# EUR-Lex - 52013DC0141 - EN

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# 52013DC0141

**COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Enhancing Maternal and Child Nutrition in External Assistance: an EU Policy Framework /* COM/2013/0141 final */**

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COMMUNICATION FROM THE COMMISSION TO
THE EUROPEAN PARLIAMENT AND THE COUNCIL

Enhancing Maternal and Child Nutrition in
External Assistance: an EU Policy Framework

Undernutrition – a preventable tragedy

The effects of poor nutrition represent one
of the most serious and preventable tragedies of our time. Progress in meeting
Millennium Development Goal (MDG) on halving the proportion of people who
suffer from hunger is lagging behind in many countries, with one in six
children still underweight. These children are victims of a vicious cycle,
where poverty, inadequate diet and disease combine to give them the worst
possible start in life, trapping individuals and societies in poverty.

The EU is a major actor in terms of food
and nutrition security – financial decisions towards rural development,
territorial planning, sustainable agriculture and food and nutrition security
amount to an average of over EUR 1 billion annually for the period
2006-2011.Particular initiatives, all of which have contributed to enhanced
food and nutrition security, have included the EUR 1 billion Food Facility,
which assisted those countries worst affected by the 2007/2008 food price crisis
and the EUR 1 billion MDG Initiative, which supports those countries which are
lagging behind in meeting these goals including in particular MDG 1c on halving
the proportion of people who suffer from hunger, as well as MDG 3 and 4, In
addition, the EU addresses acute food and nutrition insecurity through
humanitarian and development assistance. Every year, between one third and half
of the EU’s annual humanitarian budget is spent to cover food and nutrition
needs.

Recently, in the framework of the 2012
London Global Hunger Event, the Commission has taken a
political commitment to support partner countries in reducing the number of
children under five who are stunted by at least 7 million by 2025. This
Communication is the Commission's response to achieving this target and more
broadly, to reducing overall maternal and child undernutrition.

Addressing this problem requires a
multi-sector approach, combining sustainable agriculture, rural development, food
and nutrition security, public health, water and sanitation, social protection
and education. It requires recognition by partner countries of the problem and
a commitment to tackle it, so that women and infants can receive the care and
nutrients needed for a decent start in life. The international community is
determined to do all it can to support partner countries in their efforts to
enhance maternal and child nutrition.

The EU policy framework for development is
set out in the Commission’s proposal for an Agenda for Change[1] and the
ensuing Council Conclusions of May 2012[2].
The EU's approach towards food security and humanitarian food assistance in third
countries has been further refined in the Communications on the EU's Food
Security and Humanitarian Food Assistance Policies[3] and subsequent
Council Conclusions of May 2010[4].
These documents place equal emphasis on each of the four pillars of food security
– availability of food, access to food, improved nutrition, and better crisis
prevention and management and stress the particular challenges of achieving
nutrition outcomes in humanitarian contexts. This Communication completes and
develops the improved nutrition pillar.

This policy framework was complemented by
the Communication on the EU Approach to Resilience: Learning from Food
Security Crises[5],
which underlines how nutrition and resilience are highly interlinked in some
contexts (particularly in the Sahel and Horn of Africa regions where resilience
is the guiding principle of the AGIR[6]
and SHARE[7]
multi-partner initiatives to address food and nutrition crises).

Finally, the EU Plan of Action for
Gender equality and Women’s Empowerment in Development 2012-2015[8] highlighted
the strong links between MDG 1, 3 and 4 and the role of women and gender
equality.

This policy document on nutrition highlights
the need for a better coordination between humanitarian and development aid in
order to increase the resilience of affected populations. It has been requested
by Council and the Court of Auditors and it sets out the primary responsibility
of national governments for nutrition, as well as the important role of women
and men in developing countries, as drivers of change.

1.           Rationale

Scale of the problem

The World Health Organization considers
that poor nutrition is the single most important threat to the world’s health.
In many developing countries it is an underlying cause of at least one third of
all child deaths and 20% of maternal mortality every year[9]. Millions of children survive,
but grow up stunted (with a low height for their age and impaired mental
development) and/or having experienced several episodes of wasting (weight
loss) before they reach the age of five years. Globally, around 165 million, or
a quarter of the world's children, suffer from stunting[10] and 2.6 million children under
the age of five die every year as a result of undernutrition[11]. Over 90% of these children
live in Africa and Asia. In addition, around 52 million (8%) of the world’s
under-five children are wasted, with the greatest numbers are also found in
Asia and in Africa[12].

