Bhutan is no ordinary place.
A landlocked Himalayan kingdom tucked in a mostly rugged mountainous terrain between India and China, it measures prosperity by assessing its citizens’ level of happiness by way of a Gross National Happiness index.
Bhutan’s geography – with land rises ranging from 200 meters in the southern foothills to 7,000 meters in the high northern mountains – consists of three major agro-ecological zones that allow for a rich biodiversity and seasonal foods.
This natural wealth, however, comes with its caveats as
"Many families in rural Bhutan practice two meals rather than three meals a day," reports Ms. Kinley Bidha, Tarayana Foundation Field Officer in Samtse Dzongkhag. "Some for cultural reasons, others due to a shortage of food, others due to a shortage of land too farm," she adds.
– the country’s infant mortality rate declined to 30 per 1,000 live births in 2012 down from 90 per 1,000 in 1990; while the rate of stunting in children under 5 years declined 24 percent from 1986 levels.
Nonetheless, the lack of variety of foods in diet remains a key concern, especially for pregnant and nursing women as well as young children. And while most families feed their children complementary food, fewer than a quarter of parents provide them nutritious meals essential to their health.
In addition, 67 percent of Bhutanese adults consume less than the recommended five servings (or 400 grams) of fruits and/or vegetables per person a day [National Nutrition Survey (NNS) 2015].
When consumed, vegetables consist for the most part of two national staples, potatoes and chilies, which hardly provide essential vitamins and minerals.
Keeping regional variations in mind, between 16 and 34 percent of children under 5 are stunted—or too short for their age—seven percent of children are underweight, 35 percent of children of age 6-59 months and 44 percent of women of reproductive age are either anemic or iron deficient. Exclusive breastfeeding rates for six-month-old children remain at a low 50 percent (NNS, 2015).
, and predispose to adult-onset diseases (including metabolic syndrome).
Thankfully, to promote its national development.
Bhutan is no ordinary place.
Silvi is eight months old. She lives in a remote village in one of the poorest regions of Bangladesh.
Her mother Maya often reflects on her pregnancy and worries about her daughter’s wellbeing as she recalls her morning sickness, the uncertain and painful birth, and the long nights at Silvi’s side as the baby lay wide awake wailing, fighting one illness after the other.
She remembers, too, the thrills of hearing Silvi giggle at the sound of her rattle, and when she began to crawl.
Despite the little joys that her baby brings to Maya, Silvi’s early childhood was marked with apprehension: Shouldn’t she be a little heavier? When will she learn to walk? Will she be healthy and intelligent enough to earn a decent living when she grows up? Or would she be handed down her parents’ poverty and get married like Maya had to, at only sixteen?
But with the right kind of support, Silvi can have a chance at a better life and bring her family out of poverty.
Growing evidence has shown that .
Thus, —or too short for their age--, low birth weight is prevalent, and maternal nutrition remains poor.
Sadly, poor families like Maya’s are not utilizing services available to them.
In Bangladesh, chronic and acute malnutrition are higher than the World Health Organization’s (WHO) thresholds for public health emergencies—it is one of 14 countries where eighty percent of the world’s stunted children live.
Food insecurity remains a critical concern, especially in the Chittagong Hill Tracts (CHT).
Located in the southeastern part of Bangladesh, CHT is home to 1.7 million people, of whom, about a third are indigenous communities living in the hills. The economy is heavily dependent on agriculture, but farming is difficult because of the steep and rugged terrain.
With support from the South Asia Food and Nutrition Security Initiative (SAFANSI), the Manusher Jonno Foundation (MJF) conducted a food and nutrition analysis which finds that more than 60% of the population in CHT migrates during April – July when food becomes harder to procure.
Based on these findings, MJF helped raise awareness through nutrition educational materials and training. The foundation staff also formed courtyard theatres with local youth to deliver nutrition messages, expanded food banks with nutritious and dry food items, and popularized the concept of a “one dish nutritious meal” through focal persons or “nutrition agents” among these communities.
Yet, these deficiencies -- often referred to as ‘hidden hunger’ -- go largely unnoticed and affect large populations.
Night blindness, a condition afflicting millions of pregnant women and children, stems from low intake of foods rich in essential nutrients like Vitamin A.
