Nutrition: Women and Girls

Baroness Manzoor Excerpts

Wednesday 22nd February 2017 Lords Chamber

Asked by

[Baroness Manzoor]

To ask Her Majesty’s Government what action they are taking to improve standards of nutrition for women and girls globally.

[Baroness Manzoor (Con)]

My Lords, I noted with great interest that 190 noble Lords spoke over the last two days on the European Union (Notification of Withdrawal) Bill, and that the debates did not conclude until nearly midnight on both days—indeed, after midnight on the first day. Therefore, I am particularly grateful to noble Lords for staying late again tonight and for speaking in this debate, for which I thank them.

International Women’s Day will take place next month and last month there was a debate in this Chamber on employment skills for women and girls. This debate is therefore very timely. As someone who has worked extensively in the NHS, I have seen at first hand just how critical good nutrition is for survival, recovery, good health and well-being. Good nutrition is the foundation for development. Without the right nutrients at the right time, none of us would grow to fulfil our physical or, indeed, cognitive potential.

While my contribution to this debate focuses on the urgent need to tackle undernutrition in low and middle-income countries, as that is where much of the burden of undernutrition is in women, girls and children, let us not pretend that, as a rich country, we are immune to these issues. Every country in the world suffers from one or more forms of malnutrition, be it undernutrition, overnutrition or micronutrient deficiencies.

Just as in Pakistan, India or Malawi, without good nutrition our economy suffers, our society suffers, and, as individuals, we suffer too. SDG 2, to which we as a country are signed up, and fully support, states:

“End hunger, achieve food security and improved nutrition”.


Point 2.2 of the goal states,

“by 2030 end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons”.

Some good progress has been made but despite all the progress we have seen in recent years, sadly, undernutrition, much like poverty, is sexist, given that 70% of the 1.3 billion people in poverty on this planet are women. Of all those who are undernourished worldwide, 60% are women. In 2013, a woman’s life was lost in pregnancy or childbirth every two minutes, with anaemia being a major risk factor impacting around one in five deaths.

I was very fortunate to visit India last year with RESULTS UK. Uttar Pradesh is the largest state in India with a population of 200 million. According to the Rapid Survey on Children, in 2013-14, it was the home of 21 million children under five. Some 50% of the children had stunted growth, 10% had wasted muscles and 34% were underweight. It was also evident that adolescent pregnancy and anaemia contributed to a high prevalence of low birth-weight and subsequently undernourished children. However, I was pleased to note that education and nutritional programmes had been commenced to tackle these issues in the state.

Worldwide, it is estimated that more than 200 million children under five fail to reach their full development potential largely due to malnutrition. Women make up 63% of adults without minimal literacy skills and 18 million girls a year are forced into early marriage. We must not forget older women. Many of the diseases suffered by older people are the result of dietary factors, some of which have operated since infancy. These are compounded by the ageing process. It is noticeable that many Governments have few policies to prevent undernutrition in older women.

Inadequate diet and malnutrition in older women are associated with a decline in their functional status, impaired muscle function, decreased bone mass, immune dysfunction, anaemia, poor wound healing and delay in recovering from surgery and higher hospital rates and mortality. Women suffer 80% of all fractures due to osteoporosis, with diet being a key factor in this. Shocking statistics such as these are not scarce and certainly cannot be addressed without a change in approach. The Food and Agriculture Organization recognises gender inequality as both a cause of, and result of, malnutrition. We must acknowledge this inextricable link if we want to get to grips with the scourge of malnutrition.

I am proud that the UK Government have stepped up to the plate when it comes to championing good nutrition and have set the bar high. They held the Nutrition for Growth summit in London in 2013. I am sure that the Minister will say more about the impact that UK aid is having on nutrition for women and girls but it is crucial that we keep up the pace. Just a one-off N4G event cannot help us end undernutrition in vulnerable and disadvantaged groups. What is key, especially in this current climate of some anti-aid sentiment, is maintaining the political leadership. I am therefore pleased to learn that the Secretary of State for International Development intends to increase spending on nutrition, and I commend her for that. Will the Minister say what the Government’s plans are to increase investment in, and expand programmes for, women’s and girls’ nutrition in 2017? For instance, can we expect a big initiative such as Nutrition for Growth to show our Government’s continued commitment to this issue, and through which they could encourage other Governments to step up their efforts too?