Special attention will be paid to populations
suffering from undernutrition where institutional capacity is weak and frequent
disasters or conflict have a devastating effect on the most vulnerable groups
as it is the case in fragile countries.

Undernutrition traps individuals and society in the vicious circle
of poverty. Children growing up in poor households are more likely to suffer
from undernutrition, which undermines their ability to learn and makes them
more prone to disease and illness. This hinders a child’s capacity to secure a
job as an adult and to lead a productive life, thus perpetuating generational poverty.
Undernutrition is especially severe among poor rural populations and those
suffering from discrimination. The proportion of stunted children is 1.5 times
higher in rural areas than in urban ones[13].
Recognising this, the EU is committed to supporting smallholder agriculture and
rural livelihoods.

Many women in the developing countries are
also short in stature (stunted) and/or underweight. Ten to 20% of the women in
sub-Saharan Africa and 25-35% of the women in South Asia are classified as
excessively thin. Iron deficiency anaemia is the most widespread nutritional
problem for this group affecting almost half of all women[14]. The period from pregnancy
to the second birthday of a child - the first 1 000 days - is considered to be
the most critical in preventing undernutrition and its consequences throughout
adulthood. As much as half of all child stunting occurs in utero which
underscores the critical importance of better nutrition for women and girls of
reproductive age. The risk of having a small baby is high for mothers who are
underweight, stunted and/or anaemic.

Global progress on addressing stunting and
wasting has been slow. The proportion of children who are stunted fell from 40%
in 1990 to 26% in 2011[15].
Progress in addressing wasting has been even slower and shows that far more
needs to be done. As well as stunting and wasting, deficiencies of
micronutrients, essential for growth and development of individuals (e.g.
vitamin A, iodine, iron and zinc) affect almost two billion people worldwide[16].

Causes

The causes of undernutrition vary from one
context to another, and from one individual to another and are summarized in
the conceptual framework. They tend to operate at three levels (see diagram
below):

·
Immediate causes have two dimensions: inadequate
food intake (in terms of quality or quantity) and disease.

·
Underlying causes are closely linked to poverty
and comprise three categories: household food insecurity, inadequate care for
children/women and poor health environment/health services.

·
Basic causes operate at subnational, national
and international levels: from poor governance to demographic growth; from
conflict to climate change; from scarce natural resources to high and volatile food prices.

The relative importance of potential causes
depends on the specific dynamics of each situation and population group. For
this reason, a thorough analysis is a critical pre-requisite to any response
effort. The various determinants of undernutrition are interlinked and require a
multi-sectoral response.

Consequences

At the individual level, undernutrition is
the underlying cause of considerable child and maternal mortality. It
contributes to 35% of illness suffered by children under five[17], and long-term undernutrition
(stunting and/or frequent episodes of wasting and micronutrient deficiencies)
causes devastating and irreversible damage. Iodine deficiency and stunting are
associated with significant reductions in cognitive development[18].

Stunting is not only a personal and
preventable tragedy; it also conspires against economic progress – both for
individual families as well as nations. The economic costs of undernutrition
have been estimated at 10% of individuals’ lifetime earnings[19] and 2% to 8% of Gross Domestic
Product (GDP). Undernutrition also puts a strain on over-stretched health
systems, as undernourished individuals are more likely to be sick, and
undernutrition in childhood is associated with chronic, costly, diseases later
in life.

Challenges to address undernutrition

addressing undernutrition, several
challenges need to be overcome. These challenges point to the need for:

·
Increased country-level investment in nutrition
(especially over the long term). This also involves strengthening national
leadership, legal frameworks and management and strategic capacities for
nutrition so as to mobilise actors behind a common goal and a coherent
multi-sectoral approach.

·
Aligning policies that impact nutrition across
different Government ministries and donor departments. This includes
integrating nutrition as a key objective in rural development and
community-based initiatives, sustainable agriculture, fisheries, food security,
public and reproductive health, water and sanitation, social protection and
education policies.

·
Promotion of gender equality and the empowerment
of women in all sectors related to nutrition[20]
on the basis of the identification of the social determinants of undernutrition.
Women’s economic, social, reproductive and domestic roles are all essential for
food and nutrition security.

