The World Bank and International Monetary Fund just concluded their annual meetings in Washington. At an event on nutrition in South Asia, the evidence presented was clear and astonishing. On the one hand, South Asia has experienced robust economic growth averaging 6% a year over the past 20 years. On the other hand, the region continues to have unacceptably high rates of malnutrition with Bangladesh and India having a higher proportion of malnourished children than even the poorest countries in Sub-Saharan Africa. This seems inexplicable to many, and indeed is referred to as the ‘Asian Enigma’.
There is considerable evidence that malnutrition affects not only children’s chances of survival but also their cognitive capacity and learning ability. Losses of up to 13 IQ points have been attributed to micronutrient deficiencies in children under two. And children who learn less, earn less. A recent study in Guatemala showed that children who received nutritional supplements up to age three had significantly higher scores on cognitive tests and earned 34-47% higher wages as adults than those who had not received these inputs.
Some continue to question the data, even suggesting that South Asian children should be held to a different growth standard, despite the extensive evidence showing that the global growth references are credible. As documented by the World Health Organisation’s 2008 multi-country study, it is now well established that our children have the same genetic growth potential through two years of age as other children globally, if given the same opportunities in terms of food, healthcare, hygiene and environment. Indeed, a study by the Nutrition Foundation of India found that the growth curves of well nourished Indian children are indistinguishable from those of similarly nourished children in other parts of the world.
So, what explains this ‘enigma’? Researchers have spent considerable effort on this. We know that pregnant women in South Asia put on less weight during pregnancy than they should: 5 kgs on average compared to the worldwide average of close to 10 kgs. Too often, new mothers are still children themselves, a staggering 75% of them are anaemic, and some one-third of all babies in India are born with low-birth weights. We know that poor hygiene, combined with dense populations, leads to the frequent occurrence of infections which deplete young children of nutrients. We also know that while not genetic, malnutrition is inter-generational, meaning that it takes a few generations for the once malnourished girl to become the grandmother of a well-nourished child.
The ‘World Development Report 2012: Gender, Equality and Development’ highlights issues on the persistence of malnutrition in South Asia. Malnourished adolescent girls cannot deliver healthy babies. Literate and more empowered mothers have better nourished children. Recent analyses in Bangladesh reaffirm evidence that when women are involved in household decisions and have control over earnings, their children are better nourished, and that a woman’s experience of abuse and acceptance of domestic violence had a significant negative impact on her own nutritional status, affecting her ability to produce a healthy newborn. In general, efforts to improve gender equality will be critical to reducing South Asia’s disadvantage in nutrition.
In order to attain a fully healthy and well-nourished — and even more intelligent and productive — population, we need to improve access to nutritious and diverse foods, clean water, sanitary environments, female education, pre-natal services and knowledge and support for appropriate child care, such as exclusive breast-feeding for the first six months. It is possible. Take Mexico, for example. The country took a targeted approach to address malnutrition and achieved remarkable results. There was a marked reduction in infant mortality, increases in children’s height, higher enrolment rates in secondary and high school, better educational attainments, and a reduction in failure and drop-out rates between primary and secondary school.
Clearly, there are important lessons for South Asia from other countries as well, such as Thailand and Brazil that have reduced malnutrition to very low rates. First, an integrated multi-sectoral approach is needed. Second, if we invest in the right strategies, investing in nutrition has very high economic returns. Third, households respond to incentives, as has been demonstrated by the use of conditional cash transfers to encourage better nutritional practices. Fourth, the issue is not access to food alone, but access to income and information; more food per se will not necessarily solve the problem. And last, high level leadership is necessary to steer an initiative that if carefully designed and targeted can cost just about 0.5% of GDP annually.
The good news is that we see high-level commitment to addressing malnutrition across the region. Prime Minister Manmohan Singh has emphasised the importance of this issue and state nutrition missions have been launched. We know what works, what needs to be done and the remedies need not be expensive. We now need the political will to make sure that South Asians receive the adequate nutrition they need to become fully productive members of their societies. If we would take on the nutrition challenge, South Asia will build strong human capital for the future and we could experience even higher economic growth and far more impressive results in other indicators of development.
Kalpana Kochhar is the chief economist for the South Asia region, World Bank, The views expressed by the author are personal.