The Minister of State, Department for International Development (Baroness Sugg) (Con)
My Lords, I thank the noble Lord, Lord Collins of Highbury, the co-chair of the APPG on Nutrition for Growth, for tabling this debate, and all noble Lords who have made such interesting contributions.
Noble Lords have expertly made the case for the importance of addressing nutrition in our development work. The right reverend Prelate also made it clear that behind these statistics lie real human tragedies, and we should never forget that. So, given the limited time available, I will not add my own arguments, but suffice to say, I agree that to achieve our development goals we must ensure that nutrition is at the front and centre of our minds.
I echo the point made by the noble Baroness, Lady Walmsley. As a believer in spending money efficiently and effectively—both for the British taxpayers, whose money we spend, and for the benefit of those we are trying to help—we must remember that investing in nutrition is not only the right thing to do but a development best buy. As the noble Baroness pointed out, every £1 we spend to address undernutrition yields a return of £16 in increased economic productivity.
Before I answer some of the specific questions, I shall take this opportunity to draw your Lordships’ attention to a revision to my department’s estimates on nutrition. This morning DfID published a correction to one of the nutrition estimates in its annual report to improve the quality of the data and to avoid any risk of double-counting. The number of women, adolescent girls and young children who have been reached by DfID nutrition-related services now stands at 50.6 million rather than the 60.3 million that the noble Baroness, Lady Featherstone, mentioned, and which I have previously stated at the Dispatch Box. That correction has now been issued. When publishing these headline estimates, we are committed to following the UK Statistics Authority code of practice, which means we update our estimates as and when we are able to do so. We still exceeded our 2015 target of reaching 50 million people, but the department and I are fully aware that more needs to be done.
Many noble Lords asked about the ICAN request for £800 million per year. Much as I would like to be, I am afraid I am not in a position tonight to talk about the specifics of our commitments to the Nutrition for Growth Summit. We are fully aware that the summit is an important opportunity to sustain progress on SDG 2 and to accelerate actions on nutrition after 2020, when our commitments run out. We are in the process of identifying the most appropriate and impactful commitment and are fully aware of the importance of doing so at the most opportune time, but I am not able to update your Lordships on how much or when, nor am I able to update on specific attendance for July or December. I use the defence that invitations have yet to be issued. However, we are fully aware of the importance of this. We played a leading role in 2013, and DfID continues to play that leading role.
Many noble Lords spoke of climate. The right reverend Prelate spoke about the vicious circle of climate change. We know that climate change will increase the risk of malnutrition and hunger by increasing the frequency of extreme weather events and disease outbreaks. We also know that most of the additional deaths that will come from climate change will be due to undernutrition. We are working carefully on quantity by ensuring that we are funding the development and delivery of new crop varieties that are more resilient to climate, disease and pests. The noble Lord, Lord Collins, highlighted the £61 million we announced last year. We are also looking at the quality and making sure that we have affordable and accessible healthy, nutritious diets for those who need them. We are looking at the vitamin A-enriched sweet potato which the noble Lord, Lord Cameron, mentioned, zinc-enriched maize and rice, and iron-enriched beans. We are also looking at testing new agricultural technology, such as digital weather and market price information systems for farmers and solar-powered cold storage solutions, as we know that that technology will be sorely needed.
The right reverend Prelate asked about COP 26. We want to use COP 26 to help ensure that people have access to the nutritious and sustainable diets that they need. We will be looking to boost climate resilience as well as to support good nutrition as we look carefully at the future of food systems.
The noble Lord, Lord Collins, mentioned our approach to nutrition and our assessment of our historic nutrition programmes, and the noble Baroness, Lady Walmsley, said that it is important that we spend our money as effectively as possible. The noble Lord, Lord Rea, highlighted the importance of evidence and research in everything we do. The study he pointed to in Lagos was 55 years ago, but it is still relevant today. That framework of work he highlighted underpins our decisions on our nutrition-specific and nutrition-sensitive approaches. We review all our programmes on an annual basis to make sure that we are looking carefully at the evaluation of all our work. That information, as well as evidence generated by others, is used to look at the types of approaches we should take in the future.
The noble Baroness, Lady Walmsley, correctly said that poor breastfeeding practices result in 800,000 child deaths annually. Alongside saving lives, increasing breastfeeding strengthens the economy. It could save up to £300 billion per year and has the health benefits for women that many noble Lords mentioned. To reassure noble Lords who mentioned this, DfID includes support for exclusive breastfeeding in its health and nutrition programmes at country levels. We are very clear on that. We have had some really good programmes in northern Nigeria and in Bangladesh, where we are supporting health workers to bring groups of mothers together to discuss and solve problems and—not forgetting the men—we are making sure that we are working with fathers’ groups so that they understand the importance of breastfeeding and are better prepared to support their wives and ensure that they have the food they need.