·
Because undernutrition is an intergenerational problem
and is the result of crisis as much as long term trends, building greater
coherence and coordination for nutrition across the emergency – development spectrum
is vital.

·
A better understanding of ‘what works’ for
nutrition through applied research and rigorous monitoring and evaluation, is
needed for the identification of effective policies and actions for nutrition in
different sectors and for the scaling-up of interventions. Greater
effectiveness of nutrition and nutrition-sensitive interventions in line with
general principles of aid effectiveness is essential.

·
The EU considers that support to smallholder
agriculture has the capacity to increase access both of rural and urban poor to
nutritious food and to positively impact on livelihoods. This includes
identifying and taking advantage of opportunities to improve nutrition along
value chains to increase the availability, access, and intake of nutrient-rich
foods for the poor.

·
Building on global political and funding
commitments for addressing food insecurity and undernutrition, in particular in
view of the post-2015 MDG framework is required.

2.           Guiding Principles and objectives

Guiding principles

EU support is to the largest extent
possible aligned with partners' policies and priorities, in line with aid
effectiveness principles. Addressing under-nutrition requires recognition by
partner countries of the problem and a commitment to tackle it. The
international community will to do all it can to support partner countries in
their efforts to enhance maternal and child nutrition, but resources also need
to be set aside by governments themselves to ensure that under-nutrition is
tackled in a sustainable way.

The EU aims to ensure maximum
complementarity and sequencing between humanitarian and development
interventions. The EU's commitment to increasing resilience opens new
opportunities for nutrition: humanitarian and development actors will work
together in developing a common understanding of the nutrition situation (through
common analyses and operational assessments) that will be used as a basis for
defining common strategic priorities for programming of humanitarian and
development funds. The EU's assistance to undernutrition in humanitarian crises
continues to be guided by the humanitarian principles of humanity, neutrality,
impartiality and independence and follow a clearly needs-based approach.

The EU should respond through multiple
sectors to address the various determinants of undernutrition. This approach
recognises that nutrition-specific interventions alone will be insufficient for
a sustainable reduction of undernutrition. In particular, actions that address rural
development[21],
sustainable agriculture, food and nutrition security, public health, water and
sanitation, social protection and education will be highly relevant.

Nutrition development interventions will
give priority to creating the right conditions for optimal growth during the
‘crucial window of opportunity’ of the first ‘1 000 days’ between conception
and two years of age. The EU should strive to prevent and minimize any negative
effect its assistance could inadvertently have on nutrition. For instance, this
is important in relation to the safety of innovations and the use of
specialised nutrition products. Control measures are also essential to reduce
risks such as an increase in food-borne or water-borne diseases, or in women’s
workload to the detriment of childcare. Furthermore the EU will ensure
coherence and consistency between its policies that have an impact on food and
nutrition security such as trade, climate change, health, environment,
employment, etc.

The EU will strengthen its collaboration
with institutional actors: partner countries, EU Member States and other
bilateral donors, international organisations and global networks (e.g. SUN; humanitarian
cluster system). In addition, the EU should expand and strengthen its
partnerships with non-institutional actors. Where possible and appropriate, the
EU should maximise the sustainability of interventions by promoting their
integration into national policy frameworks and plans.

The EU should reinforce its partnerships
with civil society groups, non-profit organisations and research bodies,
drawing on their expertise, helping to create an enabling environment for
citizen participation/mobilisation and good governance, and supporting their
implementation/delivery capacity when relevant.

The EU should seek further collaboration
with the private sector. It wishes to facilitate the engagement of businesses
in the fight against undernutrition, to capitalise on their comparative
advantages and harness their expertise (e.g. product safety control,
fortification, enforcement of certification and communication technologies and
awareness raising through social marketing). Thereby, the EU will promote
responsible business practices, Corporate Social Responsibility, a sound policy
and regulatory environment as well as avoidance of conflict of interest and of
unfair advantage.

Objectives

The policy spelt out in this Communication aims
to enhance maternal and child nutrition by reducing mortality, morbidity, as
well as growth and development deficiencies due to undernutrition. More
specifically it aims to achieve specific objectives at two levels:

·
To reduce the number of children under five
years of age who are stunted.

·
To reduce the number of children under five
years of age who are wasted.

