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India, Pakistan, and Bangladesh have emerged as fertile spaces for economic and social growth over the last few decades. Forming the Indian subcontinent, a large sub-region of South Asia, they do share a history of colonial rule and economic uncertainties that bring different socioeconomic assets and challenges for each nation. One challenge in particular is child malnutrition caused by poverty, food insecurity, and poor awareness of malnutrition causes. Although South Asian and global mainstream media rarely speak on this issue, the Global Hunger Index has identified South Asia as having the worst child malnutrition, stunting, and wasting rates globally. Child stunting is regular malnutrition that slows a child’s height; child wasting is sudden malnutrition that dramatically reduces a child’s weight or keeps them from having a healthy weight, affecting many children who become stunted.
When discussing food and nutrition, it is important to dissect the fine line between accessing food and nutritious food. Given that 29% of global poverty is in South Asia, it is no surprise that hunger is a significant issue. Economic uncertainties brought on by the COVID-19 pandemic and war in Ukraine have worsened malnutrition and hunger. Since 2021, food prices have risen significantly, causing more than 1 billion people in the Asia-Pacific to face “moderate or severe” food insecurity and forcing families to compromise nutritious food.
In this light, it is no surprise that South Asia experiences a malnutrition burden among children aged under five years. A glance at the data from The Global Nutrition Report paints a bleak picture. Among children, the prevalence of stunting in South Asia is 30.7%, while the global average is just 22%. The region’s bulk of wasting is 14.1%, more than double the global average of 6.7%.
Stunting leads to mortality, disease, and a higher chance of stunted children being born. These consequences are all detrimental to the future of South Asian nations embarking on crucial years of development ahead.
The Illusion of Growth
What is alarming in the case of malnutrition in South Asia is how persistent it remains despite economic growth. While income is a factor in access to healthcare and awareness about nutrition, it is not the sole factor in determining the success of health initiatives. Emerging as agricultural countries, the subcontinent has taken steps for economic development. Yet, malnutrition and child stunting do not seem to be declining at the same rate. For example, the 2020-2021 National Family Health Survey in India revealed that malnourishment in children was higher than five years ago. One of the reasons for rising malnutrition despite economic growth is the government’s slow prioritization in resolving this issue.
For example, Nutrition International identified that the bottleneck in the uptake of iron and folic acid supplementation is a lack of awareness and discipline. A key cause of stunting is anemia from the mother, so child-bearing women living in the subcontinent need greater awareness about folic acid and iron consumption to have better nutritional and birth weight outcomes for their children.
Pakistan launched a multiple micronutrient supplementation (MMS) program in 2022 to target widespread iron deficiency anemia among young women, affecting their offspring and, consequently, the health of the new population. South Asian countries need to promote these public health messages through sources of information that people rely on and consume regularly to prevent malnutrition.
While it is commendable that the Pakistani government is addressing this issue now, given the recent political turmoil, 75 years into its independence from the British colony is too late to start. To complement the initiative, further awareness regarding family planning, birth control, and its positive impacts on women’s, children’s, and family’s health and wellness would help the current initiatives yield better results.
Complex Problem, Complex Solution
Knowledge and awareness turn around policy success over time, but hunger strikes with urgency with long and short-term consequences. Low and middle-income families are most exposed to the long-term impacts of hunger. Hunger ties into access to education as future choices of young people depend on their ability to become literate enough to respond to the government’s various awareness programs. When parents do not understand the health outcomes of their choices, there is little change across generations. Prevailing taboos on women’s health education in South Asia worsen these intergenerational health outcomes.
India is tackling malnutrition and literacy issues with a two-fold policy called the Mid-Day Meal Scheme. A free-of-cost hearty lunch during school hours acts as a way of ensuring children get at least one nutritious meal and also as an incentive for parents to send their children to school. This is especially true for lower-income families who generally pull children out of school and put them into small labour jobs so they can earn and feed the family. The impact of mid-day meals was such that during COVID-19 lockdowns when schools were closed, missing out on regular meals worsened nutritional problems among children.
While the Mid-Day Meal program became widespread and successful across India, each state has its ways of implementing it, and the program is not immune to corruption. Nonetheless, mid-day meal planning provides each state with a platform to experiment with diets and supplements. For example, the state of Karnataka added millet, sprouts and eggs to their mid-day meal conditions, noting a need and issue of access to those foods in children’s diets.
Bangladesh has been gradually progressing on the Global Hunger Index as of 2022. The progress has also resulted in the rate of acute undernutrition or child wasting in Bangladesh decreasing from 14.4% in 2012–2016 to 9.8% in 2017–2021. Bangladesh has also shown progress in reducing child stunting.
While positive GDP growth in the region during the COVID-19 pandemic is a contributor, much of Bangladesh’s success comes from its aggressive institutional approach. The right to food is codified in Bangladesh’s constitution. The Bangladesh National Nutrition Council (BNNC) advises all government departments, so it is a policy consideration in other decisions to account for an intersectional impact.
A United Front
Nutrition and the health of the population, along with the issues intersecting with this need, is a national priority for each of the subcontinent nations as it fares poorest on the global scale for hunger and nutrition. There is no room for politicization or partisanship in this basic necessity that allows countries to move forward with their business of governance and life.
There are examples of successful and failed initiatives across the subcontinent region for each country to learn from one another. The subcontinent’s roots have more commonalities than differences in policy intervention with the aim that a healthy population, rooted in well-nourished children and mothers, will contribute to great economic and social progress.
Edited by Anthony Hablak