Interview with Dr Katharina Lichtner, Managing Director of the Family Larsson-Rosenquist Foundation, on Breastfeeding and Malnutrition

Our Advocacy & Comms Lead interviewed Dr Katharina Lichtner, Managing Director of the Family Larsson-Rosenquist Foundation: one of the members of our Stronger Foundations community.

We wanted to learn more about the Foundation’s work on breastfeeding, as well as Katharina’s unique perspectives on the barriers facing the malnutrition community today.

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Hi Katharina! First up: can you tell us a bit about what led you to work with the Family Larsson-Rosenquist Foundation?

If I’m honest, I didn’t really choose this role — the role chose me! I was headhunted for the job whilst I was working in the tech start-up space. I had realized my role at the time wasn’t in an environment that I wanted to work in and I think the diversity of my background made my step into the Foundation a great fit.

I started my career working in science, I did a PhD in Immunology, and then I worked in consulting and finance for many years in roles spanning investment, communications and technology. The red thread throughout my business career was to build and grow things: participating in starting businesses, integrating acquired business units, building the next thing, building another organization.

All this meant that I was coming to my current role with a strong business background and private-sector orientation: something that the Foundation wanted to bring into the mix. I’m now trying to employ these skills in the development sector, which I think brings a different angle to my work.

A rich and interesting background. So, we’d like to know: what does a typical day look like in your role?

What characterizes my work the most is that there isn’t a typical day. It often ends up being quite different to what I am expecting when I look at my calendar in the morning.

The Foundation covers a broad spectrum of work and, likewise, my role spans a great deal. My work can involve anything from conceptualizing new approaches to overseeing the more operational elements of the Foundation to having scientific discussions and thinking about how we’re funding research projects. It also frequently involves working in a very hands-on way with our partners in Low- and Middle-Income Countries, which involves travelling at least a week out of every month, and liaising and strategizing with the Foundation Board.

I guess the core theme that’s weaving through the work I do is that I’m often picking out topics where I believe there is a need for deeper development: where I think the field is under conceptualizing, where we don’t really understand the inner mechanics of the problem and where we need to try new approaches.

As part of this, I’m often looking for ideas we can “steal” from the private sector, such as how we can more efficiently work towards best practices. In the breastfeeding space, for example, we have over 1000 published interventions, of which we are not sure how many will work at scale or how transferable they are from one setting to the next. I would question if we need that number of interventions, and think instead we should try to build a toolbox of maybe 20 to 30 that do work well, learn how to execute them and measure their impact very efficiently so that we can get a lot done with a lot less capital.

Let’s focus on what you find most frustrating about the space you’re working in. If you could wave a wand and make one major barrier to what you’re trying to achieve at the Foundation disappear, what would it be?

If I had a magic wand, I would take away the undue influence of formula companies on the environments in which mothers are breastfeeding.

An important report has just come out from the WHO, including research from a Lancet series, that looks at how the formula industry’s marketing practices are really subversively undermining women’s confidence and ability to breastfeed. This is plunging many children into malnutrition because it undermines not only the amount of food they consume but also the quality of it.

The thing that’s shocking about this issue is that it’s ubiquitous: it’s in any country, whether rich or poor. These companies are very hard to fight, simply because of their sophistication and the financial means they can put behind their work. It’s subterfuge really: influencing the space in a way that people can’t see, a sort of mass manipulation.

It’s also essentially a redistribution of funds from society into the coffers of the formula industry. At the end of the day, low breastfeeding rates lead to negative health impacts later in life for many, the burdens of which are being shouldered by society while the formula companies are reaping enormous revenue. And that is by no way balanced by the taxes they are paying back to states.

I’m not saying that addressing the influence of formula companies would fix everything. But it would mean we could concentrate on the other more systemic issues that need to be addressed to promote breastfeeding — many of which I believe are solvable.

Now, let’s think about solutions. If you had to prioritize a specific intervention that you believe would have the greatest impact on rates of malnutrition, which would you choose?