The first objective is aligned with the
first World Health Assembly (WHA) Global Target endorsed in 2012 i.e. a 40%
reduction of the global number of children under five who are stunted by 2025[22]. This implies reducing the number of stunted children by more than
70 million by 2025. Current trends will contribute to
alleviate stunting by approximately 40 million children, but will fall
significantly short of the WHA target. Global stunting is dropping at
the rate of 1.8% per year on average. The rate required to reach the WHA target
by 2025 is 3.9% i.e. collective efforts need to increase significantly to double
the current rate of reduction. The Commission has therefore
committed to support partner countries in reducing the number of children under
five who are stunted by at least 7 million above and beyond the current
trajectory.

Stunting as a specific objective signals
the EU’s determination to address this key barrier to human and economic
development. However, this does not preclude assistance to address other forms
of malnutrition where these are of public health significance and a priority
for partner governments.

The second objective is also aligned with
the WHA Global Target. The Commission
will contribute through its overall strategy to the global target of the WHA (2012)
to reduce and maintain the children wasting to less than 5%[23]. In humanitarian crisis, when mortality
rates or the prevalence of wasting exceeds the critical levels[24], the EU should intervene in
order to reduce the mortality toll of undernutrition.

3.           Strategic Priorities

Considering the context, its challenges and
the above principles the Commission has identified three strategic priorities
for its work focusing on maternal and child nutrition, as highlighted through
the outcomes mentioned above.

Strategic priority 1: Enhance
mobilisation and political commitment for nutrition

At country level, mobilisation and
political commitment will be sought through political dialogue and advocacy.
Leadership and national ownership are central to tackle undernutrition. The EU,
in close collaboration with the SUN Movement, should encourage reciprocal specific
commitments for the reduction of maternal and child undernutrition from SUN
members, including partner countries. The Commission and some Member States already act as SUN donor convenors in a number of countries to support national
efforts, mobilise resources and ensure greater coherence amongst donors and
overall international support.

At international level, the EU should work
towards greater harmonisation and coherence, and a more effective international
response. The EU should engage with relevant processes – especially, the
G8/G20, WHA, Committee on World Food Security, the SUN Movement, the UN Standing
Committee on Nutrition, the Food Assistance Committee and the humanitarian
cluster system. For instance, the EU should support improved coordination for
nutrition across sectors and with international actors involved in nutrition
responses to humanitarian crises, notably in those international organisations
where it has a prominent role through its funding contributions. The EU should equally
support the SUN Movement in encouraging more high-burden countries to join,
maintaining high-level political commitment and leadership, and facilitating
coordination of international efforts. It will coordinate with EU Member States
to increase effectiveness and secure greater mobilisation across sectors as
well as participation in international efforts. It will advocate to ensure that
nutrition features prominently in the objectives of the post-2015 development
agenda. The Commission recognizes the critical role which civil society can
play in getting countries to secure political commitment.

In order to enhance nutrition governance
more effectively both at national and international levels, the EU will build
on its role in the SUN and in particular on the influence of its “Lead Group”.
This Group brings together Heads of State, Heads of Development Agencies
including the EU Commissioner for Development, Heads of UN Agencies key
representatives from Civil Society and the private sector.

Strategic priority 2: Scale up actions
at country level

Scaling up actions at country level
requires better use of existing resources and additional financial resources so
as to improve nutrition outcomes. The EU should increase its financial
contribution to nutrition and encourage the development of programmes that take
a nutrition-friendly approach. The EU should actively promote this strategy to
other governments.

In development contexts, the EU’s external assistance is aligned with the
priorities and the policies set out by partner countries in support of the
implementation of national plans.

(a)
Strengthening human and
institutional/system capacity

The EU should promote the development of
national policy frameworks conducive to maternal and child nutrition (i.e.
inclusion of nutrition objectives, targets, indicators and budget
implications). It will support:

·
The development of government-owned strategies
and costed action plans[25]
for nutrition.

·
Multi-sector and multi-actor coordination
mechanisms involving humanitarian and development actors to facilitate
information-sharing, dialogue, joint planning, establishing collaborations and
sharing of roles.

·
The development of strategic and managerial
capacities within relevant bodies (e.g. government departments and humanitarian
coordination structures).

