Bangladesh has improved its nutritional status due to growth of income and wealth, education (especially maternal education), expansion of health care coverage, and improved sanitation and women’s empowerment.
However, there has been very little improvement in the quality and diversity of diet. Cereals still occupy a preeminent place in the diet. Stunting still afflicts more than one-third of children; acute malnutrition (or “wasting”) has remained worryingly stubborn and serious inequalities exist in nutritional outcomes between the rich and the poor.
According to the Global Hunger Index, an internationally comparable composite indicator of nutritional status, Bangladesh’s situation was found to be in the “serious” category in 2014.
At the current rate of progress, Bangladesh will fail to meet several targets it has committed to.
Challenges include the increasing pace of urbanisation and the damages caused by climate change. According to the Bangladesh Urban Health Survey of 2013, as many as 50% of children in urban slums were stunted, compared to 33% in non-slum urban areas.
Climate change, on the other hand, may reduce crop production. About half the population already suffers from iron and zinc deficiencies that can cause serious damage to health, especially for small children and pregnant women.
Rising carbon dioxide in the atmosphere will exacerbate the problem of micronutrient deficiencies further. Increased salinity in the coastal zones will increase prevalence of pre-eclampsia in pregnant women, in turn, aggravating the problem of low birth-weight and malnutrition of babies in the coastal zones.
The challenges with food security and nutrition will have to be fought on many fronts. But the common thread is, anything that promotes broad-based or inclusive growth -- as in, rising real incomes of the poor -- will help.
Some areas of public policy that are especially relevant for food security and nutrition are, in three broad groupings: Agriculture, social protection, and nutrition-specific interventions.
Agriculture
Enabling the production of more high-value products, diversification will raise the incomes of smallholder farmers and improve the access dimension of their food security as well as the nutrition dimension by increasing the availability of products rich in micronutrients.
The problem, however, is that farmers face a number of constraints in their efforts to diversify, such as lack of access to credit, technology, and the price instability of high-value products.
The government has already established policies and programs to provide agricultural credit and extension services for the adoption of better technology and farming practices.
However, these programs primarily serve the “better off” farmers and leave the large majority of smallholder farmers inadequately covered. It is, therefore, essential that the existing bias against smallholders is corrected.
The government should also encourage technological research on the development of a range of products rich in micronutrients, such as the zinc-fortified rice that Bangladesh produces, which can help reduce child mortality and stunting by reducing the prevalence of diarrhoea and pneumonia.
At the current rate of progress, Bangladesh will fail to meet several targets it has committed to
Vertically integrated value chains will also help, by reducing the risk of diversification. An example is contract farming, in which the farmer supplies agreed upon quantities to an agribusiness firm, usually at a price negotiated in advance.
Some private sector initiatives in this regard are already instructive; the public sector should complement them by ensuring an enabling policy environment.
When women are empowered, farming households are more likely to opt for greater diversity of production. Women’s empowerment, when combined with behavioural change communication (BCC) on nutrition also increases the likelihood that farmers who produce diversified products will also consume a diversified diet, instead of selling the micronutrient-rich products for the sake of higher income.
A final element of agricultural strategy that needs emphasis is its ability to acquire resilience against the impacts of climate change through both choice of crops and use of appropriate farming practices.
Social protection
Safety net programs are potentially an important instrument for promoting food security and nutrition. Currently, public spending on social protection amounts to around 2.44% of GDP, accounting for 13.5% of annual government budget.
Despite increased coverage, social protection in Bangladesh still faces serious shortcomings such as inefficiencies and leakages, lack of coverage of the urban poor and mis-targeting. While the new National Social Security Strategy has proposed a shift away from food transfers to cash transfers on efficiency grounds, there is still a need for food transfers.
Strengthening the current efforts to offer micronutrient-fortified foods through both open-market operations and safety-net outlets can be very helpful. International evidence suggests that this is a relatively cheap and effective way to fight micronutrient deficiency and related morbidities.
The flagship program, Vulnerable Group Development (VGD), serves almost 750,000 women. The aim of the current version of the program is to enable the VGD women, with the help of a cash grant for investment and training, to earn enough for themselves and their families so that they can move out of extreme poverty and food insecurity by the end of the two-year program cycle.
Regarding safety nets for children, the greatest coverage at present are Primary and Secondary Student Stipends. As of 2015, 13 million children received stipends, covering around 24% of primary school children and 17% of secondary school children.
However, the transfer level of the stipends is low and has been falling in real terms. The NSSS proposes to make two significant changes to the stipend schemes: (1) Extend the coverage to the poorer half of the student body, and (2) increase the amount of transfer while protecting its real value by indexing it to inflation.
Nutrition-specific interventions
Strategies for overcoming the burden of under-nutrition must begin from the premise that under-nutrition is complex and multidimensional. Household access to resources is an important determinant of nutritional status, but there are other forces as well. For example, low birth-weight babies tend to be more susceptible to stunting in later life.
For the past decade, the prevalence of low birth-weight in Bangladesh, around 37%, is high by international standards. The main reason for low birth-weight in Bangladesh is undernourishment of the foetus, caused by undernourishment of the mother. Action is required if the prevalence of low birth-weight is to be reduced.
A matter of concern is the high rate of teenage pregnancy, an important cause of low birth-weight. It is alarming that the proportion of 15–19-year-old young women bearing children has fallen only marginally in the past two decades -- from 33% in 1994 to 30.8% in 2014.
A massive social campaign, along with more focused family planning advice is needed to bring about a change in behaviour. The problem is both economic and cultural.
Shazia Omar is a poverty activist and a writer, currently working as a consultant at the Social Security Policy Support Project. This article is based on the strategic review prepared by WFP in 2016, by SR Osmani, Akhter Ahmed, Tahmeed Ahmed, Naomi Hossain, Saleemul Huq, and Asif Shahan.
