Almost half, or 46 per cent, of all South Asian children are underweight – a total of 78 million. Three South Asian countries – India, Bangladesh and Pakistan – account for half the world’s underweight children, despite being home to just 29 per cent of the developing world’s under-five population. More than 50,000 children die in Nepal each year, with malnutrition the underlying cause in over 60 per cent of these deaths. Another 44 per cent of the region’s children are stunted which means they are of a low height for their age and 15 per cent are wasted, weighing less than would be expected for their height.
Low calorie intake, poor access to health services, and lack of sanitation facilities all contribute to malnourished and undernourished mothers and children, as does the gender discrimination that marks the region. South Asia is the only region in the world in which girls are more likely to be underweight than boys: 47 per cent compared to 44 per cent. Lack of education makes women unaware of how to access resources and provide necessary care to their families. Malnourished and anaemic mothers are often ill during pregnancy.
Exclusive breastfeeding is not as widespread in South Asia as it should be because many societies have traditions that introduce children to solid foods too early. While most infants are breastfed initially, only 38 per cent are exclusively breastfed for the first six months. There is wide variation among countries, ranging from 84 per cent of babies exclusively breastfed in Sri Lanka to just 10 per cent in the Maldives. Micronutrient deficiencies that impair intellectual development and cause ill health are common.
Yet there are successes. Bangladesh cut underweight prevalence from 66 per cent to 48 per cent between 1990 and 2004; and Afghanistan, Bhutan, Maldives and Sri Lanka are on track to reach the MDG target of halving underweight prevalence by 2015.
UNICEF works with governments, health providers and communities throughout South Asia to promote exclusive breast feeding, to help ensure children can access sustainable micronutrient programmes, to establish nutrition assessment and surveillance systems, and to advocate for programmes to prevent malnutrition.
Severe malnutrition is frequently a problem in emergency situations. Following the Pakistan earthquake, UNICEF gave therapeutic feeding to severely malnourished children under age five, and set up primary health care facilities to address maternal and child health, emergency obstetric and neonatal care. The earthquake also exposed the high levels of chronic malnutrition among Pakistan’s children, not just in the affected areas but throughout the country. UNICEF is now planning programmes to address this.
In India UNICEF’s collaborations with state governments have established projects through which mothers of severely malnourished children are taught-by-doing how to prepare adequate complementary food and how to breastfeed. They learn the importance of other key caring behaviours as well.
In Afghanistan, a UNICEF project combines education on balanced diets with information on health and hygiene practices, and encourages mothers to seek prenatal care and essential vaccinations.
With UNICEF’s help, almost all countries in South Asia have adopted the International Code of Marketing of Breast Milk Substitutes, and all countries have developed and begun to implement national plans of action on nutrition.