·
Technical capacity building for nutrition
amongst humanitarian and development actors in the rural development, sustainable
agriculture, food and nutrition security, public health, water and sanitation,
social protection and education sectors.

(b)
Increasing interventions specifically
designed for nutrition in humanitarian and development settings

The EU should increase its investments in interventions
with proven effectiveness for implementation in all countries with a high
burden of undernutrition. These are often grouped in three categories: 1)
behaviour change communication (e.g. promotion of breastfeeding and adequate complementary
feeding), 2) provision of micronutrients and deworming interventions (e.g. iron
supplementation or fortification) and 3) complementary/supplementary and
therapeutic feeding interventions. The latter will be given particular emphasis
in areas where wasting is a public health concern (including in humanitarian
crises). The categories and lists of nutrition-specific interventions with
sufficient evidence to be implemented at scale in countries with a high burden
of undernutrition will be updated as new evidence becomes available. In
addition, the EU should support interventions with proven effectiveness in
specific contexts. These will include a range of actions designed for a
specific context such as diversification of diets through increased access to
nutritious food at household level or cash transfers to improve child and maternal
nutrition.

Preventing and addressing undernutrition in
women of reproductive age will be essential to reduce both maternal and child
undernutrition.

(c)
Increasing nutrition-sensitive actions in
humanitarian and development settings

·
These actions tend to address the underlying and
basic causes of undernutrition (e.g. a water/sanitation programme improving
hygiene and reducing women's workload, facilitating access to water, a food and
nutrition security intervention targeting specifically the diversification of
food intake, promoting free access to healthcare for the individuals at high
risk of wasting during a humanitarian crisis). They require that nutrition
concerns be incorporated in various sector approaches, so as to guide
implementation towards improved nutrition outcomes. This can be achieved by:

·
factoring in nutrition systematically in the
situation analysis and when deciding upon sector strategies, actions and
targeting criteria. Many sectors, whether incidentally or by design, can
contribute to nutrition. Amongst those likely to be most effective are: food
security (including smallholder agriculture, actions targeting the improvement
of rural livelihoods and social transfers), health, social protection,
water/sanitation and education;

·
including nutrition-relevant indicators in the
monitoring framework;

·
incorporating measures that strengthen the
economic power of households and women, safeguarding their ability to care for
young children.

Strategic priority 3: Knowledge for
nutrition (strengthening the expertise and the knowledge-base)

There are two dimensions to this strategic
priority: strengthening the information base for decision making and offering
technical expertise/assistance.

(a)
Information for decision-making

The EU recognises the crucial role of
relevant and reliable information to inform decisions. Therefore, it will
invest in applied research and support information systems.

·
Applied research

The EU should invest in research to expand the evidence-base on the efficiency and effectiveness of various
actions according to contexts. Ultimately, this should inform policy
development and the design of interventions and broaden
response options in various key sectors (e.g. health, water/sanitation, sustainable
agriculture, food and nutrition security).

Despite the strong theoretical rationale
for nutritional gains through food security
interventions, the empirical evidence base for this remains weak and needs to
be strengthened urgently. As one of the world’s largest donors in food and
nutrition security and humanitarian food assistance, the EU has a distinct and significant
comparative advantage, as well as a responsibility, to fill this evidence gap.
It will support operational research that will
contribute to the evidence base, comparing the performance of a range of food and
nutrition security and food assistance strategies.

For those actions with proven efficiency
(either global or context-specific), the EU should support research to identify
feasible delivery mechanisms to move from small-scale
interventions to nation-wide action.

·
Information systems

The EU should support information systems,
especially in crises-prone countries, in order to:

–
strengthen the quality and the relevance of the
information base for decision making

–
facilitate the dissemination and the use of
information for decision making

–
achieve greater institutionalisation and
sustainability of these systems

–
improve coordination of different initiatives
and systems which provide nutrition data and/or information relevant to
nutrition

(b)
Technical expertise and assistance for
building capacity

In addition to financial resources, the Commission
will also provide technical expertise and assistance for the implementation of
the present Communication, within the context of country-specific Nutrition
Action Plans and Strategies. This will target Delegations of the EU, ECHO
offices where appropriate as well as Government counterparts and partners where
feasible.

4.           Accountability for results

The Commission will track its financial
investments and monitor the associated results for both nutrition-specific and
nutrition-sensitive actions. This will allow not only for an analysis of
efficacy of use of resources, but also an analysis of trends: how much is
spent, where and to what end.

