COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Enhancing Maternal and Child Nutrition in External Assistance: an EU Policy Framework
Date: 2013-03-12
Institutions: European Commission
Subjects: food safety, humanitarian aid, hunger, least-developed country, malnutrition, undernourishment

EUROPEAN 
COMMISSION 

Brussels, 12.3.2013  
COM(2013) 141 final 

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN 
PARLIAMENT AND THE COUNCIL 

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

{SWD(2013) 72 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 Change1 and the ensuing Council Conclusions of May 20122. 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  Policies3  and  subsequent  Council  Conclusions  of  May  20104.  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 

1 
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3 
4 

COM(2011)637 
Doc. 9369/12 
COM(2010)127 and COM(2010)126 
Doc. 9597/10 

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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  Crises5,  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  AGIR6  and  SHARE7  multi-partner 
initiatives to address food and nutrition crises). 

Finally,  the  EU  Plan  of  Action  for  Gender  equality  and  Women’s  Empowerment  in 
Development 2012-20158 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 year9. 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 stunting10 and 2.6 million children under the age of five die every year as a result 
of undernutrition11. 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 Africa12. 

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 

5 
6 
7 
8 
9 

10 
11 
12 

COM(2012)586 
Alliance Globale pour l’Initiative Résilience 
Supporting the Horn of Africa’s Resilience 
SEC(2010)265 
Black  R.  E.  et  al.,  Maternal  and  child  undernutrition:  global  and  regional  exposures  and  health 
consequences, The Lancet, 2008 
UNICEF, WHO, The World Bank, Levels & Trends in Child Malnutrition, 2012 (data from 2011) 
UNICEF, Levels and trends in child mortality, 2011 
UNICEF, WHO, The World Bank, Levels & Trends in Child Malnutrition, 2012 (data from 2011) 

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rural  areas  than  in  urban  ones13.  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  women14.  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 201115. 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 worldwide16.  

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.  

13 
14 

15 
16 

Ibid 
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 
Ibid 
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 

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Nutrition Conceptual Framework

Short-term consequences:

Long-term consequences:

Mortality, morbidity, disability 

Adult size, intellectual ability, economic 
productivity,  
reproductive performance,  
metabolic and cardiovascular disease 

Maternal and child 
undernutrition 

Inadequate dietary intake 

Disease 

Immediate 
causes 

Household food 
insecurity 

Inadequate care

Unhealthy household 
environment and lack 
of health services 

Underlying 
causes 

Income poverty: employment, self-
employment, dwelling, assets, 
remittances, pensions, transfers etc

Lack of capital: financial, human, 
physical, social and natural 

Basic causes 

Social, economic  
and political context 

Source: Based on UNICEF (1990) and adapted from The Lancet Series, 2008 

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  five17,  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 development18.  

17 

18 

Black  R.  E.  et  al.,  Maternal  and  child  undernutrition:  global  and  regional  exposures  and  health 
consequences, The Lancet, 2008 
S  Grantham-McGregor  et  al.,  Development  potential  in  the  first  5  years  for  children  in  developing 
countries, The Lancet, 2007 

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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 earnings19 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 nutrition20 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. 

19 

20 

World Bank, Repositioning Nutrition as Central to Development - A Strategy for Large-Scale Action, 
2006 
Including raising the awareness of women and including reproductive health issues if applicable  

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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 development21, 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 
their 
good 
implementation/delivery capacity when relevant. 

participation/mobilisation 

governance, 

supporting 

and 

and 

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, 

21 

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

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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  202522.  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 levels24, 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 
tackle 
dialogue  and  advocacy.  Leadership  and  national  ownership  are  central 
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, 

to 

22 
23 
24 

WHO, sixty-fifth World Health Assembly, A65/11, 2012 
WHO, sixty-fifth World Health Assembly, A65/11, 2012 
Under  5  mortality  rate  >2/10000/day;  GAM>15%  or  GAM>10%  with  aggravating  factors. 
(Commission Staff Working Document on 'addressing undernutrition in emergencies') 

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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 plans25 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). 

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

25 

Including national investments 

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(b) 

Increasing interventions specifically designed for nutrition in humanitarian and 
development settings 

iron 

(e.g. 

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 
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.  

supplementation 

fortification) 

and 

or 

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. 

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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. 

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(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. 

2. 

3. 

4. 

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. 

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. 

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.  

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 

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5. 

6. 

7. 

8. 

9. 

million  and  to  develop  its  accountability  framework  to  measure  and  track  progress 
between now and 2025.  

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.  

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. 

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. 

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.  

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. 

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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.  

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