The Government of Tajikistan has approved a social and behaviour change strategy to reduce stunting and improve the health outcomes of children nationwide. The strategy is the first national social and behavior change strategy to be adopted officially in the nation, developed with the participation of Government counterparts across different sectors and supported technically by UNICEF.
Tajikistan has the highest rates of childhood stunting in the Europe and Central Asia region. According to the 2016 National Micronutrient Status Survey, just over 21 percent of Tajik children aged between six and 59 months suffer from stunting. Eight percent of children are underweight, six percent wasted, and 1.8 per cent acutely wasted. This is especially the case in rural areas, where rates of poverty and access to healthcare and information can be scarce.
The strategy complements the country’s ‘Scaling Up Nutrition’ (SUN) initiative to reduce all of Tajikistan’s undernutrition indicators and bring rates of stunting down by 17% before the end of 2022. At the same time, it will also be contributing to a World Health Assembly Target to reduce stunting in Tajikistan by 40 per cent in 2025.
For the children affected by malnutrition, the risks of mortality, illness, delayed development, and poor school performance are far greater. Damage to the brain and physical development of a child caused by malnutrition is extensive and largely irreversible. Stunting, or low height for age, negatively affects a child’s brain function, health, organ development and immune system, cognition and learning outcomes — limiting their potential productivity, and in turn the potential productivity and health outcomes of their own children in the future.
The 1,000 days between pregnancy and a child’s second birthday add up to a critical timeframe in which the foundations of a child’s cognitive and physical development are laid. The 1000 Golden Day Socal and Behaviour Change Strategy aims to create value around this period of a child’s life through encouraging preventative care seeking and building the skills of parents and healthcare workers, with a focus on nutrition, to bring down rates of stunting and improve health outcomes nationwide.
Objectives of the strategy also includes ensuring that pregnant/lactating mothers and children under 24 months of age are given micronutrient supplements as per WHO guidelines, ensuring that all children are fully immunised, supporting the physical and psychological wellbeing of pregnant women while encouraging them to attend antenatal and postnatal care appointments, improving community knowledge of healthy child feeding practices including breastfeeding, bonding with newborns, and responsive care practices. From a frontline healthcare perspective this strategy also aims to ensure that maternal and neonatal healthcare workers are informed on nutrition and hygiene related issues, positive early childhood development, as well as on the effective treatment of common childhood diseases.
Due to work that has already been carried out in Tajikistan over many years, caregiver knowledge gaps are not always the largest barriers to behaviour change for stunting. In Tajikistan especially, mothers are tasked with shouldering the majority of domestic and childcare responsibilities. In some cases, behaviour change schemes unintentionally add pressure to women’s already burdensome workloads with more messages, more materials to read and absorb, more health visits to make, and more instructions to follow. As a result, behaviour change strategies can backfire, as people shut down or stop paying attention altogether when faced with an overwhelming amount of information.
Thus the 1000 Golden Day Strategy, while directly improving the knowledge of mothers, also aims to improve the ability of caregivers to act by creating an environment that empowers mothers for change. This includes bolstering maternal skills, enhancing access to maternal and neonatal services and new ideas, and increasing the understanding of the importance of a mother’s role.
By creating a supportive environment, the 1000 Golden Day Strategy has the potential to have a substantial impact on the behaviour of mothers as well as on the behaviour of their extended members and community.