：必须通过支持孕产妇营养与健康的政策来加以保护。本文将讨论针对营养状况的相关政策。
本文旨在基于文献中的疗效研究以及在埃塞俄比亚、印度和尼日利亚北部社区进行深入数据收集的全球及部分国家的有效性研究，总结关于保护妇女营养以改善低收入和中等收入国家出生结局的政策与项目研究。该研究结果已发表在学术文献中（超过30篇论文）。现在需要向政策制定者宣传这些结论。
所解决的优先问题包括：宫内生长受限（IUGR）、妇女贫血、消瘦和发育迟缓。在孕期及孕前需要广泛推广的优先干预措施有：补充铁叶酸或多种微量营养素；扩大碘盐强化覆盖范围，尤其是偏远地区和最贫困人群；在有大量资源时针对性地提供均衡的蛋白质能量补充剂；减少青少年怀孕；通过计划生育项目增加两次怀孕之间的间隔时间；借鉴有条件现金转移项目，既提供资源，又作为公共教育的平台。所有这些措施都有已知的效果，但覆盖范围和资源投入不足。接下来的步骤是克服广泛实施的障碍，否则母婴健康和营养目标（如世界卫生组织设定的目标）不太可能实现，尤其是在最贫困国家。
这一议程需要在部委和捐助方层面以及整个行政系统做出政策决策。基于证据的干预措施已作为这些决策的基础确立，有明确的宣传信息，且不存在延迟的科学理由。
