[{"bbox": [96, 136, 1134, 189], "category": "Text", "text": "and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life); Goal 6 (Clean Water and Sanitation - ensure access to water and sanitation for all)."}, {"bbox": [96, 200, 1134, 305], "category": "Text", "text": "The **principles of ‘Leaving No One Behind’ and of ‘Do No Harm’** will guide EU interventions under this Action, ensuring that people that are often excluded or marginalized, such as children, women and girls, and persons with disabilities, can equally benefit from EU support and that beneficiaries of the interventions will not be exposed to additional or unwanted risks."}, {"bbox": [85, 347, 341, 378], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 406, 1134, 619], "category": "Text", "text": "According to the statistical data available from the latest national household survey (Inquérito sobre o Orçamento familiar, IOF 2019/2020)²⁵, the national average stunting prevalence has registered some (limited) progress in the past two decades: it is now at 38% against 43% in 2013 (latest SETSAN baseline survey) and 48% in 2003 (Demographic Health Survey, DHS). Despite the crucial issue related to the availability of quality (and comparable) data, it is estimated that, considering current population growth²⁶ rates, by 2025 at least 2 million children will be stunted, even in the optimistic scenario of malnutrition rates being successfully brought down to Government's target (35%) by 2024 (Plano Quinquennal do Governo 2019-2024). The provinces with the highest stunting rates are Nampula (46.7 percent), Cabo Delgado (45 percent) and Zambezia (44.6 percent)."}, {"bbox": [96, 630, 959, 658], "category": "Text", "text": "The major **causes and contributors to stunting** are multi-sectoral and multidimensional²⁷."}, {"bbox": [96, 668, 1134, 830], "category": "Text", "text": "**Poverty and food insecurity** are critical factors for stunting prevalence, particularly in Mozambique where nearly a third of its fast growing population is affected by severe food insecurity. However, one-quarter of Mozambican children suffer from stunting even in the wealthiest households²⁸ and in some areas of the country, chronic malnutrition has become a prevailing condition, even when the agriculture production is sufficient to ensure access and availability of food. This suggests that there are **other relevant factors** contributing to stunting, the main ones being:"}, {"bbox": [96, 839, 1134, 1267], "category": "Text", "text": "☐ **Lack of food diversity and inadequate diets and feeding practices.** According to the 'Fill the Nutrient Gap'²⁹ study, although the majority of families (93%) in Mozambique can afford to meet energy needs, more than half (54%) cannot afford the minimum costs for an adequate diet because of poverty, limited market access, and dependence on own production. The inadequate access to nutritious foods is mainly related to the low productivity and limited diversity in agricultural activities compounded by limited access to non-farm incomes. However, food habits also play a key role on nutrition outcomes. Pregnant and lactating women's decisions about what food to buy, eat and feed their young children were affected by many factors, including culture (local traditions and norms, religious strictures, personal preferences), women's workload and time allocation³⁰, logistics (food availability, food preparation and conservation), economics (access to resources to buy food, affordability of food) and social status (education level, knowledge, disability). The adolescent girl needs foods that are relatively rich in nutrients (especially vitamins and minerals) in comparison to their energy content: more vegetables, animal source foods, and fortified foods. As foods are not shared in these proportions and women and girls are unlikely to get a larger – or even equal – share of more nutritious foods, their nutrient needs are unlikely to be met. Adequate infant and young child feeding (IYCF) practices are also fundamental to protect the health and wellbeing of children. The situation of these practices is indeed precarious: only 41% of exclusive breastfeeding among infants less than 6 months and 13.2% of Minimum Acceptable Diet³¹ among 6-23 months children."}, {"bbox": [96, 1277, 1134, 1359], "category": "Text", "text": "Micronutrient deficiencies are also widespread; the main micronutrient deficiencies are in iron, vitamin A and iodine, all of which have devastating effects on the health, well-being and development of children and adults.\nAnaemia especially represents a significant public health concern in Mozambique and its prevalence is reaching"}, {"bbox": [85, 1405, 1144, 1447], "category": "Footnote", "text": "²⁵ Inquérito sobre o Orçamento familiar, IOF 2019/2020; Suplemento IOF 2019/20 - Estado Nutricional das Crianças menores de 5 anos e Percepção dos Agregados Familiares sobre a Segurança Alimentar."}, {"bbox": [85, 1449, 943, 1471], "category": "Footnote", "text": "²⁶ Secretariado Técnico de Segurança Alimentar e Nutricional / Technical Secretariat for Food and Nutrition Security (SETSAN)"}, {"bbox": [85, 1472, 672, 1493], "category": "Footnote", "text": "²⁷ Nutrition situation and casual analysis – Mozambique (European Commission, 2014)."}, {"bbox": [85, 1496, 1144, 1536], "category": "Footnote", "text": "²⁸ Among the reasons listed in the text, education level of mothers is one of the key social determinants of nutrition and explains much of the stunting among the wealthy – see https://globalnutritionreport.org/resources/nutrition-profiles/africa/eastern-africa/mozambique/."}, {"bbox": [85, 1539, 1144, 1579], "category": "Footnote", "text": "²⁹ Fill the Nutrient Gap, Mozambique (WFP, 2018). The WFP's Fill the Nutrient Gap tool analyses the nutrition situation in a country and identifies the barriers faced by the most vulnerable to accessing and consuming healthy and nutritious foods."}, {"bbox": [85, 1581, 1144, 1621], "category": "Footnote", "text": "³⁰ Does women's time in domestic work and agriculture affect women's and children's dietary diversity? Evidence from Bangladesh, Nepal, Cambodia, Ghana, and Mozambique, 2018."}, {"bbox": [85, 1624, 960, 1646], "category": "Footnote", "text": "³¹ MAD indicator combines minimum diet diversity and minimum meal frequency. See https://data.unicef.org/topic/nutrition/diets/."}, {"bbox": [1037, 1681, 1144, 1705], "category": "Page-footer", "text": "Page 7 of 31"}]