"Care" and public nutrition

In 1990, the Unicef conceptual framework for nutrition recognised the role of care, along with household food security and health services and environment, as one of the three underlying factors of child survival, growth, and development. This model has been adopted at a policy level at the International Conference on Nutrition (Rome, 1992) and over the past ten years the concept of care has been refined through literature reviews, consultative meetings and empirical works. "Care is the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members". Basically, care refers to the actions of caregivers (mainly, but not only mothers) that translate food and health resources into positive outcomes for the child's nutrition. Even under circumstances of poverty, enhanced caregiving can optimise the use of resources to promote good nutrition. Care practices have been grouped into six categories: care for women, breastfeeding and child feeding practices, psychosocial care, food preparation, hygiene practices, household health practices. They cover a wide range of behaviours, are often culturally specific and are daily, repetitive, and time-consuming activities. It must be underlined that the way care practices are performed (i.e., quality of care) is as important as the practices themselves. It has also been emphasised that children play a significant role in determining the quality of care that they receive, through an interactive process: an active child elicits more care from the caregiver, who is in turn more responsive. Care resources at household level have been described according to three categories: human (knowledge, beliefs, education, physical and mental health of the caregiver), economic (control on income, workload and time), and organisational (alternate caregivers, community support). But the availability of care also depends on support at the national or international level. As the mother is the primary caregiver, most of the obstacles to care are the constraints to the mothers, the most common characteristic of which being the low status of women in many societies. More studies are required to better understand the causal relationship between care and nutrition. Methods to measure the qualitative aspects of care and indicators that capture the complexity of care must be developed and cross-culturally tested. These will also be useful to design and monitor more effective interventions incorporating care. These programmes should first identify and support the good traditional care practices rather than simply ask for change; the activities proposed should not break the balance between the time women spend on care and the time they spend on work. Therefore one must be sure that enough resources are available. Finally, to achieve sustainable changes a participatory and comprehensive approach is definitely needed.