Globally, progress in tackling malnutrition is simply far too slow.Since 1990, the world has made some progress in addressing the burden of malnutrition: the number of children with stunted (short for age, indicative of chronic undernutrition) growth has fallen by more than a third but not adequate. With the adoption of the Sustainable Development Goals last year, world leaders have pledged to further reduce stunting by 40% by 2025, and to eliminate all forms of malnutrition by 2030.
Save the Children’srecent 14 country study report shows that millions of children are missing out on adequate nutrition because of who they are and where they live. They are discriminated against because of their ethnicity or disability; they are excluded because of their parents’ lack of income or after being forced from their homes. If we are serious about creating a world where no child is malnourished, we must tackle the discrimination and exclusion they face.
In Bangladesh, the prevalence of stunting among children under five declined from 51% in 2004 to 36% in 2014, however, rates of malnutrition remain among the highest in the world - some seven million children are estimated to be chronically undernourished.Evidence shows that if Bangladesh is to achieve zero hunger, it must tackle the discrimination and exclusion children face.
Save the Children’s new report ‘Unequal Portions’ demonstrates the huge disparities in nutritional status across Bangladesh. It shows that improvements are not spread evenly and certain areas are left behind. For example, stunting rates vary across divisions from 28% in Khulna (the lowest) to 50% in Sylhet (the highest). In fact, rural children are more likely to be stunted than urban children (38% compared with 31%). This is not to say the situation in cities is always better. The overall urban stunting rate masks considerable diversity. For example, children living in slums lag well behind national averages in terms of progress on nutrition. In 2013, 51.1% of preschool children in slums were stunted, compared to 32.1% nationally. Indeed, the 2013 Urban Health Survey showed that the stunting rate was 50% in city corporation slums – the worst affected urban areas – this was as bad as the worst affected rural areas in the country.
Bangladesh’s malnutrition rates also vary considerably by mother’s education and wealth and other women’s empowerment indicators. Children of mothers with no education are much more likely to be stunted (40%) than children whose mothers have completed secondary and higher education (29%). The differentials across wealth quintiles are even larger. Children whose mothers are in the lowest wealth quintile are 2.8 times more likely to be stunted than children whose mothers are in the wealthiest quintile.This ratio has increased from 1.6 in 2007, indicating that things are getting worse for poor children in Bangladesh.
Finally, early marriage continues to be common in Bangladesh, with 64% of all women aged 20-24 years married before the age of 18 years. This, in addition to limited access to reproductive health services, continues to drive pregnancy among adolescent girls, whose bodies are not fully developed for childbirth.
Policies need to be implemented
The Government of Bangladesh can be praised for its National Nutrition Policy and its development of a National Plan of Action. It’s particularly promising that the Policy’s goal specifically mentions disadvantaged groups. However, the problem is generally not one of inadequate policies or written commitments, but translating these commitments into practice due to the issues with governance and service delivery. Policies needs to be inclusive of:
Social protection: Often seen as a policy response for reaching the most vulnerable, social protection has significant limitations in the Bangladesh context. The existing social protection system is unreliable and ineffective, reaching just 35% of those under the poverty line in 2010. The current schemes do not adequately address nutrition during the critical first thousand days of a child’s life, nor do they reach young, married adolescents. Furthermore, there is no systematic linking of social protection beneficiaries to complementary schemes and services that could increase the extent to which social protection addresses undernutrition.
Nutrition governance: Recent studieshighlight that there are a number of issues and blockages that prevent nutrition-related services reaching the people who need them most and plans from being realised. Opportunities to improve nutrition are often missed or absent, often due to inadequate technical capacity within relevant ministries to deliver high quality and inclusive nutrition-related services. At the upazila level, many ministry staff are not aware of nutrition or its relevance to their roles, and few had any knowledge of national plans or policies related to nutrition and food security. In addition, inadequate staffing and vacant positions (in terms of coverage and quality) are common and there are widespread problems throughout the government’s nutrition-specific and sensitive service delivery system. To ensure survival and growth and ending malnutrition for every last child a dramatically different approach is needed. Therefore, the policy makers/ leaders in Bangladesh are urged to:
1) Increase multi-sectoral coordination at national (ministry) and sub-national government levels.
2) Develop strategies for appropriate policies and plans to reach those targets,for all groups of society
3) Ensure relevant ministries measure explicit nutritional outcomes
4) Adequately resource nutrition programmes in all relevant ministries (Ministry of Health and Family Welfare, Ministry of Agriculture, Ministry of Fisheries and Livestock, Ministry of Local Government, Rural Development and Cooperatives and awareness raising of ministry senior officials on nutrition-sensitive activities.
Save the Children’s new ‘Unequal Portions’ report and a fully referenced case study on nutrition inequalities in Bangladesh can be found here.
Author: Dr Sultana Khanum
Chief advisor: HealthPrior21
Former Director Health System Development, WHO
161 million children don’t get the right nutrients when they need it most – in their first 1,000 days. For these children, missing out on decent nutrition can: 1) Visibly damage the growth of some of their most vital organs; 2) Prevent the development of a healthy immune system – a key reason why 45% of child deaths under five are linked to malnutrition 3) Irreversibly stunt physical growth and cognitive development.
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