Nutrition is a child's right

Lionel WIJESIRI

National Nutrition Week is from March 23 to 29

Our successive Governments since Independence made considerable efforts to promote the health of the children. Although these efforts have decreased mortality rates, (especially among infants,) protein - energy malnutrition of children is still one of the important nutritional problems in our country. The figures based on the report 'State of World's Children 2009 by UNESCO' will make clear.

(See table)

One may argue that we are faring better than our South Asian neighbours and should be proud of the fact. It doesn't mean that we pat our backs ourselves and maintain the status quo. Our aspirations should be to reach the standards of the developed nations within the next decade.

Why does malnutrition among children tend to coexist with substantial economic progress and abundance in production of food grains? Why does it prevail despite the availability of, and access to, ways and means to address them? These are important questions, which no one can afford to ignore. There are no simple answers exist, I believe, for these questions.

Low birth weight

When speaking of child malnutrition, most critical problem faced by us today is the higher level of low birth weight experienced in Sri Lanka. It is interesting to find out what lies behind this incidence? A research done by Osmani and Bhargava few years ago covering South Asia may have an answer to this question. Osmani and Bhargava found out that even after controlling the effects of income, food, non-food inputs, urbanisation, education, and age at marriage, there remained an unexplained excess of low birth weight in South Asia. They argue that the low birth weight essentially reflects the quality of maternal nutrition, because women who experience greater nutritional stress during pregnancy tend to bear more low birth weight babies.

	  % of infants 	    % Under 5 	      % under 5
	    With low	    underweight        Stunting
	  birth weight
Sri Lanka 	22 		29 		14
India 		28 		46 		38
Pakistan 	19 		38 		37
Bangladesh 	22 		46 		36
USA 		08 		02 		01

Low birth weight indicates that the infant was malnourished in the womb and/or that the mother was malnourished during her own infancy, childhood, adolescence and pregnancy. The proportion of babies born with low birth weight, therefore, reflects the condition of women and particularly their health and nutrition, not only during pregnancy but also over the whole of their childhood and young lives.

If it is so, it is time that we move the issue of malnutrition from the agenda of welfare to the agenda of rights. It is the right of the child to have adequate care, and to grow to the mental and physical potential with which he or she was born. The right of women including their right to education, to dignity and respect, to time, to rest, to adequate food and health care, to resources and to special care in pregnancy and childbirth are a priority both in and of themselves and as a fundamental part of any permanent solution to the particular problem of child malnutrition.

One may argue that we may have better access to modern healthcare and especially to life saving antibiotics. Factually, the argument is correct and today's medical professionals definitely save more lives. But the point is they do relatively little for nutrition.

Malnutrition seems to deteriorate the life chances of children in synergy with infections. Because, malnutrition is not only a consequence of infections, but also it renders the children vulnerable to infections. For instance, malnourished children have reduced resistance to infections because of lower humeral and cell-mediated immunity. The result is that they have more frequent and severe infections, particularly diarrhoeal and respiratory diseases. Thus, it appears from the above that adequate nutrition is quintessential to prevent infections as also for an early cure.

Factors

The professionals say that child malnutrition can be combated using the three 'A' approach - awareness, access and affordability. We must create awareness not only in the community, but also among the providers - politicians, bureaucrats, NGOs and medical and agricultural professionals. Coming out of the box, we should generate innovative methods of creating awareness in the community. The media and school education can play an important role. Learning through experience sharing with mothers can help other mothers in the community.

Nutrition

Administrative and logistic failures have often brought micronutrient supplementation programs in disrepute. If efficiently implemented, they do make an impact. Our ultimate effort should be to create a community that can feed itself. A well-oiled, targeted public distribution system (PDS) can go a long way in meeting the food needs of the poor. Apart from cereals, PDS should also include millets, pulses, oil and if possible some vegetables, fruits, and animal products (milk, eggs, fish powder) to ensure dietary diversification.

We can greatly improve the access to a balanced and diverse diet to ensure food and nutrition security at the household and individual levels by decentralized production of a variety of foods (cereals, millets, pulses, vegetables, fruits and animal products) at the block or village level. Our future motto should be 'think globally, but plan locally.' Homestead gardening, dairy, poultry, fishponds, village grain-banks, seed banks, nurseries, etc. are the various components to achieve this aim.

In an agriculturally diversified country like Sri Lanka, we can improve mother-child healthcare outreach through village-level paramedics and trained attendants. To ensure proper functioning of such paramedics, we need the backup support from the government and private hospitals.