More emphasis on nutrition  

Abdul Bayes     | Published: July 16, 2018 22:15:43

Statistics show Bangladesh has of late made remarkable improvement in the field of nutrition but child malnutrition still poses a serious problem. The proportion of stunted children was 60 per cent in 1996-97 which  declined to 41 per cent in 2011 and 36 per cent at present. The proportion of underweight has also declined from 16 per cent to 11 per cent.

The improved nutritional indicators suggest that there has been praiseworthy progress on nutritional front. This is evidenced by a fall in maternal and infant mortality over time.  A number of steps taken by the government and also by non-governmental organisations (NGOs) made that happen. However, concerns still loom large. First, the ratios are still high in the global context, thus, leaving no room for complacency. Second, Bangladesh spends the least in education and health - two vital sectors in nutritional fight.

Nutritional improvement is a precondition for increased productivity. Although poverty and nutrition are said to be interwoven. The prevailing notion is to pay more attention to the former at the cost of the latter. It is thus no wonder that, in Bangladesh, fight against malnutrition is not as firm as it is with poverty reduction. But, better late than never, recent nutrition-centric concerns deserve appreciation. Good nutrition leads to healthy   growth of an economy through increased productivity of labour. Nutrition and productivity i.e. earnings are positively correlated. It is important from both inclusive and sustainable development perspectives. Nutrition is a major contributing factor to maternal and child health which has inter-generational repercussions.

Put simply, good nutrition is also good economics. Despite great progress over the last 20 years, poor nutrition still haunts Bangladesh, its children and its future. The impacts of poor nutrition run deep: they affect economic outcomes, individual and community health, as well as education. This means, improving nutrition can bring about positive changes in the short and long term that will impact upon all of society. Significant progress on nutrition policy can be made with strong leadership and proper coordination across government departments.

A few years back, the Copenhagen Consensus, in partnership with the Bangladesh think-tank Centre for Research and Information (CRI), organised a high-level nutrition policy seminar in Dhaka. Nutrition solutions are compelling when compared with interventions in many other areas. There are smart nutrition interventions, packages   and   policies, and  the new   research provides contextualised analyses for Bangladesh. There are many variables affecting nutrition, but low participation in secondary schooling among girls has been identified prominently. The rise in child marriage and subsequent high-dropout rate brings to the fore the role of girls' education in the labour market. The poor nutritional status of children is strongly associated with mothers' education. The Copenhagen Consensus researchers looked at two potential solutions to improve education and nutrition among girls. One approach was to provide stipends to encourage girls to enrol and stay in school, suggesting that additional schooling would potentially lead to increased earnings. Another approach was to focus on extending and improving secondary schooling for girls as a solution to child malnutrition. The research suggested that a higher level of education resulted in better awareness of health and nutrition.   

While dietary diversification is critical to good nutrition by adding essential nutrients and improving health and productivity, two-thirds of the average Bangladeshi family diet consists of cereals like rice. Therefore, two studies have come up with solutions to improve Bangladesh's micronutrient needs. The first evaluates the costs and benefits of increasing homestead production of animal-source-foods as a means to increase   household   income   and subsequent nutritional status. The second study focuses on the costs and benefits of promoting complementary and supplementary feeding among women and children. Complementary feeding refers to the introduction of family foods which usually occurs in infants of 6-24 months. Supplementary feeding refers to those foods high in vitamins, minerals, fibre, fatty acids and amino acids that would otherwise be not consumed in sufficient quantities.  

While Bangladesh has done much to reduce its maternal and infant mortality rates over the last several decades, mother and child under-nutrition remains a concern, even among wealthy populations. Two studies propose solutions in this area. The first evaluates an intervention designed to change the behaviour of pregnant women to stop consuming smokeless tobacco during pregnancy. Bangladesh has the highest prevalence of Smokeless tobacco among women in the world. The proposed behavioural intervention would include face-to-face counselling by a healthcare provider, and the use of printed materials; it would be run by community health-workers who would be responsible for home visits and deliver change and communication messages. Raising social awareness about both SLT's negative effects and positive impact of iron and folic acid is important. The second study focuses on the costs and benefits of three key nutrition supplements during pregnancy - calcium supplementation, balanced energy protein supplementation, and iron-folate supplementation.

A research paper also looked at the detrimental impact that poor nutrition continues to have on the health and education of Bangladeshi children, along with their economic implications. Although great progress has been made, child nutrition remains a challenge in Bangladesh. Chronic malnutrition (stunting) and acute malnutrition (wasting) are responsible for more than 300,000 child deaths a year. Children in rural Bangladesh are more at risk of stunting than those in urban areas. One option examined was the promotion of nutritious foods to improve the health and nutritional status of women, infants and young children. Another would be a nutrition package comprising nine interventions that are to be administered to mothers, babies and small children in the first 1,000 days of life. The research suggests that the latter would generate the highest benefits for every taka invested.

Research by Jonathan Rose on nutritional packages for mothers and small children shows that a package of direct nutritional interventions aimed primarily at mothers, babies and small children in the first 1,000 days would yield an improvement in physical and cognitive development. This would result in better educational achievements for children as they grow up, as well as better health, and increased earnings later, upon entering the workforce. In sum, the research suggests that every Taka spent would generate a return to society of BDT 18.8.

It is clear that there is no single solution that can address all dimensions of malnutrition.  Making progress in reducing all dimensions of under-nutrition in Bangladesh will require multiple interventions, not just one.  But the benefits - for the economy and the society - will be deep and manifold. Considering the importance of nutrition and returns on investment in nutrition, Bangladesh needs to increase the share of budgetary allocations in the health sector.

Abdul Bayes is a former Professor of Economics at JahangirnagarUniversity .


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