Contextualising complementary feeding in a broader framework for stunting prevention

• Published in: Maternal and child nutrition Vol. 9; no. S2; pp. 27 - 45
• Main Authors: Stewart, Christine P., Iannotti, Lora, Dewey, Kathryn G., Michaelsen, Kim F., Onyango, Adelheid W.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2013; John Wiley and Sons Inc
• Subjects: Body Height; Child Development - physiology; Child, Preschool; complementary feeding; conceptual framework; Family Characteristics; Growth Disorders - prevention & control; healthy growth and development; Humans; Infant; Infant Nutritional Physiological Phenomena; Nutritive Value; Original; stunting; stunting, transdisciplinary approaches; transdisciplinary approaches; World Health Organization; World Health Organization; complementary feeding; healthy growth and development; stunting, transdisciplinary approaches; conceptual framework
• ISSN: 1740-8695; 1740-8709; 1740-8709
• DOI: 10.1111/mcn.12088

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6–24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short‐ and long‐term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.