Emphasizing Nutrition

School feeding programs, such as the one pictured here in Nikki (Serekale) in the north of Benin, are a vital way for countries to ensure children have access to nutritious meals.

The foods consumed by poor people are predominantly staple grains like rice, sorghum, and maize. These are cheap and can fill the stomach to quell hunger pains. But people, especially children, need more than cereals to live a healthy life. Good health depends on dietary diversity—adding protein from animal products, groundnuts, and legumes as well as the vitamins and minerals in fruits and vegetables.

In 2008, the British medical journal The Lancet attracted international attention with a series of articles on maternal and child malnutrition. A third of all early childhoods deaths are the result of malnutrition.¹ Yet nutrition attracts scant development resources. Over the past decade, international development assistance more than doubled, while funding to respond to malnutrition remained a tiny fraction of it. Between 2002 and 2007, the major donor nations—the United States, the European Union countries, and Japan—together spent less than 1 percent of all bilateral development assistance on malnutrition.²

Moreover, the many international agencies, research institutions, aid organizations, and others with a stake in nutrition have been described as “weak and dysfunctional,” while efforts to collaborate and coordinate efforts are seen as “broken.”³ Part of the problem is confusion as to how to categorize nutrition: is it a health issue or is it a food security issue? As a result, nutrition’s champions tend to be marginalized in both camps.

The Lancet series concludes that malnutrition should move to the top of the development agenda; the problem is too urgent to remain neglected.²² One article described a long-term study in Guatemala that followed people from early childhood to adulthood. The study shows that nutrition interventions can be relatively simple to administer.⁴ In 1969, young Guatemalan children in two communities were chosen to participate in a supplementation program that provided them with a nutritious drink twice a day. One group of children received a drink called Fresco, the other a drink called Atole that had more calories and protein. The group that received the high-calorie, protein-rich drink saw a 20 percent reduction in the severe stunting that is characteristic of malnutrition, while the children who received the other drink had virtually no reduction in stunting.⁵

Because the study followed these children into adulthood, it reveals some of the positive effects that good nutrition in childhood can have on adult outcomes. Follow-up studies 25 years later showed that children who received the more nutritious drink completed primary school at higher rates, scored higher on reading comprehension and cognitive tests, and completed more grades of school.⁶ The article, as well as others in The Lancet series, connected malnutrition with lost productivity and less economic development. As adults, the children who had received the Atole drink earned an average of $870 more per year than the other group. In Guatemala, where annual per capita income is just $2,440, this is a gain of 30 percent.⁷ Malnutrition costs Guatemala and other high-burden countries up to 3 percent of Gross Domestic Product (GDP).⁸

Breast milk provides all the nutrients a baby needs.

Understanding Malnutrition

When healthy foods are missing from children’s diets, one might assume these foods are not available. But sometimes there are other factors involved. Mothers may not have accurate information about what, how much, or how often to feed their children. For example, during the first six months of life, breast milk contains all of the nutrients a baby needs. Yet in a survey of 82 developing countries, less than 50 percent of mothers exclusively breastfed their children.⁹ Understanding the reasons for this gap is the key to creating an environment where more mothers can nurse.

Exclusive breastfeeding in the first six months protects babies from contaminated water. Each year, young children make up the greatest percentage of deaths caused by unclean water.¹⁰ Contaminated water and unsanitary living conditions increase children’s exposure to disease. Illness deepens malnutrition as conditions such as diarrhea keep children from being able to digest the food they eat. More than a billion people lack access to clean water—roughly equivalent to the number of hungry people. Eight out of 10 people without access to clean drinking water live in rural areas.¹¹ “There is an enormous amount of money invested in boosting access [to safe water and sanitation] and those improvements have not reached the poorest quintile [20 percent],” says Rolf Luyendijk of UNICEF.¹²

Rates of severe malnutrition rise during the “hungry season,” the period before crops are harvested. That season varies from country to country. In Niger, an extended hungry season has become a way of life. In 2010, the country was bracing for an upsurge in severely malnourished children. After Niger’s 2005 famine, the government drew up plans to equip health centers for the rapid deployment of medicine and therapeutic food. But Niger is one of the poorest countries in the world. The reality, according to Aboubacar Mahamadou, deputy director of nutrition at the Health Ministry, is that “few centers can really provide the care in terms of quality and quantity.”¹³

Emergency food aid is a lifeline for children in the hungry season. The United States, the largest food aid donor, provides up to half of the total food aid distributed each year. One concern about U.S. food aid is that the commodities donated do not meet the nutritional needs of young children. In 2007, wheat and sorghum accounted for more than half of all U.S. food aid commodities.¹⁴ Unfortified, these and other basic grains do not contain the nutrients, vitamins, and minerals young children need. Two other commodities often provided, a corn-soy blend and a wheat-soy blend, are not much better. These fortified blended foods were developed in the 1960s, when much less was known about the nutritional requirements of pregnant women, new mothers, and young children.¹⁵

Linking Agriculture and Nutrition

Planting crops high in micronutrients is another strategy to ensure that children get the healthy foods they need. Increases in international funding for agriculture present an opportunity to develop stronger linkages between food security and nutrition. But historically, agricultural programs have rarely focused on improving nutrition.

In Bangladesh, as in other countries, improvements in women’s social and economic status have led to better child nutrition outcomes.

One of the most celebrated exceptions is a USAID-funded program implemented by Helen Keller International (HKI) in Bangladesh from 1993-2003. In Bangladesh, a poor family’s diet consists of rice and little else. Child malnutrition rates are among the highest in the world. When the program started, 30,000 Bangladeshi children were going blind each year from Vitamin A deficiency.¹⁶ Poor families didn’t have enough money to purchase vegetables regularly, and seasonal scarcities were common. Once HKI provided resources to families to plant homestead gardens with nutrient-rich vegetables, families had vegetables to eat year-round.

The families received seeds and other inputs, plus education about how various vegetables would benefit their family’s health. The program started small with 1,000 households. By the end of 2003, nearly 5 million people were benefiting—about 4 percent of the entire population of this populous nation—and the program was operating in 210 of Bangladesh’s 460 districts.¹⁷

By all accounts, the program has been a success. HKI reported that children in households that planted the gardens consumed 1.6 times more vegetables than children in households that did not.¹⁸ Moreover, the households earned on average an additional $8 per month by selling their surplus. Studies also showed that families used this extra income to purchase additional healthy foods not grown in their gardens, such as legumes and animal products.

Millions Fed, a 2009 report by the International Food Policy Research Institute, named homestead food production in Bangladesh as one of the great innovations in agriculture programming of the past half century. Homestead food production continues to expand in Bangladesh, living proof of its sustainability beyond the initial investment of $5 million by USAID. The government of Bangladesh supports the program through the Department of Agricultural Extension and donor countries promote it. Perhaps most telling as a gauge of success, homestead food production is now used in scores of other countries.¹⁹

Issues