Budget constraints limit access to nutrient-rich foods for many families, who are unaware or unable to afford a nutritious diet.
National programs help supplement diets with Iron and Vitamin, but their scope is too narrow to adequately address these deficiencies.
Fortified Milk Helps Increase Vitamins Intake
When fortified with vitamin A and D, milk, which remains a staple for many Indians, can help alleviate dietary deficiencies when supplementation is not available.
Food fortification is a relatively simple, powerful and cost-effective approach to curb micronutrient deficiencies. It is in general socially accepted and requires minimal change in existing food habits.
The process is inexpensive and costs about 2 paisa per liter or about one-tenth of a cent. And because it only adds a fraction of daily recommended nutrients, the process is considered safe.
For these reasons, food fortification has been successfully scaled up in some emerging economies.
However, except for salt fortification with iodine, India has not yet achieved large-scale food fortification.
With India’s rapidly growing dairy industry, large-scale milk fortification of Vitamins A and D is a robust vehicle for increasing micronutrients intake across the population.
In Nepali, “Sunaula Hazar Din” means, “Golden 1000 Days” – which is a critical window of opportunity between conception and the age of two years that, with good health and nutrition, can mitigate the risks of malnutrition that hamper a child’s long-term physical and cognitive development.
Sunaula Hazar Din (SHD) is also the local nickname of the Government of Nepal’s recently completed “Community Action for Nutrition Project”, implemented by the Ministry of Federal Affairs and Local Development and financially supported by the World Bank from 2012 to 2017. The project aimed to improve practices that contribute to reduced under-nutrition of women of reproductive age and children under the age of two and to provide emergency nutrition and sanitation response to vulnerable populations in earthquake affected areas.
The project used a “Rapid Results Approach (RRA)”, where target communities formed groups of nine members that would collectively select and work on an activity to address malnutrition for 100 days. RRA focused especially on the “1000 days” households– namely, households with children under 2 years and pregnant and/or lactating women and also had community -wide interventions targeted to address malnutrition.
To better understand the local dynamics around the SHD design and activities, a qualitative study was conducted, with support from the South Asia Food and Nutrition Security Initiative (SAFANSI).
The study team gathered the voices of various stakeholders, including the community members, facilitators, and the village and district-level authorities. Listening to the voices of these stakeholders makes development practitioners and project teams recognize how participatory designs may work as expected – or not – in a specific context.
A little over six years ago, Neelam Kushwaha’s first daughter was born weighing 900 gm at birth, severely underweight. Neelam went into labor while working at the local construction site in Jori village, Rewa, Madhya Pradesh, India. Many people work at such local construction sites in rural areas for daily wages ranging from INR 150-280 (about $2- 4$) per day. Her daughter Manvi, was preterm, and Neelam spent months recovering from child birth complications.
Three years later, when Neelam was pregnant with her younger daughter, Sakshi, she quit wage labor and sought employment at an incense manufacturing unit established by World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP) in 2011. At her new role, she earned more and did not engage in labor intensive work during the final months of her pregnancy. Sakshi was born a healthy 3 kilos.
In the course of my field work supported by South Asia Food and Nutrition Security Initiative (SAFANSI) in 2015, I came across several similar stories.
MPDPIP’s livelihood based approach offered several opportunities towards income supplementation for women self-help groups (SHGs) and rural households through agriculture, dairy/poultry farming and local enterprises, among others.
As evident by Neelam’s experience, MPDPIP’s benefits went beyond income and spilled over into health improvement as well.
I learnt that prior to MPDPIP, childbirth in hospitals was difficult due to prohibitively high costs of travel and hospital stay. Pre-existing government schemes such as the Janani Suraksha Yojana (JSY) offer about INR 1,400 ($20) to rural women who opt for hospital deliveries. However, this payment occurs post-partum, and pre-delivery costs have to be borne upfront by pregnant women.
Post MPDPIP, women were able to opt for hospital deliveries with greater ease due to access to credit from their SHGs. This is particularly relevant for Madhya Pradesh as it has consistently fared poorly with respect to institutional deliveries.
Happy New Year to all our Sri Lankan friends and colleagues celebrating the Sinhala and Tamil New Year this month; and Happy Easter to those celebrating it.
