Stunted children of South Asia

Malnutrition has many measures and the most significant one is the stundedness of the children. A stunted child attains short height that does not justify his/her age. International Journal Maternal and Child Nutrition (2016) presents substantive evidence that 38 per cent children in South Asia have a stunted growth caused by the nutritional deprivation. 64 million children under the age of five years are stunted children and mainly they fall in India and Pakistan.

Stunting is the cause of death of one million children annually. Stunting causes physical and neurocognitive damages which are mostly irreversible. Stunted children have stunted brains, bodies and typically lead stunted lives. The development of the whole society is dwarfed. Good nutrition means healthy children-brighter future and sustainable prosperity. Tragically, women who are themselves malnourished tend to bear stunted children, perpetuating an intergenerational cycle of ill-health and exclusion.

South Asia remains the epicenter center and the issue has yet to attain due attention by the respective governments. Alarmingly, alone South Asia is bearing 40 per cent of the global share of the stunted children. Even other regions like sub-Saharan Africa (37 per cent), East Asia and Pacific (12 per cent) and Latin America with 11 per cent have left South Asia far behind. Geneva based FAO’s economist Mr Ahmad Mukhtar sees “stunting needs to be addressed quickly for that the rate of population growth, in the region would only exacerbate this problem. Governments, and other development partners, should focus on improving food and nutrition availability and quality and prioritise required policy actions towards the most vulnerable groups of women and children. Such actions ought to be comprehensive, collaborative and sustainable”.

The WHO in 2016 revealed that in Pakistan 42 per cent of children (9.6-9.9 million) under the age of five years are stunted, 31 per cent are underweight (low weight for age) and 14 per cent are wasted (low weight for height). Approximately 39 per cent children have no access to sanitation, 9 per cent have no access to water. In absolute terms, India and Nigeria lead Pakistan.

Universally, Peru is considered to be a role model to overcome stunting. In 2005, 28 per cent Peruvian children were suffering from stunting; in 2013 they were 14 per cent. Peru pursued comprehensive policies and programmes, earmarked adequate budgets, massively involved communities and convincingly reaped overwhelming successes. India, Pakistan and Nigeria can learn from the Peruvian model.

Today half of the 594 million people living in India defecate in the open. Open defecation leads to contamination that can spread diseases and infection and making infants and children more vulnerable. According to a report of The Straits Times India homes the world’s largest number of stunted children due to lack of toilets, dirty water, poor hygiene. With 48 million children under the age of five, India has more stunted children than Pakistan, Nigeria, China and Congo combined. World Bank’s estimates suggest that India loses 6.4 per cent of its GDP ($53.8b) due to its sanitation crisis.

Though Jaswant Singh termed Manmohan Singh’s (2004-2014) rule as India’s decade of decay however under this period stunted children reduced from 49 per cent to 39 per cent. Mr. Manmohan Singh admitted that the desecration of was Babri Mosque was a stigma on India’s forehead. World Bank’s president Mr Jim Yong Kim declared stunting as a stain on “our collective conscience”. On both collections, more responsibility is expected from Mr Modi. Time and again celebrated Nobel Laureate Amartya Sen has stated that as an Indian he does not like to see Mr Modi as the prime minister of India. He has massively accused him of neglecting basic education, healthcare, nourishment and failing to protect minorities. On the recent demonetisation spree of India Mr Sen found it “minimal achievement and maximum suffering”.

On children Mr Modi has reminded me of Thomas Hardy’s The Children and Sir Nameless. His claim of governance can be set aside by the state of the children in the state of Gujarat, where he ruled for a dozen years before donning the mantle of prime ministership. Gujarat is disaster for children; among all states of India it has 41.80 per cent (highest prevalence) children as stunted, 33.50 per cent underweight and 56.90 per cent underweight adolescent girls. Kerala, Manipur and Mizoram produced best results, not Gujarat. In 2015 the Economist reported that states ruled by the BJP performed worse than those ruled by the rivals on public welfare programmes.

In 2012 Mr Modi in an interview with Wall Street Journal ignored child malnutrition saying, “The middle class is more beauty conscious than health conscious.” In 2016 India has cut its health budget and brought it to 1 per cent of the GDP, far behind China’s 5.5 per cent.

A stunted child is a stunted man and will lead to a stunted family. Like poverty, it is a parallel vicious circle. Karin Hulshof at UNICEF advises governments of this region to invest in the social sector: “South Asian nations must invest in large scale programmes along with equity-focused social and economic policies for the prevention of stunting. These governments must be based on evidence and give priority to the most vulnerable children and women”. Through the World Health Assembly, all South Asian economies are signatory to reduce 40 per cent of the current prevalence of stunning by 2025. Question is with the ongoing trends of spending on social sector, will these countries be able to honour their commitments. Empirical data is contrary to the rhetoric. Consistent political will be required to undo current stunting prevalence among children. UNICEF’s findings estimate that every 1$ invested in nutrition produces 18$ in economic returns.

Sustainable Development Goals (SDG) are in vogue sine January 2016. Goal three of SGDs seeks to ensure healthy lives and promote well-being for all and at all levels has also been recognized by the government of Pakistan. Pakistan’s health budget for 2015-16 has been enhanced from 0.42 per cent of GDP to 0.45 per cent however it is still less than that of 2013-14 and of 2014-15. For these two years it was 0.69 per cent and 0.73 per cent respectively. Pakistan’s annual Economic Survey 2015-16 does not even highlight the prevalence of stunted children in Pakistan. Yet it admits that Pakistan is spending $37 per capita on health whereas the minimum recommended from WHO is $44 per capita on required health services.

World Bank’s recently released Pakistan Development Update forecasts that its economy will grow at 5.4 per cent for fiscal year 2018 on the back of continued mushroom growth in services sector, recovery of agriculture and uptick in the development of infrastructure. At the same time Pakistan misses its growth target of 5.4 per cent for fiscal year 2016. World Bank’s country director for Pakistan Patchamuthu Illangova advises Pakistan to increase spending on health, education and nutrition as this would lead to a vibrant and dynamic society and economy.

Already Pakistan has pushed polio occurrence to near zero. Pakistan is capable of overcoming stunting through strong leadership and by the actions of the key actors-government, international partners, communities and parents themselves.

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