Saleem Samad
Bangladesh has been a world leader in reducing chronic under-nutrition in children for last 15 years and it should do more to ensure that children, adolescent and women are not stunted. Malnutrition takes tolls mostly over children and pregnant women. Women have high rate of malnutrition, micronutrient deficiencies and anaemia. Maternal anaemia increases the risk of dying during childbirth.
The policy planners and society managers understand that investment in nutrition pays a human, social and economic dividend. Malnutrition has far reaching human, social and economic consequences that last for generations. Investments to reduce chronic under-nutrition have high economic payoffs which contribute to long term poverty reduction.
Bangladesh envisages becoming a middle income country by 2021, and is committed to sustaining an annual rate of GDP growth of 10 per cent from 2017. It is likely that the benefit-cost rations from investing in nutrition in roads, irrigation, and health. It is estimated that every $1 (BDT 77.15) spent on improving nutrition in Bangladesh can have a $30 (BDT 2,333) nutritious diet. The demographic dividend will be wasted if its large young generation grows up without adequate access to a diverse and nutritious diet.
Stunting in Bangladesh has slumped from 58 per cent in 1997 to 40 per cent in 2011. This annual reduction of 1.3 per cent is one of the fastest rates of reduction in the world. This can be explained by standard statistical techniques, increasing levels of wealth accounts for 25 per cent of this reduction and improvement in women's schooling and their height another 25 per cent. Better health care and sanitation, paternal schooling, and the rise of exclusive breastfeeding have also played a role.
Despite the improvement, a 40 per cent prevalence of stunting is unacceptably high. An estimated six million children in Bangladesh are chronically undernourished. These arise because stunting has long-term physical and neurological consequences.
As role model, Bangladesh nutrition profile has several strengths, opportunities and challenges. Among the opportunities are:
# During Prime Minister Sheikh Hasina's leadership, scaling up of nutrition movement has been given impetus, along with official endeavours global efforts with civil society, UN and development partners have addressed the problem concertedly.
# Very comfortable rates of breastfeeding by lactating mothers in both rural and urban areas.
# Emerging national Strategy for the Control and Prevention of Micronutrients Deficiencies will be the vision for reduction of malnutrition in Bangladesh.
# Another success story is the iodisation of salt which has significantly reduced the prevalence of goitre.
# Vitamin A supplementation and fortification programme of edible oil fortification, avowedly to help combat Vitamin-A deficiency among large populations of poor communities in an efficient way.
# Government's commitment to introduce hot meals for primary school children.
# Innovative approaches to rice fortification including enrichment with zinc at soaking stage.
There are, of course, challenges too which are as follows:
# Political instability and consequent increase in the price of essential commodities have impacted on access to nutritious food by the most marginalised population.
# The institutional capacity to steer the nutrition agenda needs strengthening to increase convergence of government, private sector, civil society and community partnership.
# Coordinated approach towards nutrition specific and nutrition sensitive programming targeting maternal nutrition and the nutrition of adolescent girls.
The biggest plus point for increasing the nutrition intake among all includes government infrastructure including community clinics and government networks that provide services deep into rural communities.
While these direct nutrition interventions will make significant dent in chronic under nutrition in Bangladesh by themselves they will not eliminate stunting, these direct actions need to be complemented by increased use of nutrition sensitive interventions, especially in social protection agriculture and gender.
Bangladesh has an array of social protection and social safety net transfer programmes that reach millions of poor families. Evaluation of government interventions such as the Vulnerable Group Development Programme shows that these are an important means of improving household food security and reducing hunger.
Promising evidence, including ongoing work in Bangladesh by the government, civil society organisations and development partners, suggest that linking these with direct nutrition interventions - such as behaviour change communication - can reduce stunting.
Bangladesh has done a remarkable job by increasing agriculture production, most notably dramatically raising rice yields. It is difficult to understate the achievements in reducing poverty and hunger in Bangladesh. Improving the status of women can continue to help the drive to reduce chronic under nutrition.
It would not be fallacy to dream of a country where children will no longer be undernourished; rather it will be a country with a bright future.
Saleem Samad, an Ashoka Fellow (USA), is Special Correspondent, The Daily Observer