{"id":1239,"date":"2026-08-03T07:00:20","date_gmt":"2026-08-03T07:00:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1239"},"modified":"2026-08-10T16:03:36","modified_gmt":"2026-08-10T16:03:36","slug":"eat-last-count-least-five-shifts-to-make-maternal-nutrition-a-question-of-justice-in-asia-and-the-pacific-by-vani-sethi-and-aashima-garg","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/08\/03\/eat-last-count-least-five-shifts-to-make-maternal-nutrition-a-question-of-justice-in-asia-and-the-pacific-by-vani-sethi-and-aashima-garg\/","title":{"rendered":"Eat last, count least – Five shifts to make maternal nutrition a question of justice in Asia and the Pacific. By Vani Sethi and Aashima Garg"},"content":{"rendered":"

Whether a woman is nourished before, during and after pregnancy is not a medical question. It is a question of whether her right to nutrition is honoured or set aside. Asia and the Pacific is where that question will be answered for most of the world\u2019s women.<\/span><\/i><\/p>\n

More than a billion women of reproductive age live in Asia and the Pacific region, roughly half the world\u2019s total. That is why the global effort on maternal nutrition will be settled here. Across 41 countries of the region, some 362 million women of reproductive age are anaemic, 545 million women 18+ suffer from overweight or obese and 146 million from underweight; close to nine million babies are born too small every year. For almost every form we count, two-fifths to two-thirds of the world\u2019s total sits in this region.<\/span><\/p>\n

What holds us back is not a shortage of knowledge. We know what works.\u00a0<\/span><\/p>\n

The gap is one of reach, the distance between what the State knows and the woman it never quite gets to. That is where the question of justice lives. Closing it across 41 different countries within the Asia-Pacific region calls for five shifts in thinking.<\/span><\/p>\n

One: see the woman in front of you, not the woman we assume<\/b><\/p>\n

For a generation we built programmes around one image: the malnourished woman was a hungry woman. That image is now wrong. The same woman may be anaemic and overweight at once. Her neighbour may be dangerously thin. A third may be all three.\u00a0<\/span><\/p>\n

A programme designed around a single form of malnutrition is built to fail most of the women it serves.<\/span><\/p>\n

Two: the clinic cannot win against the world she eats in<\/b><\/p>\n

We counsel women to eat well, then send them home into a food environment designed to undo the advice: cheap, heavily marketed, ultra-processed food. In much of the region overweight is now the dominant reality among women.<\/span><\/p>\n

No amount of counselling beats a shelf. This is where regulation and rights meet: how unhealthy food is marketed to women and children, whether labels tell the truth, how the things that harm get priced. The food environment is no backdrop. It is one of the main battlegrounds, and one the law can shape.<\/span><\/p>\n

Three: getting her through the door is not the same as keeping her<\/b><\/p>\n

For two decades we have concentrated on getting mothers to their first antenatal visit. We never built the thing that keeps them coming back. Care in the days after birth is the weakest link almost everywhere.<\/span><\/p>\n

Women spend three to five hours a day on unpaid cooking, fetching water and care. A system that treats her time as free turns the poorest away without ever saying so. The answer is care designed around the time she does not have: shorter appointments, services closer to home.<\/span><\/p>\n

Four: rights do not pause in an emergency<\/b><\/p>\n

Much of the region lives with fragility: conflict, displacement, floods, the isolation of scattered island states, a climate risk that falls hardest on children and mothers. The right to nutrition does not lapse when an emergency arrives. The State\u2019s duty to a pregnant woman in a flood or a war does not shrink. It grows.<\/span><\/p>\n

Five: the national average is an alibi<\/b><\/p>\n

The most dangerous figure in public health is the national average. It lets us announce progress while the woman who most needs us goes missing.\u00a0<\/span><\/p>\n

And the inequity is not only about money. It runs along lines of ethnicity, language and geography: the minority woman, the woman whose clinic does not speak her language, the woman at the far end of the road.\u00a0<\/span><\/p>\n

A universal offer for every woman has to come with extra, targeted care for those most at risk: the adolescent, the woman living with anaemia, underweight or obesity. Equality that refuses to see difference is not really equality. We have neglected that second group for a decade.<\/span><\/p>\n

The burden is also heavily concentrated. Five countries \u2014 India, China, Indonesia, Pakistan and Bangladesh \u2014 hold close to nine in ten of the region\u2019s malnourished women; India alone holds more than two-fifths. India carries well over half its anaemic women, and with China two-thirds of its overweight.<\/span><\/p>\n

Which brings us to South Asia. It remains the global centre of anaemia among girls and women: close to half of those of reproductive age are anaemic, and a quarter of babies are still born too small. These figures have barely shifted in ten years. More than one in four girls is married before she has grown up, and three in four of those child brides have their first baby while still adolescents. They carry the nutritional cost of a decision the law itself says they were too young to make.\u00a0<\/span><\/p>\n

One more woman the average hides is the hardest to reach: the one in the path of the storm or the war. The Philippines was struck by twenty-one typhoons and Cyclone Ditwah tore through Sri Lanka; the conflicts in Afghanistan and Myanmar do much the same. In conflict-torn places, extreme poverty runs about five times higher than in calmer ones; services thin for everyone and vanish for her first.<\/span><\/p>\n

She is a rights-holder<\/b><\/p>\n

We know what needs doing, and how to do it. But for too long we have treated women as the route to a healthy child rather than a rights-holder to good food, services and equal opportunity. That is the habit this decade has to break. For far too long average hide women who are reached at the door and lost long before delivery. So, the test of the coming decade is whether we reach the women who keep being missed: the poor mother, the adolescent mother, the mother with no spare hour in her day. Or whether we quietly decide we will not.<\/span><\/p>\n

Authors<\/strong><\/p>\n

Vani Sethi<\/strong><\/p>\n

\"\"<\/p>\n

Aashima Garg<\/strong><\/p>\n

\"\"<\/p>\n

Vani Sethi and Aashima Garg, Global Practice for Child Nutrition and Development, Global Programme Division, UNICEF<\/span><\/i><\/p>\n

The views expressed are personal.<\/span><\/i><\/p>\n

Declarations of Interest<\/strong>
\nNo interests to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"

Whether a woman is nourished before, during and after pregnancy is not a medical question. It is a question of whether her right to nutrition is honoured or set aside. Asia and the Pacific is where that question will be answered for most of the world\u2019s women. More than a billion women of reproductive age […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":525,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1239","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1239","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/users\/525"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/comments?post=1239"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1239\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/media?parent=1239"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/categories?post=1239"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/tags?post=1239"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}