Malnutrition in children: A dent in the multifaceted growth of South Asia

With an annual growth of 7 percent since 2014, South Asian economies have become the fastest growing sub region in the world. Within these economies, Bangladesh, India, and Nepal have contributed to this strong growth trajectory, and are anticipated to contribute up to 2.8 percent in 2021, by the World Bank. 

The economy of Bangladesh, India and Pakistan have flourished over the years due to an increase in private consumption in telecommunication and a reduction of prices of resources such as cotton and oil. 

The Nepalese economy bloomed through private consumption and continued strength in investment, supported by the progress on earthquake reconstruction projects. 

The Sri Lankan economy saw a 7.6 percent reduction of urban and rural poverty from 2006 to 2010 and literacy increment of 0.53 percent from 2010 to 2018.

Similarly, Afghanistan's economy steadily improved in the last decade by 3.9 percent in 2019, due to the return of a large number of wealthy expats, the modernization of the nation's agriculture sector and the establishment of more trade routes with neighbouring and regional countries. 

Once placed in the list of the world's 20 poorest countries, Maldives now is regarded as an upper-middle income country driven by the rapid growth of its tourism and fisheries sectors. It has also made considerable improvement in education as its literacy rate stands at almost 98 percent today from 87.12 percent of 1977.

Bhutan enjoys solid growth and macroeconomic stability, with hydro-power construction, supportive fiscal and monetary policy contributing to this growth. Single-digit inflation, a stable exchange rate, and accumulating international reserves attest to this stability. It has also made tremendous progress in reducing extreme poverty by 3.8 percent since 2012 to 2017.

Despite setting an exemplary standard of economic progress, South Asia is still facing the daunting burden of a global plague known as child malnutrition, which is relatively more acute in this region.

According to the World Health Organisation (WHO), stunting of a child is a failure to grow physically and cognitively due to chronic or recurrent malnutrition. 

Wasting, or acute malnutrition, is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death. icddr,b defines underweight as abnormally low weight-for-age. 

In Bangladesh, severe and acute malnutrition have overwhelmingly affected a majority of the children populace; anaemia affecting 52 percent, stunting affecting 41 percent, wasting affecting 16 percent and underweight children comprising 36 percent. 

Recent developments show a decline in child chronic malnutrition, as measured by stunting levels, which fell by 14 percent from 2013 to 2019

The common denominator for malnutrition in India has been linked to deficiency of Vitamin A, iron, iodine, zinc and folic acid - causing the deaths of more than 3,000 children under five years of age daily, while every second child in this group is suffering from malnutrition. 

Chronic malnutrition in Pakistan has stunted the growth of more than 44 percent of children. Every year, 35 percent deaths occur due to malnutrition. Only 38 percent of children are exclusively breastfed for the first six months of their lives. Consequently, deficiencies in vitamin A, zinc, and vitamin D in children under five-years-old ranges from 40 percent to 50 percent while 62 percent children are anaemic.

In Nepal, nutrition rates in children substantially declined over the past two decades. From 1996 to 2016, stunting decreased by 21 percent, prevalence of underweight and child wasting was reduced by 15 percent and by five percent, respectively. 

Each year vitamin A deficiency is responsible for the deaths of 9,000 children and causes permanent blindness in 2,500 children. Nearly 21 percent of children suffer from zinc deficiency. 

Sri Lanka suffers from 17.3 percent stunting. A Health Ministry study revealed more than 50 percent of children in the country are suffering from vitamin D deficiency. Despite insufficient data, small studies suggest that nearly 57 percent male and 50 percent female preschool students were found to be zinc-deficient. 

Twenty-two out of 34 provinces in Afghanistan are in risk of acute malnutrition. The 2013 National Nutrition Survey found that 25 percent of children under the age of five were underweight, 45 percent suffered from anaemia, and 41 percent were reported to suffer from stunting. Wasting prevalence was 9.5 percent. Children under the age of five also suffer from vitamin A deficiency, children aged between 7 to 12 predominantly suffer from iodine and vitamin D deficiency while 81 percent children aged between 6 to 59 months suffer from vitamin D deficiency. The 2018 drought only made the situation worse.

On an optimistic note, the health status of children in the Maldives has improved dramatically. The number of malnutritioned children has nearly halved. Despite these improvements, malnutrition rates for children remains high for a middle-income country - one in five children are stunted. 

Additionally, 17.3 percent of children are underweight while 10.6 percent are wasted.

In Bhutan, keeping regional variations in mind, several reports suggest that around 16 to 34 percent of children are stunted, 7 percent are underweight, 35 percent aged between 6 to 59 months are either anaemic or iron deficient. 

South Asia bears the highest risk, with 3.9 million more children aged  under five expected to suffer from wasting because of Covid-19. 

Wasting is only the tip of the iceberg as it is most likely to increase stunting and micro-nutrient deficiencies due to poorer diets resulting from greater poverty and hindrance in nutrition services. Hence, a key indicator of economic inequalities and discrimination in this region also lies in the general access to nutritious food.

Several international legal instruments have guaranteed the right to nutrition. It is also important to ensure that the vulnerable population has effective access to adequate, healthy and nutritious food, through the inclusion of a rights-based framework. 

Given the current mechanism for action, there are many obstacles to implementation, including insufficient food supply, poverty, increased health-care expenses and financial illiteracy.

The heads of the four United Nations agencies are therefore calling for the protection of children's right to nutrition by ensuring access to nutritious, safe and affordable diets, investing in support for maternal and child nutrition, early detection and treatment of child wasting, maintaining the provision of nutritious and safe school meals and expanding social protection to safeguard access to nutrition.

The challenge of eliminating malnutrition is one that needs to be addressed through a coordinated effort. As a result, private and public institutions in South Asia need to combine their hands for a healthier future, otherwise the exemplary multifaceted developments achieved by this region in other fields throughout the years will lose their importance to a large extent.  

Alaikah Ahmed is an LLB student of BPP University, UK.

Tasnim Nishat Bushra is an aspiring lawyer currently pursuing LLM.

Arafat Reza is employed as a teaching assistant at LCLS(South).