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Indian malnutrition before age 2
Indian malnutrition before age 2
Sadly the worst malnutrition comes from poor nutrition info and strikes babies before age two. The recent UN report is key to ending foolish feeding practices in India. This problem is bigger than diseases and affects millions of children:
Report Warns Malnutrition Begins in Cradle
By CELIA W. DUGGER
Nutrition education programs for parents would do a better job than large and politically popular feeding programs in fighting the rampant malnutrition that is stunting the development of more than 100 million children worldwide, a new World Bank report says, finding that a lack of food is usually not the main cause of child malnutrition.
Children are irreversibly damaged by malnutrition by age 2, long before they begin primary school. The World Bank report contends that aid efforts must concentrate on the brief window of opportunity before that age. And in areas not hit by famine or other crises, the report says, efforts must focus more on teaching mothers to properly feed and care for babies and toddlers than on school meal programs.
While experts interviewed yesterday generally agreed with the bank's assessment of the evidence on malnutrition, some of them argued that feeding programs did have an important role to play in improving the nutrition of children.
The debate about how to tackle the problem is an important one at a time when the world is pushing to reduce child mortality by two-thirds over the coming decade. Malnutrition is implicated in more than half of the deaths of children globally, "a proportion unmatched by an infectious disease since the Black Death," the bank's report says.
The World Bank, as the International Bank for Reconstruction and Development is popularly known, is the largest financier of antipoverty programs in developing countries. Its report, titled "Repositioning Nutrition as Central to Development," maintains that countries like India with staggering rates of malnutrition need to change their approach to speed up progress.
Outside of regions in crises, nutritionists at the bank say, programs should shift their emphasis from directly providing food to changing the behaviors of mothers – for example, to breast-feed exclusively for the first six months of life or seek quick treatment for their children's diarrhea. Improvements to sanitation and health care are also needed.
The origins of malnutrition often lie in the way infants and young children are fed, not the quantity of food available.
In many societies in Africa and South Asia, the first days of thick, yellowish breast milk, called colostrum, are discarded, though it contains antimicrobials that can protect children against infection. It is then replaced with local concoctions that all too often include bad water that can give children diarrhea. For school-age children, nutrition education, iron supplements and deworming medicines are usually better investments for improving nutrition than providing meals, the report says. It acknowledges that feeding programs increase school attendance, but emphasizes that they should not come at the expense of efforts to reach preschool children.
"You get more bang for your buck without the food," said Meera Shekar, the lead author of the report, who described feeding programs as costly and vulnerable to corruption. "The food brings in votes for politicians. We have very little evidence it improves nutrition."
Advocates of feeding programs reply that food can be a magnet that draws mothers and children to centers where nutrition counseling is offered – and that food itself can provide pregnant women and children under 2 with a richer, more varied diet, while attracting older children to school and helping them concentrate on learning.
"If you feed the children well, they'll all be there," said Jean Dreze, an economist and leading advocate of free lunch programs in India, which now serve more than 100 million primary-school students. "The response to food is phenomenal."
Some of the facts about malnutrition, familiar to experts but not widely understood, seem counterintuitive. For example, rates of malnutrition in South Asia, including India, Bangladesh and Nepal, are nearly double those in sub-Saharan Africa, which is much poorer.
India's programs to feed children in school have multiplied in recent years, but its nutrition program for preschool children mainly assists those between the ages of 3 to 6 – too late to prevent the stunting and damage to intellect that occur by age 2, bank nutritionists and other experts say.
A spokesman for the Indian Embassy in Washington said yesterday that he had not yet read the report and could not comment on it.
The problem of malnutrition in India, known for its well-educated, high-tech workers, is striking. Almost half the children are stunted by malnutrition, but the problem is not limited to the poor. A quarter of the children under age 5 in the richest fifth of the population are also underweight and nearly two-thirds are anemic, the report says.
"Think of the power of India if all these kids were not malnourished and could participate fully," Ms. Shekar said.
Nutritionists say the implications of the large body of research that informs the bank's report is clear: countries must intervene before children turn 2.
"If you miss that period, the damage is irreversible, especially in cognition, but also in growth," said Marie Ruel, director of the division of food consumption and nutrition at the International Food Policy Research Institute.