causes of anemia—affecting about a quarter of women
and children37 worldwide—is iron deficiency. Iron deficiency is also the most common micronutrient deficiency
and a common form of undernutrition. It affects cognition and a person’s ability to maintain attention. Anemia
disrupts children’s intellectual development; scores on
intelligence tests have been shown to decrease along with
red blood cell levels.38
Preventing iron deficiency anemia requires early, routine iron supplementation for pregnant and postpartum
women, children under two, and preterm or low birth
weight babies. It also includes promoting consumption
of iron-rich foods and iron-fortified foods and explaining
how to avoid consuming foods that inhibit iron absorption (such as coffee and tea). Maternal anemia can be reduced through maternal iron and folic acid supplementation campaigns.39 To help control anemia, women should
receive de-worming medication during routine prenatal
visits and children should begin treatment at 12 months.
A third top-priority Copenhagen Consensus costeffective nutrition intervention is micronutrient
fortification—primarily iodizing salt and fortifying
basic food items with iron.40 Iodine is required for the
production of thyroid hormones, which are essential
for normal brain development. Inadequate levels of
iodine during pregnancy, particularly in the earliest
stages of pregnancy, causes irreversible brain damage,41
often severe, in the child. Communities with chronic
iodine deficiency show a significant population-wide
loss of intelligence quotient points.42 Severe iodine
deficiency may have visible signs such as thyroid goiter;
however, many people suffer from iodine deficiency
without exhibiting such signs. When goiter is observed
in a population, it’s likely to be the “tip of the iceberg,”
suggesting community-wide iodine deficiency.
Iodine deficiency tends to be concentrated in
geographic areas where there is little iodine in the diet—
typically remote inland areas where no marine foods
are eaten. Iodine deficiency can be prevented through
mass fortification and distribution of iodized salt or
iodine supplements to pregnant and lactating women
as part of routine maternal and child health services in
targeted regions. Strong evidence indicates that universal
salt iodization43 is a feasible and highly cost-effective
intervention to control iodine deficiency.44 Small local
salt farmers can contribute effectively to the iodization
effort; it is also important to support national-level
systems to ensure that sufficient high-quality iodized salt
is produced and distributed.
8 Briefing Paper, February 2012
Sara A. Holtz/Photoshare
• Iodine Deficiency and Universal Salt
Iodization
A woman sells salt at a weekly market in Affem Boussou, Togo. Universal
salt iodization is a cost-effective intervention to control iodine deficiency.
Promoting Optimal Infant and Young Child
Feeding
Optimal infant and young child feeding is an effort that
begins during pregnancy and continues through at least the
first two years of life. Although breast milk is low-cost, the
“gold standard” in infant nutrition, and available to nearly
all newborns, many mothers do not breastfeed exclusively
(giving no other food or drink). In fact, only 37 percent of the
world’s babies are exclusively breastfed for the recommended first six months.45 Yet exclusive breastfeeding is critically
important—partial or no breastfeeding is associated with a
more than doubled risk of death46 in the first few months of
life. Efforts to promote breastfeeding and appropriate complementary foods (for older babies) have well-established effects on child survival and nutritional status.47 Education,
counseling, and behavior change campaigns should support
exclusive breastfeeding for the first six months, continued
breastfeeding for two years or more, and feeding of nutritionally adequate, safe soft, semi-solid, and then solid foods starting in the sixth month. The period from 6-12 months, when
breast milk provides only about half the nutrients that a baby
needs, is often when babies stop growing adequately.48 All