Food security versus malnutrition

Bangladesh has achieved self-sufficiency in rice production and has already exported 25,000 metric tonnes to Sri Lanka. Now a move is under way to export rice to food-deficit north-eastern states of India. This is a welcome development. But it does not certainly suffice for all that the country really needs to do to cut malnutrition and poverty in the country.
A recent study, released by the World Food Programme, has found alarming level of malnutrition in several districts of Sylhet and Chittagong divisions. These are relatively two better-off regions in terms of poverty status. Sadly, the rate of malnutrition in those areas is the highest.
The WFP and the Bangladesh Bureau of Statistics (BBS) jointly conducted the study.
According to WFP's Vulnerability Analysis and Mapping Unit official Kayenat Kabir, the nutrition status of the south- and the south-western regions is better than that of the country's two other relatively developed regions.
The situation in Sylhet division, however, is the worst. Stunting and underweight rates have been found not in the remote haor areas alone, but also in all upazilas of the region. This rate is above the World Health Organisation (WHO)-set critical threshold level, said the study.  Both stunting and underweight rates are the highest among the under-five children in Sylhet -- with 44.6 per cent being stunted and 38.5, underweight children.
Barisal and Khulna divisions have the lowest stunting and underweight rates.
It has been found that 40.4 per cent of children suffers from stunting and 32.3 per cent, from underweight in Dhaka while stunting level is 41 per cent and that of underweight children is 34 per cent in Rajshahi. In Rangpur the level of stunting is 42.1 per cent and that of underweight 35.7 per cent.
The WHO studies have found Bangladesh as having one of the highest levels of stunting in the world. It is unfortunate that the country is even worse off than many Sub-Saharan countries. Its stunting prevalence is 41 per cent where in Sudan it is at 40 per cent.
Certainly, food security is a very important issue. About 30 per cent of the country's population does not have access to foods that will enable them to lead a healthy life. If one considers the stunting level at 41 per cent, then it will be quite clear that food insecurity is sky-high among such families.
Experts have set three common rules to be evolved to cut malnutrition. These are a number of minimum meals served to a child; a minimum number of food groups means here diversity in the diet and animal source food. Every Bangladeshi knows how expensive these foods are now. It is indeed a matter of serious consideration.
In case of food security, awareness is also more important than access. Because three-fourths of our population can access nutritional foods but they do not have the awareness to provide their children with nutritional foods. The government and different non-governmental organisations (NGOs) have to carefully consider these issues in their programmes.
It is a fact that mere availability of rice does not mean food security. The country has a shortage of pulse, vegetable and fruits in terms of production, not to speak of poultry and other small fishes. Egg price has increased 150 per cent. How can a lower middle class family avail it daily, not to speak of the poor people?
The government has taken an initiative to mainstream nutrition programme through community clinics under the National Nutritional Service. What is important now is how and when the nutritional plan is implemented thoroughly. The country should have at least one community health worker dedicated to nutritional care in every community clinic.
Unfortunately, it lags behind in terms of availability of skilled human resources. According to the WHO, there is a need for 23 health workers for every 10,000 people. India has 14.6 and Sri Lanka, 22. In Bangladesh, the number is only 7.7. More community health workers could implement nutrition programmes at the grassroots level.
Bangladesh needs some direct nutrition-specific interventions like Vitamin A supplement, Iron Folic Acid supplement, micro nutrient powder, iodised salt and treatment of severe acute malnutrition. At the crux of all these interventions lies effective counselling that is known as behaviour-change communication. Through such interventions, the country will be able to reduce incidence of malnutrition but not by100 per cent.
The country also needs nutrition-sensitive interventions that are indirect ones like women empowerment and improvement in female literacy and livelihood. According to Dr Tahmeed Ahmed of ICDDR,B, only nutrition-specific interventions cannot eradicate malnutrition to a greater extent.
She says, even if the nutrition-specific interventions is scaled up to 100 per cent, this would help reduce child mortality only by 15 per cent. So nutrition-sensitive interventions, along with nutrition-specific ones, are needed. Nutrition-sensitive interventions are food security, water sanitation and hygiene, employment generation, women empowerment and so on.
Rural people rush to Dhaka in search of a better livelihood but they end up in the dire living conditions of slums. In the urban slums, 60 per cent of all the children are zinc-deficient. So without improvement of employment opportunities, better health and nutrition for such internal migrants and their children cannot be ensured.  
The ministry of health and family welfare alone cannot take the responsibility of nutrition-sensitive intervention. Other ministries like those of agriculture, women and children affairs and so on need to work in tandem with the ministry of health.
Bangladesh has also the potential for becoming self-sufficient in production of nutrient foods like lentils, wheat, corn etc. For tapping this potential, the right kind of incentives should be put in place. This is where a multi-sectoral approach is most relevant. Multi-sectoral activities have also to be coordinated from the highest level of government.
In Brazil, President Lula had led the multi-sectoral programme on nutrition and achieved remarkable success within a few years. Bangladesh needs leaders to take nutrition programmes further. Active participation from private sector will further help strengthen it.
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