Approaches That Work
To succeed, the fight against malnutrition must be waged on many fronts.
Actions as diverse as improving women's access to education, fortifying staple foods with essential nutrients, enhancing the spread of practical information and increasing government social-sector spending have all led to improved nutrition in a number of countries. The challenge is in devising overall strategies that address specific nutrition problems.
The range of factors necessary for nutrition improvement was explored in a recent study by the United Nations,1 which confirmed that there is no one formula to follow but that certain elements are essential.
For example, the empowerment of women is of central importance to improving nutrition of both women themselves and their children. This includes legislative and political efforts to combat discrimination against and exploitation of women and measures to ensure that women have adequate access to resources and care at all levels of society. Improving education for girls and women is also vital.
The United Nations report had this is to say about the following specific factors involved in improving nutrition.
Nutrition and economic growth: Most countries in which nutrition has improved over the last two decades also enjoyed relatively high rates of economic growth over a sustained period. Nonetheless, the relationship is not completely straightforward.
In countries where economic growth has resulted in increased household income and resource access for the poor, the nutritional pay-off has been large. In Indonesia, for example, economic growth from 1976 to 1986 was accompanied by a 50 per cent rise in the income of the poorest 40 per cent of the people. Im prove ments in nutrition have been relatively constant throughout the economic boom, although they could have been even better.
Household food insecurity -- one of the key underlying causes of malnutrition -- is often the pivotal point in the relationship between economic growth and nutritional status. Poor households spend a large proportion of their income on food. While poor households do not always use income increases to raise their calorie consumption significantly, in many countries greater income has led to in creased consumption of higher-quality foods that tend to be rich in protein and micronutrients -- the vitamins and minerals needed in very small but regular amounts to assure nutrition.
But while economic growth must be understood as a frequent contributor to nutrition improvement, it is not a necessary condition for it. A number of countries, such as the United Republic of Tanzania in the case described below, have achieved widespread nutrition improvement without significant overall economic growth.
Nutrition and the status of women: A major conclusion of the United Nations report is that in countries where nutrition improvement has lagged behind economic growth, social discrimination against women is common. In Pakistan, for example, widespread discrimination against girls and women is behind high levels of illiteracy among women and girls, a very high fertility rate and lower female life expectancy. Child malnutrition rates in Pakistan are among the highest in the world, as is the proportion of low--birthweight infants, at 25 per cent.
Some experts place the major blame for the very high child malnutrition and low birthweight throughout much of South Asia on such factors as women's poor access to education and low levels of employment, compared with other regions.
On the other hand, women in Thailand, where nutrition has improved remarkably in the last two decades, have very high literacy, high participation in the labour force, and a strong place in social and household-level decision-making.
Photo: Growth monitoring is a powerful tool to protect children's nutrition and to empower communities. A child is weighed at a health centre in Ethiopia.
Nutrition and social-sector spending: Investment in health, education, sanitation and other social sectors -- especially with emphasis on access of women and girls to these services -- is among the most important policy tools for improving nutrition.
As a child survival and development measure, UNICEF has cham pioned the 20--20 Initiative -- the allocation of at least 20 per cent of government spending to basic social services to be matched by 20 per cent of donor funding in these areas. The value of such investment is becoming increasingly apparent. For example, there is evidence from Sri Lanka and a number of other countries that increases in spending on public health services are more strongly associated with reduced infant mortality and better nutrition than are overall increases in income.
After Zimbabwe achieved independence in 1980, explicit policies were followed to redress the lack of access of many communities to basic services. As a result, there were vast improvements in health services and immunization, family planning and a range of educational services for the poor -- all of them important determinants of the improvements in nutrition that the country has enjoyed.
The approaches described above are all essential -- and driven by the right of children and women to adequate services and resources.
Actions that are more directed to nutrition improvement as a principal outcome -- improving the quality of staple foods through fortification, improving local-level nutritional surveillance capacity, protecting women's right to breastfeed, sharing information on better complementary foods -- may have a more rapid and focused effect on nutrition.
A number of these more direct approaches that have worked are described below.
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