Preventing Malnutrition in Children Under Two years of Age (PM2A)
Recent work such as the Lancet Series on Maternal and Child Undernutrition and the landmark prevention-vs-treatment study of child undernutrition in Haiti has highlighted the importance of focusing on preventing malnutrition during the 1000-day ‘window of opportunity’ (i.e. from pregnancy through two years of age) rather than treating malnutrition once it has occurred. In response, Food for Peace Act Title II program policies and program guidelines now encourage agencies implementing Food-Assisted Maternal and Child Health and Nutrition (FA-MCHN) programs to use the “Preventing Malnutrition in Children Under Two years of Age Approach” (PM2A) rather than the traditional recuperative approach that had previously been used in these programs.
The PM2A targets all mothers during pregnancy and children up to the age of 2 years with a package of health and nutrition interventions designed to address the underlying determinants of malnutrition - food, health and care. The primary interventions consist of: 1) Food – usually a fortified food ration (e.g. corn soy blend (CSB)) provided for the target beneficiary (usually with a family food ration); 2) Health - required attendance at regular preventive health visits which include pre- and postnatal health visits for pregnant and lactating women and preventive health and nutrition services for children < 2 years of age (e.g. immunization, vitamin A supplementation, growth monitoring and promotion, etc.); and 3) Care - required participation by beneficiary mothers in behavior change communication (BCC) activities which are designed to improve maternal and child care, health and nutrition related knowledge and practices.
The PM2A approach is currently being evaluated by IFPRI in Burundi and Guatemala (2010-2015), in partnership with the Food and Nutrition Technical Assistance-2 project (FANTA-2); Mercy Corps in Guatemala; and a Catholic Relief Services-led consortium of private voluntary organizations in Burundi. The study addresses several key design and operational questions which will allow further refinement of the PM2A to maximize its impact and cost-effectiveness in future programming, and will facilitate its replication in different contexts. The key research questions addressed in the evaluations conducted by IFPRI are organized around three broad objectives: 1) Assess the impact and cost-effectiveness of PM2A on child nutritional status; 2) Assess the differential and absolute impact of different compositions and sizes of food rations provided in the PM2A; and 3) Assess the differential and absolute impact of varying the duration of exposure to PM2A on child nutritional status.