Transcript Undernourishment: Dimensions, Determinants and Policies

Undernourishment and
Child Malnutrition in Asia
S. Mahendra Dev
Director, Centre for Economic and
Social Studies, Hyderabad, India
Contents
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Dimensions
What are the reasons for high levels of
Undernourishment and Child Malnutrition?
What are the policies and actions needed to
reduce them? (Including best practices)
We concentrate more on child malnutrition
because it reflects the status of adults also
particularly women’s health and well being.
Dimensions
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Two measures of Hunger under MDGs:
One measure is undernourishment : the proportion of
people consuming less than the minimum dietary
requirement (suffer from hunger)
Another measure is Child malnutrition or undernutrition
: Weight for age
FAO data on undernourishment : 820 million
undernourished in developing countries: 524 million in
Asia
The undernourishment rate declined from 20% in 1990-92
to 16% in 2001-03. The decline was mainly due to China
from 194 to 150 million.
India has the largest number in the world. Declined
marginally from 215 to 212 million in one decade.
Dimensions
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The number in DPR Korea doubled from 3.6 to 7.9 million. In
Tajikistan prevalence was 60%.
The more important indicator of hunger is Child Malnutrition
(underweight: weight for age)
Levels of child malnutrition is exceptionally high in South
Asia. 45% to 48% of Children in India, Bangladesh and Nepal
suffer from underweight.
It is 38% in Pakistan, 30% in Sri Lanka.
These numbers are much lower for other countries – 28% in
Sub-Saharan Africa and 8% in China.
Many of the Asian countries may achieve MDG in income
poverty but not in undernourishment and child malnutrition.
What are the Reasons for High Levels of
Undernourishment and Child Malnutrition?
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Low per capita income. Cross-section data –the percentage
decline in malnutrition is roughly half the rate at which GNP
per capita grows.
Thus economic growth alone can not reduce malnutrition. For
example, in India, GDP growth was 6 to 7% per annum
during 1992-93 to 2005-06.
But child malnutrition declined from 52% to 47% --0.5
percentage points per annum.
In fact, the per cent of underweight children in India declined
only one percentage point from 47% in 1998-99 to 46% in
2005-06 inspite of high economic growth.
Reasons for high Levels
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Income poverty is another reason.
However, studies have shown that malnutrition exists
even after removal of poverty.
For example income poverty in India is 26% while
child malnutrition is 46%.
The data for India, Bangladesh and some other
countries show that malnutrition levels are
surprisingly high even in rich income quintiles.
Thus, reduction in malnutrition is going to be a
bigger challenge than income poverty.
Reasons for high Levels
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Therefore, one has to look beyond economic growth,
income poverty and food availability
Adequate nutrition during pregnancy and first six months
of life are critical because of the impact on birth weight.
Thus, the problems often start before, during and after
pregnancy as malnourished mothers are more likely to
produce low birth weight babies.
Poor nutritional status at birth is perpetuated by
inadequate breastfeeding and supplementary feeding
habits.
Subsequently in the first two years, they do not give
sufficient quality food –particularly mothers with low
education.
Reasons for High Levels
Similarly, public health services are poor in South
Asian countries.
 Health sector performance in some of the Asian
countries show that there are basically six problems
--low levels of health indicators
--slow progress in these indicators
--significant regional, social and gender disparities
--poor quality delivery systems in health
--privatization of health services
 Low standards of health and hygeine play important
part since sick children are able to absorb essential
nutrients.
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Reasons for high levels
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Micro nutrient deficincy is another reason
Age-specific interventions upto five years are important.
But, lack of institutional arrangements for age-specific
nutritional programs is another problem.
To conclude, there is a strong association between child
malnutrition and women’s health/well being.
For example, one third of Indian women suffer from
Chronic Energy Deficiency and BMI of less than 18.5kg
58% of pregnant women in India suffer from anaemia
About 68% of pregnant women make first ANC visit after
4th Month of pregnancy.
One third of them visit after sixth month of pregnancy
About half of the deliveries take place at home
What are the Policies and Actions Needed?
