Hungrier Than Ever: Generations of Undernourished and Overlooked Mothers, Women, and Girls

Pregnant women attend an antenatal session at Malam Sidi Primary Health Care Centre in Nigeria to learn about preparing nutritious meals and maintaining a balanced diet. Photo: Apochi Owoicho / UNICEF

More than 1 billion women and adolescent girls are malnourished, according to data from the United Nations. This staggering figure sheds light on a global crisis that has long been relegated to the shadows and overlooked. When food is scarce, women — and especially mothers — eat last and least. UN agencies are increasing calls for action, so every mother can feed her child without going hungry herself.

Four years of floods in South Sudan have washed away access to food in the country’s northern regions. Surrounded by water and unable to grow crops or raise livestock, mothers are feeding their children the only thing they can: water lilies.

“I’ve never seen that before in South Sudan,” says Aachal Chand, the World Food Programme (WFP) Head of Nutrition in the country, who recently returned from visiting the area. Explaining why this act of desperation is cause for concern, she says that a “water [lily] is not the most nutritious thing to eat. It is carbohydrate-rich, so it can fill the stomach. [But] children need a range of vitamins and minerals to grow to their full potential.”

Climate change, conflicts, inflation, the COVID-19 pandemic, and other forces are fueling a global food and nutrition crisis — a crisis that is disproportionately affecting women and adolescent girls, especially those in low- and middle-income countries such as South Sudan.

Somaya, a UNICEF-supported community health worker, educates mothers about the importance of good nutrition in Kitijik, Daikundi Province in central Afghanistan. Photo: Mark Naftalin / UNICEF

Amid these global challenges, the health and well-being of women and girls — and that of their children — are most directly affected. They are more likely to experience extreme and prolonged health risks because of insufficient nutrition, which — in severe cases — can result in death. And without immediate intervention, those impacts can ripple across families for decades.

“Nutrition is passed down … it is intergenerational,” Chand says. A malnourished mother will give birth to a malnourished child, which increases the likelihood of the child performing poorly in school, and if that child is a girl, of one day becoming a malnourished mother herself. “We have to make interventions at all of these critical stages of the life cycle because they’re completely linked to each other,” Chand adds.

The United Nations Children’s Fund (UNICEF) is bringing new attention to this global food and nutrition crisis with its March 2023 report. Titled “Undernourished and Overlooked,” the data confirms that the number of pregnant and breastfeeding women and adolescent girls who are acutely malnourished spiked by 25% since 2020. That same report found that women and girls in 12 crisis-hit countries, including Afghanistan, Ethiopia, Somalia, South Sudan, Sudan, and Yemen, are among the most severely impacted.

Hosnia Abdul, a 20-year-old, pregnant and lactating mother of a one-year-old son, undergoes nutrition screening during an antenatal care visit to AlBiritani Health Centre in Sudan. Photo: Mojtba Moawia Mahmoud / UNICEF

Malnourished Mothers

Pauline Akabwai has seen in real terms what the report’s soaring statistics reflect. A Nutrition Officer with WFP in Ethiopia, she notes that “there’s been an increasing trend [of malnutrition] for both children under 5 and women.”

In 2020, Akabwai’s team assisted 1.2 million children. Just two years later, 2.1 million children needed their help. A similar surge has occurred among pregnant and breastfeeding women — ballooning from 600,000 women seeking support in 2020 to 1.5 million by 2022.

Misra Amin Rashid is one of those women. “With my five children and I am also pregnant, we eat only breakfast and dinner because of [a] shortage [of] food. We use only sorghum for the two meals,” Rashid tells WFP. “Because of the inflation, we could not afford to buy food items. We are [facing a] critical problem especially with my pregnancy.”

Faced with food shortages in Ethiopia, Misra Amin Rashid has had to skip meals, causing her to feel exhausted and weak. After receiving Super Cereal Plus — a fine flour that supplements nutrition — from WFP, the mom of five says she feels stronger and more energized. Photo: Michael Tewelde / WFP

She is now receiving a fine flour nutritional supplement, known as Super Cereal Plus, from WFP. Since introducing the fortified flour to her diet, she says she has noticed a big difference. “There are some changes including being active and feeling healthy since I started eating [the Super Cereal Plus],” Rashid says. “Before, I lost appetite, [and felt] exhausted and physically weak.”

Shedole Kefela, 20, also from Ethiopia, shares a similar story with WFP.

“I have not enough food, no livestock and no other livelihood means, that is why my child became malnourished,” she says. “We eat only once, only when we get it [and if] not, we go hungry to bed.”

She is currently selling firewood to make ends meet, but the income from that is not enough to feed her and her family — which is why WFP’s assistance has been so critical.

“Without this support,” she says, “only God knows what the fate of my child will be.” She continues, “My children, if I am able, I want them to be educated so that they will reach [a] higher level and be happy and healthy.”

With no livestock of her own and too little food, Shedole Kefela and her family often go to bed hungry – causing her child to become malnourished. She says she is grateful for WFP’s food assistance, which will help her children grow up strong and healthy. Photo: Hugh Rutherford / WFP

Why Women and Their Children are Going Hungry

Intersecting global crises are disrupting people’s access to nutritious food, jeopardizing their ability to feed their families. Women are especially vulnerable. In 2021 alone, there were 126 million more food-insecure women than men, compared with 49 million more in 2019, more than doubling the gender gap of food insecurity.

