The 'Development Paradox' that Bangladesh is reported to be facing has many dimensions. Happily, one of those dimensions tends to belie the so-called "Asian Enigma' - implying usually high rates of child under-nutrition relative to its income levels as well sluggish reduction in under-nutrition. It is because the empiric has largely ignored Bangladesh's sustained reduction in child under-nutrition for at least two decades.
Among countries with the highest burden, Bangladesh has in fact been one of the most successful at reducing under-nutrition rates of mothers and children. From 1997 to 2011, for example, stunting rates among pre-schoolers fell from about 59 per cent to 40 per cent, with most of the reduction taking place in poor rural areas.
Derek Heady of the International Food Policy Research Institute (IFPRI) delved deep into the 'unheralded successes of Bangladesh. He prepared a policy brief for Leveraging Agriculture for Nutrition in South Asia (LANSA) (Issue 1, January 2015). The brief apparently claims a departure from the ongoing analyses relating to nutrition at least on two counts. First, while most statistical research on nutrition analysis so far identified determinants of nutrition at a single point in time, Derek's data merges together five rounds of Bangladesh's Demographic and Health Surveys (DHS) from 1997 to 2011. Second, the researcher applies statistical regression techniques and a simple linear decomposition to understand the sources of nutritional change over time. "This rare dynamic approach to studying nutritional change allows us to assess the drivers of nutritional change over time".
There is in fact a number of causes to explain the variations in nutritional intake, and the factors could range from individual to institutions--from household level indicators to community level indicators e.g., parental education, asset of households, prenatal care, order of child birth etc. Among individual factors, asset accumulation is reported to have made the single largest contribution, explaining one-fourths of the total explained change in child growth outcomes in Bangladesh (height for age or HAZ score).
Education of parents does matter for children's nutrition where maternal and paternal education together accounts for 26 per cent of the variations in nutrition. Interestingly and unsurprisingly perhaps, the bulk of this coming from maternal education gains (16 per cent) paripassu more rapid expansion of girl's secondary education supported by stipend programme. Thus women's education is needed not only to reduce birth rates but also to keep the kids physically fit.
Birth order and birth interval have sizeable effects too. For example, a firstborn child is about 7 percentage points less likely to be stunted than a child born sixth in a family. This suggests the important role of family planning. The author also finds that access to toilet - or eradication of open defecation - has reasonably a large effect on stunting, though it is a non-linear effect. Further, he finds a much stronger association between open defecation and child growth in urban areas, since open defecation is more harmful in high density populations where a given disease carrier (e.g. files) can reach more people. These results provide a substantial support for reducing open defecation at the community level such as in the Community Led Total Sanitation (CLTS) approach that was pioneered in Bangladesh.
LANSA's policy brief by Derek Heady does not stop with findings only. It stretches further to policy recommendations also. Analysing the contributory factors, one could reach the conclusions that continued improvement in child growth can come from: (a) investment in agriculture - noting that higher yield level of rice has some relations with raising weight of children or fortified rice could raise zinc level; (b) major progress in access to improved health services (which is very limited) such as community clinics with proper logistics; (c) continued broad-based economic growth - a rise in per capita income is necessary if not sufficient to improve nutritional outcomes; (d) dietary diversification connected with both nutritional programming and food policies - shifting away from mono-cropping systems to crop diversification would require changes in incentive packages and policy attentions and (e) expanded and enhanced nutrition programmes to improve infant and young child care and feeding practices which still remain well below in Bangladesh.
Besides the contents of the policy brief, we can also mention a few more points on Bangladesh. A priori reasoning would suggest a positive correlation between food and health indicators e.g., agricultural and health inputs grow, people would rise above malnutrition. But the improvements in nutrition status in Bangladesh, particularly child nutrition outcomes, have been relatively slow, despite remarkable improvements in the country's food sector as well as health sector.
At present, more than 40 per cent of children under-5 years of age are stunted, a whopping 51 per cent of children aged 6 to 59 months are anemic. A comparison with WHO norms of prevalence shows that the nutrition situation in Bangladesh is at a critical level. Thus, the continuing grim nutrition situation has been an issue of serious concern and also much of an enigma. The past four decades have seen a doubling of the GDP per capita and a reduction in the head count poverty index to 31.5 per cent from 75 per cent at independence, agricultural growth rate accelerating from less than 2 per cent per year between 1970 and 1989 to 3 per cent in the 1990s and to more than 4 per cent between 2006 and 2011; access to pure drinking water and sanitation and food intake increased but these developments do not seem to have translated into perceptibly nutritional improvement.
The issue of food safety and quality has received very little attention from policy- makers. The failure to ensure this aspect of food security is causing a huge public health burden. The existing food safety laws are outdated and few. More specifically, there is capacity constraint alone line ministries involved in food security.
In fact, the approach to achieve food security has been a partial one, with policy provisions focusing excessively on increasing the availability of food, primarily rice. The 'accessibility' pillar of food security has received little attention while the neglect of the 'utilisation' pillar is conspicuous by the dearth of appropriate policies and laws for ensuring food safety. The efforts in the health sector have largely concentrated on expanding the coverage of primary healthcare, with little consideration of equity and quality. Thus there exists a wide window of unexplored opportunity to align the remarkable increase in food production and advances in the health sector with nutrition considerations toward an improved nutrition status in Bangladesh.
The writer is a Professor of Economics at Jahangirnagar University.
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