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Economic Growth: Inclusive, broad based, pro-poor
Agriculture and Rural Transformation: Through
agricultural diversification and promotion of rural nonfarm sector can improve productive employment
Small and marginal farmers should diversify. This can
increase purchasing power and reduce undernourishment.
Food and nutri. security does not mean ‘foodgrain’
security
China offers many lessons for rural transformation
Urbanization: Urban areas also have high levels of child
malnutrition.
Urban outcomes in metropolitan areas are poorer than
rural in some countries (e.g. Bangladesh). Therefore,
special challenges posed by urban areas must be
Policies and Actions
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Sector Specific Policies: Economic growth is not enough.
Sector specific policies are needed.
For example, a package consisting of expanded child and
maternal immunization, antenatal care coverage,
nutritional supplementation (including breast feeding) and
home based neo-natal services (including treatment of
pneumonia) bring about significant reduction in both
infant mortality and child malnutrition .
In other words, basic health services have to be
improved.
Women’s Health and Well Being: Malnutrition can be
reduced by enhancing women’s health, promoting gender
equality and, empowerment of women including female
education.
Innovative programs: Experience of
Bangladesh, India and Thailand
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Bangladesh Experience: Broad picture is high economic
growth, infrastructure development, women’s agency (female
secondary education) and NGOs presence for high human
development.
Women’s agency in the form of women’s groups and female
secondary education (targeted interventions like Female
Secondary School Stipend Program)
The contribution of the NGO Gonoshayastha Kendra (GK) in
raising health indicators in many areas is noteworthy.
Indian Experience: The regional experience shows that
differences in health provisioning, improvements in child
care, and health status of women explain malnutrition
differences across states.
Indian Experience
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The high performing states in India have shown:
rise in women’s nutrition status,
increase in the proportion of children under the age of three
breastfed within one hour of birth,
rise in the percentage of children with diarrhoea who
received ORS.
In India, Tamil Nadu and Kerala states have done well in
reducing malnutrition.
The innovativeness and success of Tamil Nadu mid-day
meal nutrition scheme is well known.
India : Public Distribution System (PDS) and nutrition
programs
The Integrated Child Development Scheme (ICDS)
launched in 1975, aims at the holistic development of
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Indian Experience (contd.)
ICDS: children up to six years of age with a special focus
on children up to two years, besides expectant and nursing
mothers.
However, the progress has not been satisfactory. The
Government wants to strengthen nutrition programs in
India during 11th Five Year Plan.
There is a broad framework of action ‘children under six’
in the 11th Plan.
Three interventions involve integration of three related
systems, focusing on: (a) food and nutrition;(b) health
services; and (c)child care.
Many of these interventions can be taken care of through
the ICDS.
‘Universalization with Quality’ is the overarching goal of
ICDS in 11th Plan.
Innovations
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Thailand Experience: Thailand is considered as one of the
most outstanding success stories of reducing child malnutrition
in the post-1970s.
The success is attributable more to the direct nutritional
programs by the govt. than only to rapid economic growth.
The country launched large focused programs on nutrition in
1977. The child malnutrition declined from 51% in 1979-82 to
17% in 1991.
These programs reduced child malnutrition through a mix of
interventions including intensive growth monitoring and
nutrition education on breastfeeding
and complementary feeding, strong supplementary feeding
provision, iron and vitamin supplementation and salt
iodisation along with primary health care.
Institutions, Rights Approach
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Institutions and Service Delivery: Increase in public
expenditure is important. India spends 0.9% of GDP on
health. However, institutions to fit the needs and
aspirations of 21stCentury are needed.
Social mobilization, community participation and
decentralized approach are needed.
Rights Based Approach: Rights based approach is
important. It may be difficult to make the right
completely justiciable.
However, rights approach puts pressures on public action
and would lead to effective implementation of the
policies and programs (In India, Supreme Court
intervention on nutrition programs).
conclusion
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To conclude, improvement in incomes of poor,
proper health services and quality environment are
important for reduction in malnutrition.
Womens’ health and well being are crucial
However, in the short run, direct nutritional
programs should be the priority.
Finally, political will is needed to sustain effective
programs to reduce under nourishment and child
malnutrition.