When the global COVID-19 pandemic began, measures to contain the virus had a different impact on women than men across all dimensions of food and nutrition security, as highlighted in UNICEF’s recent findings. These included reduced food production and access, distribution capacities, and decreased incomes.

And on top of the effects and consequences of COVID-19, climate change has continued unabated. It’s not a coincidence that the countries experiencing the most devastating climate impacts caused by drought, storms, floods, and other extreme weather events are the same countries experiencing record high levels of food insecurity. In fact, a February 2022 report from the Intergovernmental Panel on Climate Change (IPCC) found that girls and women are at higher risk than boys and men of food insecurity caused by climate shocks.

Severe drought in Ethiopia, for example, has collided with inflation and rising food prices to drastically reduce the country’s food supply, forcing women to make tough decisions about where to get their next meal.

“When there is drought in the region, particularly in pastoral communities, men typically move to search for water,” Akabwai says. “Women are left behind. So, all the health-seeking vehicles, all the child caring is left to the women, even food production. They bear the burden of occurrences like drought and converging crises like the COVID-19 pandemic,” she adds.

Dr. Ramadhani Noor, a nutrition specialist with UNICEF in Ethiopia agrees, underscoring the importance of increasing opportunities for women and girls to participate in decision-making at all levels, including as leaders. “If you empower a woman, then you … empower the household and you empower the community and ultimately, the nation,” he says.

A woman and her children walk through flood water in South Sudan. Food sources have been depleted due to flooding and a high number of malnutrition cases have been reported, especially among children and the elderly. Photo: Bullen Chol / UNICEF

How to Fix Hunger for the World’s Mothers

The world’s hunger problem is essentially a funding problem.

“We are in a situation in South Sudan, where we take from the hungry to feed the starving because we don’t have enough to address both,” states Chand. “There has to be concerted efforts to ensure that funding keeps coming in.”

UNICEF and WFP are mobilizing resources and saving lives. But unless there is resiliency over the long term, those efforts still won’t be enough.

As Akabwai points out, governments need to “move from an emergency response to resilience or longer-term projects. If [they] can support funding for these resilience projects, there’d be sustainable solutions, not just humanitarian [ones].”

This requires addressing underlying factors that are holding women and girls back from realizing their full potential and optimal health. Akabwai says that a holistic response can include investing in comprehensive health systems, expanding nutrition programs, boosting mobile connectivity to enable cash transfer initiatives, and paving more roads to ensure women can safely travel to markets.

“If you don’t build resilient communities, resilient systems [then] next year, we’ll be back at the same place,” echoes Noor.

A staff member stocks UNICEF-supported food supplies at a health center in Anguwan Lambu, Adamawa, Nigeria, renovated with EU-UNICEF support. Photo: Andrew Esiebo / UNICEF

Chand recalls an encounter with a young mother of four, illustrating how contextualized, holistic approaches for nutrition support services are essential to make a lasting impact.

After leading a community training for mothers along the border of Laos and China, which among other lessons, emphasized the importance of incorporating protein into children’s diets, the young mother told Chand: “‘You made me feel like a very bad mother.’”

Confused, Chand asked why. The 24-year-old explained that she didn’t have access to the tools she was told to use. She asked where she could get eggs if she didn’t have chickens or money to buy them, and besides, the nearest market wasn’t walkable.

The lesson, Chand says, is being “sensitive that you don’t ask people to do things without giving them the means to do it, or at least supporting them with the means to do it.” Food systems that are “more gender-sensitive and more gender-responsive,” are key, she adds.

UNICEF and other agencies have echoed the same sentiment, recommending that the route to good nutrition for adolescent girls and women be accessible, comprehensive, and clear. The agency created an acceleration plan to prevent, detect, and treat wasting — the worst form of malnutrition — with an ambitious goal of reaching 12.2 million children and 9.3 million women with essential nutrition services by the end of 2023.

As long as UNICEF’s recommendations are fully contextualized, Noor notes that they “will allow us to better address the root causes … for undernutrition.”

But when it comes to reversing rising malnutrition rates among children, he is adamant that there must be a renewed focus on prevention — and that starts with taking better care of mothers. “Unless we improve the nutrition of adolescent girls and women, we are unlikely to end childhood malnutrition,” he says.

A young mother purchases vegetables at a market in Dollow, Somalia. As part of WFP’s innovative ‘e-vegetables’ program, mothers who attend mother-and-child health and nutrition centers receive a cash-based incentive, which they can use to buy foods including fresh vegetables, fruit, meat and eggs. Photo: Knowles-Coursin / UNICEF

The Bottom Line on Hunger: ‘A Coffee and a Muffin’

But UNICEF and WFP cannot tackle this global crisis alone.

For too long, the global community has tolerated and accepted undernourished, overlooked, and undervalued as a defining experience for generations of women, mothers, and girls.

Food is a right for all people. It is “a right that is enshrined in multiple international human rights treaties,” as underlined in UNICEF’s report.

Catherine Russell, Executive Director of UNICEF, makes the case that as the “rights-holders, leaders, healers, teachers and innovators,” women are the solution. We must listen to them — and invest in them, their health, education, and their futures.

And that investment isn’t expensive.

“The cost of saving a life is not much in reality,” Chand points out. “For you, it’s a coffee and a muffin, and that’s enough to buy one month’s food for children in the program that WFP runs.”

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