Of the estimated more than 20 million low-weight births each year in the developing world, more than half occur in South Asia and more than one third in India.
Contributing to the problem is that only one in four births is weighed in South Asia, making it the region with the largest proportion of unweighed births.
With a rate of 46 per cent, the levels of children underweight in South Asia are staggering. Three countries – India, Bangladesh and Pakistan – account for half the world’s underweight children, despite having just 29 per cent of the developing world’s under-five population. Underweight prevalence in the region declined from 53 per cent in 1990 but the average annual rate of 1.7 per cent is insufficient to meet the MDG target. Yet five of the region’s eight countries are on track to halve the proportion of under-fives who are underweight by 2015.
Bangladesh, despite declines in underweight prevalence between 1990 and 2004, still has the second highest proportion of children underweight after Nepal. Both India and Pakistan are making progress but it is insufficient. Bhutan reduced its underweight prevalence by half in about 10 years, and Afghanistan and Maldives have also made significant progress.
In South Asia other forms of undernutrition have persisted – 44 per cent of under-fives are stunted and 15 per cent are wasted. In many countries, a chronically poor diet and lack of access to safe sanitation is compounded by gender discrimination. South Asia is the only region in which girls are more likely to be underweight than boys. In India, one out of every three adult women is underweight23 and therefore at risk of delivering low birthweight babies.
While most infants are initially breastfed, only 38 per cent are exclusively breastfed for the first six months. Regionally, only half of households consume iodized salt, but Bhutan has shone, becoming the first country in the region to achieve universal salt iodization.24
Advances have been made in vitamin A supplementation. More than 85 per cent of children between the ages of 6 months and 5 years in Afghanistan, Bangladesh, Nepal and Pakistan are now protected by twice-yearly doses of vitamin A.
In Pakistan, food security and nutrition surveys undertaken shortly after the October 2005 earthquake showed no declines in the immediate nutritional status of children under five. Even the highest levels of wasting found were below the national average of 13 per cent.25
23 International Institute for Population Sciences (IIPS) and ORC Macro, National Family Health Survey (NFHS-2), 1998–99, IIPS, Mumbai, 2000, p. 245.
24 Universal salt iodization is considered achieved when 90 per cent or more of households consume iodized salt.
25 ‘Health & Nutrition Survey in Earthquake Affected Areas, Pakistan’, UNICEF/WFP/WHO Joint Survey in collaboration with the Ministry of Health and National Institutes of Health, Islamabad, January 2006 (internal document).