Fighting malnutritionWe cannot expect young and undernourished mothers to give birth to healthy children
Since 2001, there has been a significant decline in maternal and child mortality rates in Nepal, but the phenomenon is still prevalent. Maternal and child mortality is directly and indirectly related to the effects of malnutrition in women and children, and the nutrition situation of women and children in Nepal is far from satisfactory. Malnutrition is a condition resulting from a diet with either too little or too much nutrition. In low income countries like Nepal, the cases of under nutrition remain high. Nepal is one of the top 20 countries with the highest number of stunted children—those who do not get sufficient nutrition during critical periods of growth and development between 0-59 months after birth. According to the World Heath Organisation (WHO), malnutrition is a factor in more than half the children who die within the first month after birth.
In Nepal, stunting among the children below five years has decreased by only four percentage points in the last five years—far behind the Millennium Development Goal (MDG) target of 28 percent. According to a 2014 report of the Unicef, 37 out of 100 Nepali children below five years are found stunted (too short for age), 30 percent are underweight and 11 percent are wasted (very low weight for height). Among them, about one-third are severely affected with different forms of undernutrition. The number of children who are underweight went up to 30 percent in 2014 from 29 percent in 2011, although the MDG target was to bring it to 27 percent by 2015.
As for malnutrition in women, 18 percent were undernourished and about 14 percent overnourished in the country, as per the 2011 Nepal Demographic and Health Survey (NDHS). This shows that overnutrition among women is also increasing in Nepal, as only nine percent of the women were overnourished according to the NDHS 2006. It is unfortunate that the rate of malnutrition is not decreasing as anticipated in Nepal.
Root and underlying causes
The root causes of maternal and child malnutrition in Nepal include poverty, political instability and ecological structure, among others. Some underlying causes are lack of a diversified diet, lack of education and disparities in the use of health services. Similarly, child undernutrition results from maternal undernutrition, which can be a result of early childbearing, usually below the age of 18. Till 2014, teenage pregnancy rate in the country stood at 16 percent.
Also, 35 percent of reproductive age (15-49) women in Nepal are already anaemic, as per the NDHS 2011. Anemia during pregnancy is a matter of concern because it is associated with low birth weight, premature birth and maternal mortality. Again, several women are bearing more than four children, which leads to them not getting enough care and food. So the situation for some girls is tragic. The mothers are already physically immature and undernourished, and then they bear many children. How then can we expect them to give birth to healthy children?
We can also see the direct effect of wealth on malnutrition in all developing countries, including Nepal. Several health indicators are worse in poor countries. Stunting among children is two times higher in the rural areas (56 percent) than in urban areas (25 percent). Similarly, stunting has only decreased by 14 percent in 20 years; however, while it decreased by 12 percent among the poor, it went down by 64 percent among the rich.
Nutrition and government
Nutrition plays a vital role in not only the physical growth of children, but also in their mental and cognitive growth, especially between conception and the second birthday of a child, or the first 1000 days after birth. Scientists have found that a baby’s brain develops by about 80 percent within the first 1000 days. Moreover, it is beneficial for every state to address malnutrition even from the point of view of economic growth. One estimation of the World Bank shows that malnutrition decreases the Gross Domestic Product of a country by three to seven percent.
Nutrition is crucial for the economic as well as social development of a nation.
The government of Nepal, in partnership with the European Union and Unicef, has recently launched the Golden 1,000 Days public awareness campaign for improved nutrition of children and women in the country. This is a step in the right direction. But the government needs to address other causes behind malnutrition such as poverty, lack of diversified food, lack of quality healthcare in rural areas and sanitation, among others.
The government should realise that merely investing in campaigns will not yield the desired result. It is crucial to bring about behavioural changes among people, particularly in the rural areas. Education plays a key role to this end. So investment in education should be a national priority. Moreover, the government and donor agencies should increase investment in nutrition. They have to assess the situation on the ground more frequently so as to design area-specific programmes and activities in the days ahead.
Ghimire is a PhD student at Texila American University