The State of the World's Children 1998: Summary

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Malnutrition: Spotlighting the causes

An understanding of the causes of malnutrition is important to appreciating the scale and depth of the problem, the progress achieved to date and the possibilities for further progress that exist.

Immediate causes

The interplay between the two most significant immediate causes of malnutrition — inadequate dietary intake and illness — tends to create a vicious circle: A malnourished child, whose resistance to illness is compromised, falls ill, and malnourishment worsens.

Underlying causes

Three clusters of underlying causes lead to inadequate dietary intake and infectious disease: inadequate access to food in a household; insufficient health services and an unhealthful environment; and inadequate care for children and women.

  • Household food security

    This is defined as sustainable access to safe food of sufficient quality and quantity to ensure adequate intake and a healthy life for all members of the family. Household food security depends on access to food as distinct from its availability. There may be abundant food available on the market, but poor families that cannot afford it are not food secure.

  • Health services, safe water and sanitation

    An essential element of good health is access to affordable, good quality health services. In as many as 35 of the poorest countries, however, 30 to 50 per cent of the population may have no access to health services at all. The lack of ready access to a safe water supply and proper sanitation and unhygienic conditions in and around homes have significant implications for the spread of infectious diseases. More than 1.1 billion people still lack access to safe water, and about 2.9 billion people lack access to adequate sanitation.

  • Caring practices

    Care is manifested in the ways a child is fed, nurtured, taught and guided and is the responsibility of the entire family and the community. The following caring behaviours are most critical.

Feeding: Breastfeeding provides the best nourishment and protects children from infection. However, a child must have

Photo: UNICEF/93-1726/Lemoyne complementary foods at the six-month point, since breastmilk no longer meets all nutritional needs. From about 6 months to 18 months of age, the period of complementary feeding, a child needs frequent feeding — at least four times daily — and requires meals that are both dense in energy and nutrients and easy to digest.

Protecting children's health: Children must receive essential health care at the right time. Immunizations, for example, have to be carried out according to a specific schedule. Sound health information needs to be available to communities, and families need to be supported in seeking appropriate and timely health care.

Providing emotional support and cognitive stimulation for children: For optimal development, children require emotional support and cognitive stimulation from parents and other caregivers. Several studies have found that malnourished children who were given verbal and cognitive stimulation had higher growth rates than those who were not.

Caring for and supporting mothers: The unequal division of labour and resources in families and communities that favours men jeopardizes the well-being of both children and women. The elements of care most critical for women during pregnancy and breastfeeding include extra quantities of good-quality food, release from onerous labour, adequate time for rest, and skilled pre- and post-natal health care from trained practitioners.

Basic causes

Political, legal and cultural factors may defeat the best efforts of households to attain good nutrition. These include the degree to which the rights of women and girls are protected by law and custom; the political and economic system that determines how income and assets are distributed; and the ideologies and policies that govern the social sectors.

Overcoming entrenched poverty and underdevelopment requires resources and inputs that few developing countries can muster. In 1995, aggregate resource flows to the developing world from all sources totalled $232 billion, with $156 billion of that from private investment and loans. Yet the two regions of the world with the highest rates of childhood malnutrition — sub-Saharan Africa and South Asia — received only $1.6 billion and $5.2 billion respectively.

At the same time, developing countries overall owed more than $2 trillion in external debt in 1995. If the basic causes of malnutrition are to be addressed, greater and better-targeted resources and better collaboration are needed between sections of national governments and between governments and all development partners, including donors, UN agencies, non- governmental organizations (NGOs) and investors. Above all, the poor themselves must be a major part of the process.

Action against malnutrition is both imperative and possible. The world, as the next part of this report explains, has already accumulated a wealth of experience and insight on which progress can be built.

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