High economic growth can't alone fight undernutrition

Economic growth and poverty reduction alone cannot solve the problem of undernutrition. Had that been the case, with respectable economic growth and a fairly rapid rate of poverty reduction in the last quarter century, Bangladesh would not have faced the nutrition challenge that it does today.

Prof SR Osmani, a development economist with vast experience in the areas of poverty, inequality, hunger, and nutrition, emphasised investment in women's empowerment, mother and child care, in order to make a significant dent in the persisting undernutrition.

"Nearly a third of our babies are born at low birth weight. Some of them die prematurely, while a large number of those who survive are brought up undernourished," said Osmani, who is a teacher at Ulster University, Northern Ireland, the UK.

In an interview with The Daily Star, Osmani explained, "A lack of nutrition that many of the young and under-aged mothers suffer from, ultimately passes on to the next generation."

Many of these mothers were themselves born as low birth-weight babies and brought up as undernourished girls. Many of these girls are getting married early and giving birth to babies at a time when they themselves are growing as teenagers. As a result, during pregnancy young mothers and foetuses compete for food, a competition in which the mothers almost invariably win, leaving the foetuses nutritionally deprived. This, together with poor nutritional history of the mothers, results in babies being born with low birth-weight, he said.

Economic growth and increased food production would not eliminate the problem of undernutrition, noted Osmani, unless the issues of mothers' history of malnourishment, teenage marriage and inappropriate diets are addressed.

And the best way to do so, according to Osmani, is to launch a mass campaign in support of mother and child care and against teenage marriages.

"Bangladesh has a legacy of running successful campaigns of this magnitude. Take for example – the population control campaign, immunisation campaign, sanitation campaign. We should draw inspiration from those."

Osmani came to Dhaka recently to attend the launch of a World Food Programme-commissioned report -- Strategic Review of Food Security and Nutrition in Bangladesh.

He is the lead author of the report, which notes that an alarmingly large number of people still remain food insecure and hungry – a quarter of the population or 40 million people – and most people do not have a sufficiently nutritious and diverse diet in Bangladesh.

More than 1 in 3 children are still afflicted by stunted growth, and acute malnutrition has not decreased significantly over many years, the report noted.

Osmani, a first generation researcher of the country's premier think tank -- Bangladesh Institute of Development Studies (BIDS) -- applauded the fact that the prevalence of stunting among children has come down from 55 percent to 36 percent in the last 20 years but argued that the rate of reduction is not rapid enough to meet the targets.

"If stunting continues to fall at the current pace, Bangladesh will risk missing out on the global nutrition targets for 2025 as set by the World Health Organisation."

In order to meet those targets, the rate of reduction in the prevalence of stunting must be doubled from the current rate of 2.5 percent reduction per year, he said. 

Malnourishment manifests itself in many different ways – for example, being underweight for one's age, too short for one's age (stunting), too thin for one's height (wasting), deficiency in vitamins and minerals (micronutrient deficiency), and also obesity and overnutrition.

Stunting is the primary manifestation of undernutrition caused by inadequate nourishment on one side and recurrent infections on the other in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother.

Wasting (low weight for height) indicates in most cases a recent and severe process of weight loss, which is often associated with acute starvation and/or severe disease.  

The problem of undernutrition is compounded by inappropriate child care and child feeding practices, said Osmani, who worked under the tutelage of Nobel laureate Amartya Sen at the World Institute for Development Economics Research, Helsinki, prior to joining Ulster University.

Nearly half of the newborns are not exclusively breast-fed in the first six months of their life, and after six months, many of them do not receive complementary food in the right quantity, quality and frequency.

He emphasised the importance of taking special care of children in the first 1,000 days of life - from conception as a foetus to the age of two, since what happens to them on the nutritional front during this period has a profound impact on their subsequent physical and cognitive development.

"This is the period we need to focus on if we really want to make a difference in the nutrition scenario."

Osmani, who obtained his PhD from London School of Economics, observed that many safety net schemes are at work in Bangladesh but none of them directly targets the newborn.

He also emphasised the need for eating a more diversified diet.

Eating a large quantity of food does not by itself result in adequate nutrition, a balanced diet does, he said.

“It is a matter of concern that over the last two decades, there has been very little change in our excessive reliance on cereals – as much as 77 percent of our energy intake still comes from cereals. Diets need to be diversified, along with taking measures related to the wellbeing of women and children," concluded Osmani.