College faculty member co-authors foundational UNICEF report

A College of Veterinary Medicine faculty member is a contributing author to UNICEF’s inaugural report on women’s nutrition, “Undernourished and Overlooked: A global nutrition crisis in adolescent girls and women.”

Elizabeth Fox '09, Ph.D. '16., assistant professor of practice in the Department of Public and Ecosystem Health, helped to synthesize evidence included in the report, which shines a spotlight on the nutrition challenges that disproportionately affect adolescent girls and women across the globe.

“Women have not been prioritized and their rights to adequate nutrition haven’t been realized,” Fox said. “Making sure that women have access to nutritious diets and nutrition services involves recognizing them as human beings who have rights to nutrition, and addressing inequities that make it difficult for women to realize those rights.”

Fox began working with UNICEF, an agency of the United Nations that provides aide to children worldwide, several years ago. Cornell M.P.H. students also contributed to this more recent collaboration. Francesca DiGiorgio, M.P.H. ’22, supported preparation of evidence summaries for early drafts of the report, and Cole Hauser, M.P.H. ’22, assisted with identifying existing data about women’s nutrition, which was later analyzed by the UNICEF data team for the report.

Widening gaps, slow progress

In recent years, global crises have exacerbated women’s nutrition problems, the report found. For example, the global gender gap in food insecurity more than doubled between 2019 and 2021. That is, in 2019, 49 more women than men were considered food insecure; that gap increased to 129 million in 2021. This suggests that women’s food insecurity worsened during the COVID-19 pandemic.

“Progress has been so slow for women’s nutrition, and rates of undernutrition and anemia among women have been relatively stable over the past 20 years,” Fox said. “But now COVID-19, climate emergencies, and conflict are contributing and worsening existing trends.”

There is a relationship between maternal and child nutrition, and poor nutrition in women is passed on across generations. Half of children with stunted growth become stunted during their mother’s pregnancy and in the first six months of life, when they are dependent on their mothers for nutrition. The report highlights that maternal factors such as short height, being underweight, child marriage, and lack of education are associated with child stunting outcomes.

Social and gender norms play a significant role in women’s undernutrition. UNICEF surveys in eastern and southern Africa found that more than two-thirds of pregnant and breastfeeding women reported reducing their consumption of foods from at least one food group during the pandemic. This is likely due to gender norms as women often trade off their own nutrition for other members of the family, including children.

Broad support needed

For the most part, current interventions are not doing enough to address the problem, the report found. But there are some pockets of success in addressing poor nutrition among women, and they provide examples for more effective interventions, Fox said.

“All women and girls should have a right to good nutrition, and there are pathways forward for supporting this,” she said. “However, it requires engaging multiple systems — food systems, health systems, social protection systems — and reaching women and girls not only during pregnancy and breastfeeding.”

The report offers a wide range of actions to help governments and non-governmental organizations address the problem. For Fox, the most effective programs highlighted in the report support women and families more broadly by providing childcare, paid leave, reduced workload, and free health insurance.

Fox has spent her career investigating the underpinnings of maternal and child nutrition. She holds a bachelor’s degree in Nutritional Sciences with a minor in Global Health and a Ph.D. in International Nutrition from Cornell. She completed a post-doc at Johns Hopkins’ Berman Institute of Bioethics. And she’s worked in nutrition programs that support pregnant and lactating mothers and young children both domestically and internationally, studying the social and environmental factors that affect individuals’ nutrition decisions.

In contributing to reports like this one, she hopes to help provide evidence-based solutions that address the problem of undernutrition in women globally.

“Reports like this are important because they provide an opportunity to assess the current situation, have a common language and goal about the problem, and to identify actions that we can take at all levels of a community and across multiple sectors to make progress,” she said.

Written by Sheri Hall