Bangladesh's overall hunger and undernutrition situation has gradually improved since 2000, but a closer look at the underlying picture reveals reasons to be worried.
In 2000, Bangladesh suffered from an "alarming" level of hunger on the Global Hunger Index (GHI). In five years, the hunger level shifted from "alarming" to "serious", and has remained at this level until 2019 when the latest index was released.
This, according to the GHI scale, indicates that the overall level of hunger has decreased.
The GHI is a peer-reviewed annual report, jointly published by Concern Worldwide and Welthungerhilfe, that is designed to comprehensively measure and track hunger at the global, regional and country levels. The aim of GHI is to trigger action to reduce hunger around the world.
The GHI is based on four component indicators – undernourishment, child stunting, child wasting, and child mortality.
Over the course of 19 years, Bangladesh has made progress in each indicator, except child wasting which has fluctuated since 2000. The 2019 data show that the rate of child wasting, which is subject to seasonal variation, is higher than that in 2000.
Bangladesh has thus made steady progress both in the overall hunger situation and in performances in individual indicators of the GHI.
In spite of this, women and children in Bangladesh still face nutritional challenges. What they eat does not meet the necessary nutrition intake requirements.
Poor nutrition, low dietary diversity
Rice is the main staple of Bangladesh. The country is self-reliant in rice production as it produces enough rice to meet its domestic needs.
Nevertheless, it is the poor access to food that remains an ongoing problem.
As much as 15.2 percent of the population is still considered undernourished and does not have sufficient access to calories, the 2018 GHI report says.
Experts say consumption of an imbalanced diet plays a key role in malnutrition, which is a risk factor for chronic diseases.
"One can get 2,100 kilocalories in a day by only eating rice. But if someone eats rice, he gets energy only from rice. The demand for protein, fat, vitamins and minerals in his body is not being met," Khaleda Islam, professor at the Institute of Nutrition and Food Science of the University of Dhaka, told The Business Standard.
She said deficiency of protein, fat, vitamins and minerals leads to anemia, immune system loss and various other problems.
At present, the calorie intake of Bangladeshis – 2,210 kilocalories in a day – is close to the global average. However, nutritional deficiencies continue because of deficiency in animal protein and higher dependency on rice.
The GHI report also points to the lack of dietary diversity, saying that this, along with micronutrient deficiencies, is prevalent in the country.
Bangladeshis get around two-thirds of their calories from rice. Vegetables and fish, in addition to rice, also are key components of the diet.
Child stunting still a concern
Despite the problem of stunted growth in children showing a downtrend in recent years, it is still a big concern.
The GHI report says this may be explained by the nutrition status of pregnant mothers.
In 2015, 22.6 percent of Bangladeshi babies were born with low birth weight, and there is evidence that this condition contributes to child stunting.
Stunting begins even before birth. According to a 2018 study of children in the urban slums of Bangladesh, the length of babies at the time of birth and socioeconomic status independently influenced stunting at the age of 12–24 months, whereas dietary diversity and exclusive breastfeeding did not show significant effects.
Another 2018 study involving people in Dhaka's Mirpur area showed that a child's size at birth and the mother's weight were strongly associated with the child's height at age two.
According to the Health Bulletin 2018, 22 percent of children are born with low birth weight, 31 percent are stunted, 8 percent are wasting and 22 percent are underweight.
The problem is aggravated by a high rate of teenage pregnancy, which puts a nutritional strain on the developing fetus because the mother's body is still growing and has greater nutrition needs, according to the GHI report.
In 2014, 31 percent of 15-to 19-year-old women had already given birth, down from 33 percent in 1993-94.
Diets are commonly inadequate for children under the age of two, a period when proper nutrition is considered critical to healthy development.
According to the 2014 Bangladesh Demographic and Health Survey, 77 percent of children under the age of 24 months receive age-appropriate breastfeeding, but just 23 percent of children aged 6–23 months were fed the "minimum acceptable diet".
The minimum acceptable diet is a standard that combines minimum dietary diversity and minimum meal frequency. It has different recommendations for breastfed and non-breastfed children.
Health status affects nutrition
The GHI report says studies have shown a potential connection between childhood stunting and environmental enteropathy, a condition involving abnormal intestinal function due to exposure to environmental pathogens.
A 2015 study in Tangail showed that E. coli bacteria were commonly found in soil that nearly 30 percent of children were reported to have consumed within the preceding week. These children were twice as likely to be stunted as other children nine months later.
Evidence from other rural parts of the country also suggests that environmental contamination characterised by poor water, sanitation, and hygiene conditions in the household causes faltering growth by means of environmental enteropathy.