While it is crucial to have the resources to carry out this important work, it is equally important to identify the right places to invest them. Programmes such as Supporting Nutrition in Pakistan, involving food fortification with iron and folic acid, and other efforts in agriculture and sanitation are being led by the World Bank, the Australian Aid agency and NGOs with a strong understanding of this issue, such as the Canada-based Micronutrient Initiative. These are good examples of how the UK is leading efforts on women’s and girl’s nutrition in partnership with other stakeholders. Another superb initiative is the Scaling Up Nutrition movement.

I am sure we all agree that aid alone will not solve this problem. We all want to see countries stand on their own two feet and lead this fight. By bringing together civil society and Governments across 58 of the world’s poorest countries, SUN is developing a unique platform that can facilitate the kind of shared learning that drives country ownership. I saw this first hand when I visited Uttar Pradesh. I would be interested to hear about the Minister’s assessment of SUN and whether his department has plans to scale up support for the movement given the importance of the work it does.

It is also important here to talk about adolescent girls, as they are such a critical link in the cycle of malnutrition and poverty. The aid agencies and NGOs are doing an important job in improving nutrition among other demographics, but there is evidence that adolescent girls are still being left behind. One in three girls aged 15 to 19, in countries where data are available, are anaemic. This is absolutely shocking. How can we expect adolescent girls to attend school—forget excelling —when they are constantly weak, dizzy, lack concentration, and at risk of disease through reduced immunity? I appreciate that there is a huge blind spot in data and in our knowledge of the nutritional status of many of these girls globally. However, this is an area where the UK could lead the way, with much greater outcome-focused programmes and research.

Another area where I see space for greater impact and value for money is through better integration. Given the links nutrition has with other development sectors, such as health, agriculture and education, perhaps more could be done to better integrate nutrition into DfID’s other aid programmes. I hosted a round-table discussion in this House just before Christmas with RESULTS UK, and I was pleased to hear the DfID official in attendance state that steps were already under way to better combine health and nutrition programming. It is crucial that, where possible, DfID includes specific nutrition objectives and indicators in its other programmes that have an indirect impact on nutrition outcomes for girls and women. Perhaps the Minister could share with us a little bit about the progress in this key area.

To conclude, on a more general note, like many noble Lords in your Lordships’ House, I was deeply concerned when I heard about the reversal in the United States of the Mexico City policy, or the gag law, as it is otherwise known. Increasing access to family planning services—I say this as I was a midwife and a health visitor in my early twenties—is one of the most practical solutions to reducing malnutrition in women as well as giving women basic empowerment over their own bodies. Bill and Melinda Gates have already made it clear that,

“this shift could impact millions of women and girls around the world”,

and,

“could create a void that even a foundation like ours can’t fill”.

I echo this concern and ask the Minister what assessment the Government have made of the impact of this policy change on our own aid programmes and how they might be affected.

At times like these, bold UK leadership is more important than ever. As a nation, we have made the decision to leave the European Union, giving us the opportunity to forge a new role for ourselves in the world. Our commitment to the world’s poorest and most vulnerable has seen us, in recent years, become the only G20 country to allocate 0.7% of GNI to overseas aid. We should stand tall and be proud of this commitment, carrying it forward with us as we make the important strategic decisions that lie ahead. Delivering the Conservative Party 2015 election manifesto pledge to improve the nutrition of 50 million people by 2020 is the perfect way to do this, and would demonstrate to the world that Britain is a compassionate and outward-looking global leader, committed to improving the lives of the world’s poorest—better nutrition for better lives.

In conclusion, I put on record my appreciation and thanks to RESULTS UK and Age International for supporting me in the preparation of this debate.