DfID clearly supports the implementation of the International Code of Marketing of Breast-milk Substitutes. In countries where we work, we know that the inappropriate marketing of breast-milk substitutes undermines breastfeeding and that infants in developing countries who are not breastfed are more likely to get sick and die. We remain concerned that manufacturers of breast-milk substitutes continue to contravene the code. Our position is that we do not partner with companies that are not compliant with the code. We are also funding the Access to Nutrition Index, which monitors performance and progress by those companies. Enforcement is more challenging. That is done at country level and is dependent on Governments’ legislation. However, we are supporting Governments to put better nutrition policies in place, using the wording of the code. For example, in Yemen we work closely with Save the Children and are working to translate that monitoring into future enforcement.
My noble friend Lady Manzoor asked what consideration we give to nutrition when we look at our pledge to Gavi. That is another pledge that we are not able to talk about—the announcement or the target—but it is being carefully considered. We very much look forward to hosting the Gavi summit in June. As hosts, it is a great opportunity to continue to champion efforts to bring all health services, including vaccination and nutrition services, together under the single umbrella of universal health. We pushed for that at the UHC summit this year, held by UNGA, and we will continue to so. That includes ensuring that all our investments in health systems are strengthened through Gavi and that other health multilateral organisations take this integrated approach, as noble Lords have advocated.
My noble friend Lady Manzoor also asked about ready-to-use therapeutic foods. As we invest in health system strengthening and service delivery, we ensure that integrated nutrition is available in countries such as Bangladesh and the Democratic Republic of the Congo as part of our efforts to achieve universal health coverage. That includes ensuring that more predictable financing is available to cover ready-to-use therapeutic foods to treat child wasting.
My noble friend also asked about the private sector. I agree that it plays a very important role in creating jobs and enabling people to improve their income so that they have the money to spend on more nutritious foods. We want more businesses to step forward and make commitments, and we will be working on that at the Nutrition for Growth summit. However, we want to avoid some of the poor practices that we have seen in the private sector and ensure that any investments that it makes have positive impacts.
I have already spoken about what we are doing to ensure that we do not work with companies that violate the International Code of Marketing of Breast-milk Substitutes. We have also worked with CDC, our development bank, to ensure that the investments do not support ultra-processed and other damaging foods.
I take this opportunity to thank the noble Lord, Lord Cameron, for his continued engagement with the department on nutrition and agriculture. I entirely agree about the need to invest in advancing people’s knowledge of and practice in agriculture to improve nutrition. We have to ensure that we support farmers to diversify what they grow.
On the point about weaning foods and nutrition education, we know that we have to give families access to the right information on what to feed their children. Just this morning, one of the nutrition team showed me a bowl that we use as part of our training. It shows very clearly the kinds of foods that will give children a nutritious diet. However, we also need to be clear that nutritious diets remain unaffordable for the poorest and that the cost often exceeds the entire average income of poor households. Because of the economic barriers to good nutrition, we need to invest more in improving the affordability of nutritious foods and the economic security of the poorest. I also agree with the noble Lord on the importance of having integrated services so that families can access nutrition and health services at the same time.
The noble Lord, Lord Collins, asked about the importance of civil society support. Since 2012, we have been a clear supporter of Scaling Up Nutrition—the SUN civil society network. That includes funding through the SUN pooled fund to ensure that we properly support advocacy efforts in countries with a high burden of malnutrition. We are also working closely with the Government of Japan to make sure that civil society is properly acknowledged at the summit.
On gender, one of my favourite topics, which was raised by the noble Baronesses, Lady Featherstone and Lady Tonge, we know that family planning interventions have a positive impact on nutrition. The evidence is clear: without family planning, we can contribute to high levels of child malnutrition as well as child mortality. That is why the WHO recommends gaps of 18 to 24 months between pregnancies and why it is so important that we continue our support for voluntary family planning. I am proud of the work that DfID does in giving women a choice on their family size. We estimate that, every year, our investment will support nearly 20 million users of contraception in total, preventing 6 million unintended pregnancies. I make no apology for repeating those figures.
We know that girls and women are particularly vulnerable to undernutrition, sometimes because they prioritise other family members over themselves. We need to get better at making sure that our investments in health, nutrition and other sectors meet their needs.
I am running out of time. I wanted to talk about obesity, the other side of the malnutrition coin; we will maintain our focus on tackling undernutrition, but we need to make sure that we are looking at the double burden as we move forward. On domestic obesity and malnutrition, I am afraid that I do not have any details of the holiday meals scheme, but I will come back to the noble Baroness, Lady D’Souza, on that.
I am out of time. There was quite a lot to get through in 12 minutes. I have done my best, and I will follow up in writing. I thank noble Lords for their contributions to tonight’s important debate. I look forward to briefing the APPG team on our preparations for the summit, which will be a pivotal moment. We need to make sure that Governments, the UN, civil society and businesses—everyone—step up to do more. I take the opportunity to reassure noble Lords that we remain fully committed to nutrition. We know that preventing malnutrition delivers enormous benefits for child survival, health and future prosperity. We will continue to play a leading role globally to make sure that more actors take action to help end malnutrition entirely.