Achieving MDG targets in nutrition: Does inequality matter?

Rashed Al Mahmud Titumir Bangladesh is one of the most malnutrition prevalent countries in the world. In addition, recent hikes in food prices have been impacting on the nutritional status of the people. Escalation of prices of essential commodities are not only forcing the marginalised people of the country to cut back on the quantity and quality of their food intake but also changing their consumption patterns -- aggravating malnutrition. A non-government organisation (NGO) carried out a research on "Achieving the MDGs Targets in Nutrition: Does Inequality Matter?" In its report, the organisation identified that social structure, unavailability of required nutrition, inadequate budgetary allocation and lack of requisite spaces for sporting facilities are contributing towards persistence of malnutrition. The report further observed that inequality prevailing in every sector creates barriers to the achievement of the targets of Millennium Development Goals (MDG). Inequality in stunted children exists in terms of sex, and division and wealth quintile. Female children are more stunted than male children. The percentage of the stunted (height-for-age) children might stand at 35 per cent in 2015 at the national level than that of the target of 31 per cent set in the MDGs. The report further adds the inequality scenario of wasted (weight-for-height) children. The rate (0.2 per cent) at which the reduction in the percentage of the wasted children has taken place since 1996-1997, gives an indication that the achievement of the target of MDGs of 8.0 per cent by 2015 might not be achievable. Division-wise, Chittagong might have a lower percentage (14.9 per cent) of the wasted children, and Barisal division may have higher percentage (21.3 per cent) than the other divisions by 2015. Moreover, the percentage of the wasted children has increased during 1996-1997 to 2007 in all wealth quintile groups (lowest, middle and highest). Making comparative analysis, the report further demonstrates that the rate in the percentage of the thin or malnourished [Body Mass Index (BMI) less than 18.5] women in Bangladesh has decreased from 52 per cent in 1996-1997 to 29.7 per cent in 2007 than that of the target of 20 per cent by 2015. This percentage decreased from 53.8 per cent to 32.6 per cent in rural areas and from 35.8 per cent to 9.6 per cent in urban areas during the same period. If these rates of decline prevail, the achievement of the targets of MDGs might be possible for rural and urban areas and for national level as well. The declining rate of the percentage of malnourished women indicates that all the divisions except Barisal and Sylhet might achieve the targets before the timeline. The current price hike of essential food commodities has a major impact on food security. The marginalised people of the country are forced either to cut back quantity of their food intake, or change consumption pattern due to excessive price hike of essential food commodities. The retail price of rice has increased from Tk 16 per kg in 2005 to Tk 32 per kg in June 2011. These increased trends of price of rice and wheat have resulted in decreased consumption of both rice and wheat- 442.21 grams in 2010 and 451.72 grams in 2005, showing a decrease of 9.51 (2.13 per cent) grams per capita per day during this period. This price hike may result in food insecurity and malnutrition, with adverse implications in both short and long term. In spite of initiatives taken by the government to address the problems of malnutrition, the improvement in nutritional status is not satisfactory due to several reasons. First, the problem begins with the existing social structure. Women are largely affected by the social discrimination from the beginning of their life within the family. They are subject to inferior diet than their male counterparts and become malnourished. This predetermined mindset has been prevailing from time immemorial and consequently malnourished mothers give birth to malnourished children. Secondly, successive governments including the current one have always claimed to have enough reserve of food. The claim has come into question because of the failure to ensure availability of required amount of food to marginalised sections of the society. The situation has been further aggravated due to lack of an effective public food distribution system. The policy of leaving market forces to determine the prices of food in some cases has resulted in predatory fixing of prices while the open market sales programme or the supply through safety net programmes remain limited. These market manipulations and the inadequacy of public food distribution system have a negative implication on the nutritional status. Thirdly, the proposed budgetary allocation of the government is lower than their committed amount in National Health Policy. The proposed budgetary allocation in health sector is Tk 88.89 billion in the current fiscal, which is 5.43 per cent of the total budget. However, the government has committed to allocate 7-12 per cent of the total budget in this sector for ensuring a healthy nation. This budgetary allocation for a population of 142.3 million is insufficient to cope with the problem of malnutrition of children and women. Lastly, minimal scope for physical exercise also leads children to malnutrition. Moreover, lack of open spaces for sports has resulted in unhealthy lifestyle for children being confined to their homes. Even if these children were to get a balanced diet in terms of nutrition, their mental-cum-physical growth would suffer due to lack of sport facilities. This is one of the emerging barriers to the balanced growth of children. The writer is a member of Unnayan Onneshon