Sri Lanka has a long history of tackling child malnutrition
- Sri Lanka continues to languish way down in international rankings on child nutrition indices
- According to the report, Sri Lanka is ranked in 56th position out of 176 countries in tackling child malnutrition
- The child malnourishment issue is not confined only to developing countries
Ministry of Health, Nutrition and Indigenous Medicine has a Child Nutrition Unit which is responsible for uplifting the nutrition status of children under the age of 5 years. Among the unit’s broad areas of responsibilities are infant and young child feeding, child growth monitoring and promotion, nutrient supplementation and managing nutritional problems of children under five years of age.
In addition to this unit, we do have a number of progressive mother and child care policies. And, significant financial resources have also been expended on child-related programmes. Tragically, in spite of such well-structured systems and organizations, Sri Lanka continues to languish way down in international rankings on child nutrition indices.
Global Childhood Report
Save the Children International - London based worldwide non-profit organisation, which aims to improve the living condition of children worldwide, has released its third annual Global Childhood Report for 2019. The report examines the major reasons why childhood comes to an early end. According to the report, Sri Lanka is ranked in 56th position out of 176 countries in tackling child malnutrition. On the positive side, our ranking is better than any other South Asian country. For example, India is ranked in 113th position.
There are three key physiological measures of undernourishment in children. (1) Stunting - being ‘too short for one’s age’; (2) Wasting - being ‘dangerously thin for one’s height’; and (3) Underweight - low weight-for-age in children.
Sri Lanka’s under-5 mortality rate is 8.8 deaths per 1,000 live births: Child stunting is 17.3 per cent: Child wasting is 15 percent; Child underweight is 21 percent.
According to child experts, Sri Lanka’s child underweight rate is three times as high as what would be expected of a country with its level of infant mortality.
The Government can rejoice for being the best in South Asia. But, in reality, we could have fared better if we had the commitment and determination. It’s time to wake up and take a long look into the future. What needs to be done, where, how and by whom are the questions we need answers to.
Globally, malnutrition rates remain alarming. Stunting maybe declining worldwide, but too slowly to be happy with, while wasting still impacts the lives of far too many young children. Nearly half of all deaths in children under 5 worldwide are attributable to undernourishment. Therefore, undernourished children are at greater risk of dying from common infections.
The child malnourishment issue is not confined only to developing countries. Even though USA is among the most developed, wealthiest countries in the world, they continue to trail behind most of Western Europe in helping children reach their full potential. In fact, nearly 1 in 4 rural children grow up in poverty.
Sri Lankan experience
Sri Lanka has a long history of tackling child malnutrition. In fact, the first Nutrition Policy for Sri Lanka was developed in 1986. In 2010, a revised version of the Policy was initiated to provide a platform to accelerate efforts to achieve optimum nutrition for all.
However, after the release of the Demographic and Health Survey done in 2016/17 by Department of Census and Statistics, the Government realised that in spite of the initiatives taken to alleviate child malnutrition, the levels have not improved considerably over the years.
The report also pointed out that certain population segments. For example, in the estate sector, the prevalence of child malnutrition was severe. For example, 30% of children under 5 years of age were underweight while 25% babies had low birth weight. Poor dietary habits were a significant reason for malnourishment in the estate sector.
The report pointed out that children coming from “socio-economically poor” segment is twice as likely to be underweight than a child in the socio-economically rich segment.
Addressing child malnutrition requires interventions across different relevant sectors, such as agriculture, health, water and sanitation, education and social protection. Considering this, the Government must emphasise a cross sector, multi-level approach to tackle malnutrition. Until now, however, interventions have often been uncoordinated, resulting in the loss of money and efficiency.
Interventions have been both inefficient and ineffective, especially in relation to service delivery at local level. There is no proper system to account for nutrition or to coordinate the design, plan or implement nutrition interventions.
This writer believes that what we need is a new implementation framework that captures all the various sectors defining the responsibilities of each sector. This would help the Government to link more units, ministries and personnel to the programme.
Learning from Brazil
There are two remarkable feats that Brazil has achieved in handling child malnutrition. Firstly, the high rate of child stunting was reduced rapidly over 10 years. Secondly, the speed at which the number of stunted children has declined has been accelerating.
As a first step what Brazil did was to look at the underlying causes of child malnourishment. The main factors were inadequate access to nourishing food, inadequate care for children and women, insufficient health services and an unhealthy environment. These were the areas it set about focusing on.
One of Brazil’s biggest policy initiatives was to focus on poverty reduction. A group of well-designed pro-poor public policies were introduced in early 2000s. This involved ensuring better income distribution and increased access to services.
Income distribution was a key element of the policies. Brazil’s income transfer programme is now recognised as one of the factors of their success in tackling child malnutrition. Families with income below the poverty line receive a monthly stipend which puts them above the poverty line. Women and children in these families are required to attend primary health centres and older children must attend schools regularly.
The policy was designed on the premise that poverty reduction can only be achieved with a better income distribution rather than increased economic growth. At the time of the rapid decline in child stunting, in 2005, Brazil’s Gini coefficient which measures inequality sat at 0.60 (zero is perfect equality and one is perfect inequality). With 10 years, it declined to 0.50. But economic growth at that time sat at just 1.4% per capita. It’s clear from that the reduction in poverty was not driven by economic growth, but by income distribution.
The main benefit of improving income distribution is that the social disparity in child stunting can be reduced rapidly. By 2006, child stunting prevalence was around 6% in most regions. The regional inequalities had disappeared in 10 years. The reduction in economic inequalities in child stunting was also strongly reduced.
The pro-poor policies also focused on increased access to essential public services. For example, access to antenatal care was dramatically improved. In 2000 only 37% of the poorest quintile of mothers had access to antenatal care. Within 10 years, this was increased to 80%, substantially reducing the socioeconomic disparities in antenatal care. This was achieved with investments in primary health clinics and family health teams, particularly in poor settings.
There was also a comprehensive education drive. Big investments were made in school programmes. This included allocating more funds to support primary education in poor areas. Lastly, investment was made in infrastructure to improve the environment. Water supply and sewage systems were improved in backward areas.
Brazil still has millions of people living in poverty, and subsidising the basic needs of so many people is not cheap. But it all comes down to basics. Better-fed, healthy people contribute more to a country’s well-being. Malnutrition does the opposite, costing lives and resources.
The Brazilian experience should top the agenda of priorities for our country, too, which is committed to improving quality of life for future generations.