Although poverty and nutrition are said to be interwoven - one leads to the other - the prevailing notion is said to pay more attention to the former at the cost of the latter. It is thus no wonder that in Bangladesh, fight against malnutrition is not as shiny as it is with poverty reduction. But, better late than never, recent nutrition-centric concerns deserve appreciation.
The reason for the applause is quite reasonable. Good nutrition allows for healthy growth of an economy and development of a society; nutrition and productivity (earnings) are positively correlated. Nutrition is important from both inclusive and sustainable development perspectives. Inadequate nutrition is a major contributing factor to maternal and child well-being which entails inter-generational repercussions. Put simply, good nutrition is also good economics. Despite great progress over the last 20 years, poor nutrition still hurts Bangladesh, its children and its future. The impacts of poor nutrition run deep: they affect economic outcomes, individual and community health, and education. This means that improving nutrition can bring about positive change in the short- and long-term that will impact upon all of society.
Significant progress on nutrition policy can be made with strong leadership and coordination across government departments. Existing nutrition strategies need to spend the budget allocated, and more needs to be spent across all tiers of a government.
This year, the Copenhagen Consensus, partnered with the Bangladesh think-tank Centre for Research and Information (CRI), organised a high-level nutrition policy seminar in Dhaka. Minister for Health and Family Welfare Mohammad Nasim spoke to the audience, as did policymakers and Copenhagen Consensus researchers.
Nutrition solutions are compelling even when compared with interventions in many other areas. It is clear that Bangladesh can exercise control over its own budgets and policy priorities, and draw on international agendas on its own terms. There are smart nutrition interventions, packages and policies, and the new research provides Bangladeshi contextualised analyses.
There is a volley of variables affecting nutrition but low participation in secondary schooling among girls is prominently attributed. Rise in child marriage and subsequent high-dropout rate bring to the fore the role of girl's education in the labour market. The poor nutritional status of children is strongly associated with mothers' levels of education. The Copenhagen Consensus looks at two potential solutions to improve education and nutrition among girls. One approach is to provide stipends to encourage girls to enrol and stay in schools, suggesting that additional schooling would potentially lead to increased earnings. Another approach is to focus on extending and improving secondary schooling for girls as a solution to child malnutrition. The research suggests that a high level of education results in better awareness of health and nutrition.
While dietary diversification is critical to good nutrition by adding essential nutrients and improving health and productivity, two-thirds of the average Bangladeshi family diet consists of cereals like rice. Therefore, two studies have come up with solutions to improve Bangladesh's micronutrient nutrition needs. The first evaluates costs and benefits of increasing homestead production of animal-source foods as a means to increase household income and subsequent nutritional status. The second study focuses on costs and benefits of promoting complementary and supplementary feeding among women and children. Complementary feeding refers to the introduction of family foods which usually occur in infants from 6-24 months of age. Supplementary feeding refers to those foods high in vitamins, minerals, fibre, fatty acids and amino acids that would otherwise not be consumed in sufficient quantities.
While Bangladesh has done much to reduce its maternal and infant mortality rates over the last several decades, mother and child under-nutrition remains a concern, even among wealthy population. Two studies propose solutions in this area. The first evaluates an intervention designed to change the behaviour of pregnant women to stop consuming smokeless tobacco during pregnancy.
Bangladesh has the highest prevalence of smokeless tobacco among women in the world. The proposed behavioural intervention will include face-to-face counselling by a health care provider, use of printed materials and would be run by community health workers who shall be responsible for home visits and delivering change and communication messages. Raising social awareness about both negative effects and positive impact of iron and folic acid is important. The second study focuses on the costs and benefits of three key nutrition supplements during pregnancy - calcium supplementation, balanced energy protein supplementation and iron-folate supplementation.
And finally, a research paper looks at the detrimental impact that poor nutrition continues to have on health and education of Bangladeshi children, along with their economic implications. Although great progress has been made, child nutrition remains a challenge in Bangladesh. Chronic malnutrition (stunting) and acute malnutrition (wasting) are responsible for more than 300,000 child deaths a year in Bangladesh. Children in rural Bangladesh are more at risk of stunting than those in urban areas.
One option examined is the promotion of nutritious foods to improve health and nutritional status of women, infants and young children. Another would be a nutrition package comprising nine interventions that are to be administered to mothers, babies and small children in the first 1,000 days of life.
The research suggests that the latter would generate the highest benefits for every taka invested. Research by Jonathan Rose on nutritional packages for mothers and small children shows that a package of direct nutritional interventions aimed primarily at mothers, babies and small children in the first 1,000 days would yield an improvement in physical and cognitive development. This would result in better educational achievements for children as they grow up as well as better health, and increased earnings later, upon entering the workforce. In sum, the research suggests that every Taka spent would generate a return to the society of Tk 18.8.
It is clear that there is no one single solution that will address all dimensions of malnutrition. Making progress in reducing all dimensions of under-nutrition in Bangladesh will require multiple interventions, not just one. But the benefits - for the economy and the society - will be deep and manifold. Invest Tk.1 on nutrition, get Tk.18 in return - fabulous fortune!
Abdul Bayes is a Profeessor of Economics at Jahangirnagar University; Hasanuzzaman belongs to Copenhagen Consensus Centre.
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