Through its reporting, the Commission will
seek to increase accountability to the European citizens, partner countries,
Member States of the EU, partner agencies and its beneficiaries.

(a)
Monitoring/measuring results

The Commission will develop a system to
measure the nutrition outcomes of its action, with a specific focus on the
reduction of stunting. This target is a major shift away from simply measuring
of inputs and outputs and the Commission has set itself the challenge of
assessing objectively the extent to which our efforts will contribute to
achieving the reductions in stunting that we would like to see. It will work
towards a common nutrition monitoring system among development partners and
countries. The Commission will continue to report on the outputs of its
interventions on under-nutrition in humanitarian crises.

(b)
Resource tracking

The EU should strengthen its system of
tracking investments for nutrition, to more accurately derive data on the
relative spending on nutrition-specific and nutrition-sensitive approaches. Better
tracking is an essential component of an enhanced accountability framework for
nutrition. It will also contribute to a financial tracking system that is
shared by development partners and countries under the umbrella of the SUN Movement.
The use of a nutrition marker, in addition to the OECD DAC code system, will be
explored. The system should improve the accuracy of reporting and consistency
across donors, thereby, allowing for a better understanding of spending flows
for nutrition globally and greater accountability at all levels. It should also
improve accuracy through using criteria that are driven by the objectives and
expected outcomes of individual actions. The information will be shared for
public scrutiny, reviewed and acted upon to remedy any biases or gaps.

5.           The Way Forward – Summary of the steps
the EU should take

By focusing on maternal and child nutrition,
the EU takes a step forward and places itself at the forefront of the struggle
to combat world hunger and food and nutrition insecurity. This Communication
points the way towards ensuring improvements in nutritional outcomes and how
this can be achieved:

1.           The EU should support
countries in their efforts to combat undernutrition and its most harmful
manifestations, stunting and wasting. Tackling nutrition is primarily the
responsibility of partner countries, who are encouraged to develop strategies
and costed action plans, which should include national investments. EU development
support should be aligned with partners' policies and priorities, in line with
aid effectiveness principles. Also, the EU will ensure the coherence between
its policies that have an impact on food and nutrition security.

2.           The first 1 000 days of
life are considered critical in preventing undernutrition and its consequences.
The EU should therefore work towards improving the nutrition of mothers and
children. In addition, girls and women of reproductive age should also be
targeted as a priority group.

3.           The humanitarian response
to crises will focus on the most vulnerable suffering from, or at risk of
suffering from, acute undernutrition. The EU should continue, in line with the
principles of resilience, to address the problem of chronic undernutrition in
such circumstances.

4.           Increased investments are
needed in nutrition to improve nutrition outcomes, both in a development and
humanitarian context and the Commission will develop an accountability
framework for these investments. It will develop and
share tools to track investments in nutrition and a methodology to measure
impact and outcomes of efforts to combat undernutrition. The Commission has committed to support
partner countries in reducing the number of children under five who are stunted
by at least 7 million and to develop its accountability framework to measure
and track progress between now and 2025.

5.           Tackling nutrition
requires a multisectoral approach. The EU should promote an approach which
recognises the need to align policies on rural development, sustainable
agriculture, public health, water and sanitation, social protection and
education so as to improve food and nutrition security and effectively impact
on the nutritional status of women and children. A systematic review of
countries nutritional status will be undertaken so that the EU can ensure that
nutrition concerns are incorporated in relevant sector approaches and to guide
implementation towards improved nutrition outcomes, both in humanitarian and
development actions.

6.           Tackling nutrition
requires close cooperation between humanitarian and development actors. The EU
is committed to strengthening such linkages, for example through joint vulnerability
analysis and operational planning, so as to build the resilience of the most
vulnerable populations.

7.           The
EU should invest in research to expand the
evidence-base on the efficiency and effectiveness of various actions in
relation to nutrition. It will also support information systems and the
creation of technical expertise and capacity on nutrition.

8.           Engagement of business is
essential in the fight against undernutrition and the EU should seek to foster
collaboration with the private sector in a way that promotes responsible
business practices.

