Rationale for a new community of practice exploring how we can help babies be Clean, Fed & Nurtured

By Hanna Woodburn

Originally published June 14, 2013 on the Gates Foundation Impatient Optimists blog.

In early May a gBangladesh woman and child GM (2)roup of experts gathered in a Washington, D.C. conference room. Such meetings are commonplace in this town, particularly within the international development community. But this meeting was different, not because it connected luminaries and experts, but because they represented three different sectors—water, sanitation, and hygiene (WASH); nutrition, including infant and young child feeding (IYCF); and early childhood development (ECD). Representatives of these sectors came together to explore ways to work toward a common goal: ensuring that babies around the world are Clean, Fed & Nurtured.

The participants largely determined the course of the meeting, organizing working groups on topics that most interested them. Before parting ways, delegates from academia, funding organizations, international NGOs, and the private/commercial sector made personal commitments for actions to kickstart integration of the three sectors within their spheres of influence.

The science is becoming clearer: for children to reach their full human potential both physically (including to prevent stunting) and cognitively, improving food intake alone is not enough. An estimated 165 million children under 5 years of age have significantly impaired physical growth and are unable to reach their full potential. Increasingly, we see that to tackle stunting at scale, we must work together.

Recently, governments, donors, and private sector organizations made a significant commitment to reaching the benchmarks established in the Global Nutrition for Growth Compact. To achieve these objectives, it will be essential that intersecting disciplines are no longer placed in separate silos. Certainly progress has been made in this regard.

As The Lancet asserted in the June 2013 series on maternal and child nutrition, integration among complementary program interventions—including WASH, nutrition, and ECD—has the potential to increase efficiency and enhance benefits. We could not agree more.

While adequate nutrition in the first two years is critical to prevent stunting, research also points to the important role of ECD, including early childhood stimulation, to support brain development and to strengthen the impact of nutrition interventions. And increasingly, evidence links WASH interventions to improved child growth.

The experts have previously worked on two-way integration. WASH + nutrition sectors have lately shown a lot of collaboration. Likewise, ECD + nutrition researchers are putting the finishing touches on a special issue of Annals of New York Academy of Sciences on integrated interventions in nutrition and child development (watch for this issue by end of 2013). But rarely do programs or studies put a focus on all three sectors.

How might this new focus on the Clean, Fed & Nurtured baby shift the ways we promote child growth and child development? Participants’ commitments were concrete. Members of one NGO, who represented all three sectors, pledged to work together to choose at least one country where they can “collectively put our heads together to influence programs.” A leader in WASH pledged to encourage that sector to add the indicator for child stunting (height for age) into the WASH evaluation plans. The author of an internationally sanctioned guide for child health, nutrition, and child care announced that there is still time to build in guidance on WASH – under-represented in earlier versions – and asked meeting participants for contributions. A small group stepped up to define a set of “essential hygiene actions,” offering programmers an add-on to the existing “essential nutrition actions.” Participants offered to make immediate modifications to build integration into programs they are designing, conference themes they are developing, or studies they are about to launch.

The Clean, Fed & Nurtured consultative meeting demonstrated nascent steps toward these integrated objectives, but we cannot go it alone.

Practitioners, keep an eye out for opportunities for integration. Prepare programs to train, equip, and evaluate frontline field agents in each of these areas.

Researchers, help us fill the gaps in the evidence. What indicators should an integrated program include? How can frontline workers and families integrate multiple household practices to promote child growth and development?

Finally, join in these evolving conversations by inquiring, sharing successes, and disseminating pertinent research. Right now, the primary vehicle for doing so is a new Clean, Fed & Nurtured LinkedIn Group, which we hope you will contribute to. We can also be found on Twitter, @thrivingbaby, and ask you to begin using #CleanFedNurtured.

Promote the idea, promote the brand, promote the practice!

At the May 2013 Clean, Fed & Nurtured meeting, we made small, accessible commitments to build upon. How can you do the same?

Co-sponsors of Clean, Fed & Nurtured Consultative Meeting: Alive & ThriveFHI 360, the Global Public-Private Partnership for HandwashingSave the ChildrenUSAID and WASHplus.