I am so pleased that Kristof highlighted the importance of micronutrients for mothers who are pregnant and children under two years of age, particularly folic acid, iodine, zinc and vitamin A. Many are unaware of the devastating consequences of micronutrient deficiencies on physical and cognitive abilities that if not addressed early, are permanent for a lifetime.
Over 2 billion people suffer micronutrient deficiencies cumulatively. Vitamin A and zinc deficiency alone contribute to over half a million child deaths annually – both of which are amenable to simple, effective and low-cost interventions. Iron deficiency among pregnant women and children has major implications on cognitive function and productivity.
The best way to get micronutrients is through nutritious foods. Rich sources of folate for example, include spinach, brocooli, brussel sprouts, bok choy, asparagus, romain lettuce, fresh beans and peas, sunflower seeds and certain fruits like cantaloupe, honeydew melon, grapefruit juice, banana, raspberry, grapefruit, and strawberries.
But many get folate and other B vitamins from fortified products such as pasta, cereal, flours and bread. There are programs who are working in developing nations to help fortify these products such as GAIN, Micronutrient Initiative and USAID’s A to Z. Vitamin A and zinc supplementation to children under five years of age is another way to get nutrients to kids in need during their first few years of life. Iodine can be added to salt, and ironically, some of us lucky ones have never consumed salt that isn’t iodized. Yet in many poor areas of the world, such as Africa and Southeast Asia, iodized salt is there, but households just don’t have access to it.
All of these interventions, can be delivered very cheaply. Iodized salt would cost $0.05 per person per year. A package of measures – vitamin A supplements, de-worming, and nutrition screening – costs $0.56 per child. Fortification of staple foods such as flour with iron can be done at a cost of only $0.10-0.12 per person per year.
Another critical area for essential nutrient delivery that Kristof did not go into was infant feeding. Suboptimal breastfeeding in the first 6 months of a baby’s life results in 1.4 million deaths per year and in the developing world, less than 40% of infants under 6 months are exclusively breastfed. Optimal infant and young child feeding which includes exclusive breastfeeding for 6 months and continued breastfeeding with the timely introduction of adequate complementary food to at least two years has a significant impact on under five child mortality and stunting.