This is my first opportunity to celebrate these various holidays in my adopted country. I love the energy, the buzz of excitement everywhere and the decorations coming up in many of the commercial districts. I have been asking so many questions about the importance of the New Year holiday; and at the same time enjoying the preparations for the festivities, the anticipation of the big day as well as the serious messages.
I have learnt that the Sinhala and Tamil New Year, also known as 'Aluth Avurudda' (in Sinhala) and 'Puthandu' (in Tamil) is very important to all Sri Lankans and it celebrates the traditional Lunar New Year. It is celebrated by most Sri Lankans – a point of Unity and a Joyful occasion.
Even more importantly the holiday coincides with the New Year celebrations of many traditional calendars of South and South East Asia – a regional point of unity! Above all, this is also known as the month of prosperity.
So what does the holiday mean to you as a Sri Lankan, or maybe you are someone like me who may not be Sri Lankan but loves the country and its people?
At the World Bank Group, promoting shared prosperity and increasing the incomes of the poorest 40 percent of people in every country we work in is part of our mission. The first goal is to end extreme poverty or reduce the share of the global population that lives in extreme poverty to 3 percent by 2030.
The state of Madhya Pradesh in India is largely vegetarian with limited consumption of eggs and meat.
While these dietary preferences are commonplace in other Indian states, Madhya Pradesh is facing a protein deficiency epidemic which threatens the long term health of its population.
How did it get there?
In 2015 I spent five weeks in rural and tribal areas of Madhya Pradesh evaluating the World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP II), with the support of the South Asia Food and Nutrition Security Initiative (SAFANSI)
Across the 8 districts I visited, families shared how they had improved their agricultural productivity, started backyard kitchen gardening, and supplemented their income through dairy and poultry farming, collective procurement and small scale enterprises.
As I examined local village level health records, Anganwadi Center (AWC) registers, Auxiliary Nurse and Midwife (ANM) registers and Primary Health Center (PHC) documents, I noticed a reduction in severe malnutrition and severe anemia among pregnant women and under 5-year-old children.
However, this decrease did not extend to moderate or mild malnutrition and anemia.
Amena Begum resides in a village in the Habiganj district in Bangladesh and is a mother to three young children. Last year Amena spent US$100 to construct a toilet to ensure her three children were hygienically protected from feces.
Even though her family members have adapted to using the toilet, exposure to fecal contamination can occur anywhere. For example, while playing outside, a child may accidentally ingest soil with animal feces, or the child could be exposed when he or she eats food off of dishes washed with pond water.
It is also not uncommon for families without toilets to throw feces into a nearby bush, which remains exposed in their living area. These actions can lead to the contraction of hazardous, lethal diseases and create a traumatizing effect on the lives of many children, not to mention the unfavorable impact on the environment.
A new study on early childhood diarrhea in rural Bangladesh found that despite high on-site latrine access, frequent fecal contamination was present along all environmental pathways investigated. Human fecal markers on children’s hands and in soil, and rotavirus in stored water, soil and on hands had been detected. Animal (particularly ruminant) fecal markers were highly prevalent in water, soil and on hands.
During a recent visit to Barsam village in the Saharsa district of Bihar, I talked with members of a women’s self-help group - one of over 480,000 such groups formed under Jeevika, a rural livelihoods program supported by the World Bank in Bihar.
Among the group was nineteen year old Shobha. Like millions of girls across the country, Shobha had never been to school. She was married at fifteen, and now has a ten-month old daughter. Shobha sat among us, cradling little Anjali on her lap.
I was happy to hear that, when she was pregnant, Shobha enrolled herself at the local Aanganwadi center which offered nutrition and health services for both mother and child under a public program. At the center, Shobha learnt how to care for Anjali. As a result, the child was exclusively breastfed for six months and received all the necessary immunizations. Now the little girl is being correctly fed a diverse diet of vegetables, pulses, cereals and animal milk, while continuing to be breastfed.
But my happiness was only momentary. As we talked, it emerged that Anjali was only being given a spoonful or two at most of these foods. While the amounts were far from adequate, Shobha thought they were enough for a child of Anjali’s age. And, all the other women agreed.