From my end, I wouldn’t want to even answer that question because it’s fundamentally projecting ideas that I think we should get away from. I don’t think there’s any single intervention on anything — whether it’s for breastfeeding, malnutrition, climate, education, health — that can make a substantial difference for a significant number of people. And I think the earlier and the more we start to move away from that view, the better.

One of the criticisms I would have of the development sector and of many institutions within it is that we are still dreaming of this golden bullet. But we need to move towards systemic views and process-oriented approaches where we define and develop complex solutions for complex problems.

At our Foundation, our approach is to work more flexibly with the solutions that already exist and think about how they can be combined with other systems and interventions in new ways. This helps us develop plans that are more complex and able to deal with issues in a much more fundamental and sustainable way.

As long as we keep a view on individual interventions, we’re not going to solve the problems. We need to focus on where those issues are embedded and understanding the larger systems and complexities at play.

A very valid point. As we wrap up, here’s one for the food-lovers in our community: what was the most memorable dish you’ve ever had?

I’ve been very lucky to have eaten well in so many places around the planet, for so many years now, that I find it hard to say. However, one meal does stand out among the rest.

We did some work in China for a while and I was invited to what must have been the best fish dinner I’ve ever had. We had a table full of highly curated pieces of fish, lots of different kinds. There were beautiful little fillet pieces and fish balls, all raw, and we had a simmering pot of really nice Chinese vegetable broth. You would put the bits of fish on top of the soup and let them simmer through. We were just eating fish and the bits and pieces from the soup all evening and everything was phenomenally delicious and well decorated. It was basically a fish Fondue Chinoise done in a very sophisticated way — which I loved.

Nourishing Equality

By Martha Flynn, Advocacy and Communications Lead, Stronger Foundations for Nutrition

Last year, I made a bold step from almost a decade’s work in the gender equality space and took up the helm as the Advocacy & Communications Lead at Stronger Foundations for Nutrition: an ambitious coalition of private philanthropies working to end malnutrition.

Though I was by no means an expert, I did know that malnutrition was profoundly gendered: girls and women are 50% more likely to be undernourished than boys and men, in part because they often eat last and eat least when food is scarce. But the scale of the gender inequalities in malnutrition would soon shock me.

In late 2022 we discovered that rates of malnutrition among women were even more profound than had been imagined. Research by Lancet Global Health found that a staggering 2 in 3 women of reproductive age were lacking the essential vitamins and minerals they need to thrive – far higher than previously expected. And this week, ahead of International Women’s Day, UNICEF released new data showing that a staggering 1 billion adolescent girls and women worldwide suffer from undernutrition.

These rates might not have come as such a shock to my new colleagues in the nutrition community. They already knew that global hunger was increasing after years of decline and that the rising cost-of-living was eating away at many people’s ability to buy healthy and nutritious food. They also knew that food crises like the ones we find ourselves in today often hit women the hardest.

This International Women’s Day must be the start of a shift in perspective: we must recognize that the fight to end malnutrition and the fight to achieve gender equality are intimately intertwined.”

Good nutrition provides the building blocks for every person’s chance in life: determining everything from our ability to ward off disease to our emotional and mental well-being. And globally, we’re building on unstable foundations. For example, almost a third of women worldwide suffer from anemia: a condition associated with low iron levels that zaps your energy, clouds concentration and weakens your immune system.

True equality cannot exist if so many women are lacking the basic nutrients they need to learn, to thrive, to discover what they’re truly capable of.

And this not only has dramatic implications for women individually. Women’s malnutrition is a vicious cycle that compounds inequalities from each generation to the next: many malnourished women go on to become malnourished mothers who give birth to malnourished children who may, eventually, become malnourished mothers themselves.

Challenging the underlying causes of inequalities in malnutrition will also force us to wake up to the discrimination and biases that are driving them: the reasons why resources are so often unequally shared, why so many women face barriers to the care they need and why they disproportionately feel pressure to prioritize their children’s needs over theirs. All questions that are key to the broader struggle to realize women’s rights.

So as we wake up today to calls to action to strengthen girls’ education, close the gender pay gap and boost women’s political representation, let us remember that nourishing equality must start with addressing malnutrition from the earliest points in girls’ and women’s lives. Because a better — and more equally — nourished world is a stronger one.