A popular myth about nutrition is that overt hunger and starvation are the world's main nutrition problems'. It Is also widely assumed that lack of food is the onlv reason for malnutrition. But if this were true, why is it that children become malnourished before their second birthday when the child's food needs are relatively small, rather than from two onwards when food needs are significantly greater? While poverty is the underlying cause of food insecurity at the household level, malnutrition is also found among families in higher in come groups in Bangladesh. A general sense of resignation has prevailed that until poverty is eradicated, malnutrition is bound to persist Until recently, it was not recognised that investment in well-conceived nutrition programmes can have K returns and such recogni is still not universal.

tidSs tode^i^ ZmSViin" dren above the age ot two indfr cates a particularly serious problem .specific to children lie-low that age While the older children eat. the younger ones are fed. and thus the problem tn their case is primarily one of feeding practices Particularly in terms of breastfeeding, wean ing and complementary feeding of children under two. these practices cost a negligible amount of total household Income

Malnutrition Is the outcome of many complex biological and social processes. Inadequate di etary intake and disease are the immediate causes, both inter acting synergistically House bold food Insecurity inade quale caring practices and in adequate access to basic health services together with an un healthy environment are the u ruler lying causes of Inadequate dietary Intake and disease resulting In malnutrition

A global cooperation be tween North-South lor address

Ing the prevailing widespread malnutrition is vital. Unlike the South. Northern nations are prosperous, have fewer pen pie. low undernutrition (though over-nutrition among children is emerging as a malnutrition issue there), and hold most of the world's wealth. Undeniable fact is that. North and South divisions also exist within a country and a community Within a nation or community there are a fortunate few (known as North) who possess most of tlie wealth.

F irther North South exists wifliui the households where a

seen. For ex-

food Intake, medicare during need, preference for education decision-making authority, etc are all distributed favour ing I he adult male (known as North of the household).

The World Food Summit (WFSI has global and national significance In mitigating mal-nulrltlon problems Bangladesh Prime Minister Sheikh Hasina In her speech has rightly pointed out that "Asin me fastest growing region in tlie world, la paradoxically the home lor more than 500 million undernourished men women and children ' In fact out of about 167 million under weight children under five in the world halt are found In Just three South Asian countries -Bangladesh India and Pakistan Bangladesh a share la abpnt 14 million

We slxiuld now tare the fact that Bangladesh has among the worst nutritional level in the workl that ii»e roots of malnu IrtUr ii run k--p into Its social

soil, and that malnutrition has not changed significantly dur ing l tie last two decades in spite of large investments in many foot! distribution programmes. Since 1980s. much of the money spent on food aid. food subsidies and food-for-work schemes have lieen Inequitably targeted Considerable resources are be Ing spent on food subsidies for population groups which are not necessarily tne most food insecure. Even where food schemes are aimed at the dlsad van! aged, it Is impossible to target these at the mainour IshecJ. because there is nainsti tnormalised system of monitor ing the growth of the nutrition ally vulnerable. Targeting Is Therefore often based on estimates of Income or landless ness. characteristics that do not fully cover nutritional vul nerabtfity Aside from In equities In targeting, other lac tors In the design o( many food programmes have affected their effectiveness In Improving the nutrition of vulnerable groups For example some programmes benefit primarily men rather than the women and young children who are nutritionally more vulnerable

About 65 per cent of c hildren in Bangladesh suffer from Jrowth retardation (stunting) ue lo chronic and gradual malnutrition They lag lurilier behind as time passes Children with retarded growth become stunted less productive adults and are more likely lo sutler from chronic diseases Stunting has several functional cause quetwes Including high ilealli rales and reduced learning |x> lent lai impaired immunity

and work productivity. Malnu trition kills silently; over half of child mortality in Bangladesh is attributed to malnutrition Mildly malnourished children are more than twice as likely lo die as well nourished children

Iodine Deficiency Disorders pose a major risk lor the physi cal and mental development of the people living in iodine deficient environments in Bangladesh The entire popula tion Is at risk of iodine defi ciency The most obvious sign of this deficiency is gpitre but most are not visible. Iodine de flcient pregnant women arc. prone to give birth to cretins, babies with severe permanent developmental defect* that in elude mental retardation, deaf ness and physical handicaps. But less obvious mental retardation occurs in a broad spectrum of ’he population Chil dren with iodine deficiencies have IQs 13 5 points lower on average, than those of children in normal populations Everv one In Bangladesh Is at risk of some degree of Intellectual Im palrment

Anaemia Is another com mon nutritional problem af lectlng about half of the popu lation and two thirds of preg nanl women It lowers work n pact tv of adults and educational at hlevrmenl in children of all ages Anaemia in pregnancy in creases the risk of maternal deaths Of tire estimated women wIk> die during or around the time of delivery each year in Bangladesh about 25 per mt some 5 (XX) deaths arer.iuaed by anaemia Even a small amount of blood loss during tie

livery can be fatal for an anaemic mother. Perhaps the most damaging effect for poor families is needlessly reduced work capacity They work only a fraction of their normal capacity. Anaemia causes a 10-15 per cent reduction in work out put in many different occupa

We have to keep several promises made to our children In the World Summit for Children. heads ol government and State, including Bangladesh, recognised reduced malnutrition as one of the priority basic needs of children. World leaders signed a Social Contract" with the world's children. in which they promised to give a first cil lor children Through that act. good nutrition was not only recognised as basic need, but as a human right The promise of leaders was transformed to an obligation of the stale to respect protect and fulfill the chiklren s right to nutrition

The Prime Minister at the recent speech in the WFS posed a moral and ethical question that "is reserved for two judges; our children to whom we shall bequeath either a pillaged earth or a habitable world and the hungry million whom we are pledged to serve — and have, so often, so short Thia has to be answered by each of the world s leaders to their children This has made us piedMe-bound to the children for removal of need less hunger and malnutrition faced by the children and women today

In Bangladesh, towards meeting those promises. Integrated Nutrition Project la one important step for a compre-

hensive and coordinated programme to reduce malnutrition among its population The gov ernment has recognised that investment in the nutrition of its people is an important contribution to the human capital of the country and is committed to making this investment adequate and appropriate and to optimise Ils returns.

One of the unique features of the Integrated Nutrition Project is the targeting of children 0-24 months and women based on nutritional criteria instead of traditional socio-economic indicators This is intended to tackle the causes of most serious malnutrition among those groups and produce the best results and long-term benefits. The most effective strategy to reduce malnutrition among the under five and school children Is to focus the Interventions before they are born and are under-two. after that it is al-nkSTtaJ Ute and too CxfiMTsfyv

communities tn understand the causes and consequences of malnutrition and to enabling them to combat it. The project provides a comprehensive and long-term solution to the root causes of malnutrition through an inter-sectoral approach. as nutrition is the out come of activities undertaken by several sectors. An Inter-sectoral Nutrition Fund is available to support innovative nutrition projects of various sectors and NGOs

The Implications of the Bangladesh Integrated Nutri tion Project for other national priority programmes, for ex ample, the Family Planning programme, are likely to be favourable An effective nutrition programme would enhance child survival and women s so rial status, both of which are known to help fertility reduction.

The writer Is Programme Officer of World Bank at Dhaka