9.           The EU should promote
nutrition in international fora such as the G8/G20, the WHA, the Committee on
World Food Security, and continue to engage in key initiatives such as the SUN
Movement, the Standing Committee on Nutrition, the Food Assistance Committee,
the Zero Hunger Challenge, the International Conference in Nutrition (ICN2) and
the humanitarian cluster system. The EU should also strive to ensure that
nutrition is well reflected in the post-2015 development agenda and will continue
to work towards stronger governance of nutrition internationally.

10.         The SUN Movement has been
instrumental in raising international awareness about nutrition. The Commission
will continue to promote the work of the movement and its efforts to reduce
undernutrition at country level. The Commission will encourage more high-burden
and donor countries to join the movement.

This Communication is complemented by a
Staff Working Document on Undernutrition in Emergencies, outlining the basic
principles for humanitarian response to nutrition problems and describing best
practice.

The European Parliament and the Council are
invited to express their views on the course of actions proposed by the
Commission.

Annex
1: Glossary

Food security exists when all people, at all times, have physical and economic
access to sufficient safe and nutritious food that meets their dietary needs
and food preferences for an active and healthy life.

Humanitarian crisis is an event or series of events which represents a critical threat
to the health, safety, security or wellbeing of a community or other large
group of people. A humanitarian crisis can have natural or manmade causes, can
have a rapid or slow onset and can be of short or protracted duration.

Malnutrition
is a physical condition related to the body’s use of nutrients. There are two
forms of malnutrition: undernutrition and overnutrition.

Micronutrient deficiencies are the form of undernutrition related to vitamins and minerals. Deficiencies
of iron, iodine, vitamin A and zinc are amongst the top 10 leading causes of
death through disease in developing countries.

Nutrition is
the science of how nutrients and other substances in food act and interact in
relation to health.

Undernutrition includes: i) intrauterine growth restriction which leads to low
birth weight; ii) stunting iii) wasting and nutritional oedema; and iv)
deficiencies of essential micronutrients.

Underweight
includes children with low weight for height (wasting) or low height for age
(stunting).

Wasting is a
condition resulting from recent rapid weight loss, or a failure to gain weight,
over a short period of time. It is characterised by low bodyweight compared to
height.

Stunting describes
chronic undernutrition, characterised by low height compared to age The longer
timescale over which height-for-age is affected makes it more useful for
long-term planning and policy development.

[1]               COM(2011)637

[2]               Doc. 9369/12

[3]               COM(2010)127 and COM(2010)126

[4]               Doc. 9597/10

[5]               COM(2012)586

[6]               Alliance Globale pour l’Initiative Résilience

[7]               Supporting the Horn of Africa’s Resilience

[8]               SEC(2010)265

[9]               Black R. E. et al., Maternal
and child undernutrition: global and regional exposures and health
consequences, The Lancet, 2008

[10]             UNICEF, WHO, The World Bank, Levels & Trends in
Child Malnutrition, 2012 (data from 2011)

[11]             UNICEF, Levels and trends in child mortality,
2011

[12]             UNICEF, WHO, The World Bank, Levels
& Trends in Child Malnutrition, 2012 (data from 2011)

[13]             Ibid

[14]             De Benoist B . et al., Worldwide Prevalence of Anemia
1993-2005: WHO Global Database on Anaemia, WHO and Centers for Disease
Control and Prevention, 2008

[15]             Ibid

[16]             WHO, WFP, UNICEF, Preventing and controlling
micronutrient deficiencies in populations affected by an emergency - Multiple
vitamin and mineral supplements for pregnant and lactating women, and for
children aged 6 to 59 months, 2007

[17]             Black R. E. et al., Maternal
and child undernutrition: global and regional exposures and health consequences, The Lancet, 2008

[18]             S Grantham-McGregor et al., Development potential in
the first 5 years for children in developing countries, The Lancet, 2007

[19]             World Bank, Repositioning Nutrition as Central to Development - A Strategy for
Large-Scale Action, 2006

[20]             Including raising the awareness of women and including
reproductive health issues if applicable

[21]             Strong community based rural policies that take a
multisectoral approach may be part of the solution

[22]             WHO, sixty-fifth World Health Assembly, A65/11,
2012

[23]             WHO, sixty-fifth World Health Assembly, A65/11,
2012

[24]             Under 5 mortality rate >2/10000/day; GAM>15% or
GAM>10% with aggravating factors. (Commission Staff Working Document on
'addressing undernutrition in emergencies')

[25]             Including national investments