[mgj-discuss] World Bank Report finds malnutrition...didn't know it was lost..

[Morrigan Phillips]

Some how the World Bank seems to always get what's wrong, just not how 
they help perpetuate what's wrong. He's an article from the NY Times 
about a new report from the World Bank that apperently warns 
"Malnutrition Begins in the Cradle"......Stunning conclusion! Ok as 
someone who does media for a living I can honestly say this is a most 
unfortunate quote from the lead author of the report "you can get more 
bang for your buck without the food."

March 3, 2006
Report Warns Malnutrition Begins in Cradle
By CELIA W. DUGGER

Nutrition education programs for parents would do a better job than 
large and politically popular feeding programs in fighting the rampant 
malnutrition that is stunting the development of more than 100 million 
children worldwide, a new World Bank report says, finding that a lack 
of food is usually not the main cause of child malnutrition.

Children are irreversibly damaged by malnutrition by age 2, long before 
they begin primary school. The World Bank report contends that aid 
efforts must concentrate on the brief window of opportunity before that 
age. And in areas not hit by famine or other crises, the report says, 
efforts must focus more on teaching mothers to properly feed and care 
for babies and toddlers than on school meal programs.

While experts interviewed yesterday generally agreed with the bank's 
assessment of the evidence on malnutrition, some of them argued that 
feeding programs did have an important role to play in improving the 
nutrition of children.

The debate about how to tackle the problem is an important one at a 
time when the world is pushing to reduce child mortality by two-thirds 
over the coming decade. Malnutrition is implicated in more than half of 
the deaths of children globally, "a proportion unmatched by an 
infectious disease since the Black Death," the bank's report says.

The World Bank, as the International Bank for Reconstruction and 
Development is popularly known, is the largest financier of antipoverty 
programs in developing countries. Its report, titled "Repositioning 
Nutrition as Central to Development," maintains that countries like 
India with staggering rates of malnutrition need to change their 
approach to speed up progress.

Outside of regions in crises, nutritionists at the bank say, programs 
should shift their emphasis from directly providing food to changing 
the behaviors of mothers ? for example, to breast-feed exclusively for 
the first six months of life or seek quick treatment for their 
children's diarrhea. Improvements to sanitation and health care are 
also needed.

The origins of malnutrition often lie in the way infants and young 
children are fed, not the quantity of food available.

In many societies in Africa and South Asia, the first days of thick, 
yellowish breast milk, called colostrum, are discarded, though it 
contains antimicrobials that can protect children against infection. It 
is then replaced with local concoctions that all too often include bad 
water that can give children diarrhea. For school-age children, 
nutrition education, iron supplements and deworming medicines are 
usually better investments for improving nutrition than providing 
meals, the report says. It acknowledges that feeding programs increase 
school attendance, but emphasizes that they should not come at the 
expense of efforts to reach preschool children.

"You get more bang for your buck without the food," said Meera Shekar, 
the lead author of the report, who described feeding programs as costly 
and vulnerable to corruption. "The food brings in votes for 
politicians. We have very little evidence it improves nutrition."

Advocates of feeding programs reply that food can be a magnet that 
draws mothers and children to centers where nutrition counseling is 
offered ? and that food itself can provide pregnant women and children 
under 2 with a richer, more varied diet, while attracting older 
children to school and helping them concentrate on learning.

"If you feed the children well, they'll all be there," said Jean Dreze, 
an economist and leading advocate of free lunch programs in India, 
which now serve more than 100 million primary-school students. "The 
response to food is phenomenal."

Some of the facts about malnutrition, familiar to experts but not 
widely understood, seem counterintuitive. For example, rates of 
malnutrition in South Asia, including India, Bangladesh and Nepal, are 
nearly double those in sub-Saharan Africa, which is much poorer.

India's programs to feed children in school have multiplied in recent 
years, but its nutrition program for preschool children mainly assists 
those between the ages of 3 to 6 ? too late to prevent the stunting and 
damage to intellect that occur by age 2, bank nutritionists and other 
experts say.

A spokesman for the Indian Embassy in Washington said yesterday that he 
had not yet read the report and could not comment on it.

The problem of malnutrition in India, known for its well-educated, 
high-tech workers, is striking. Almost half the children are stunted by 
malnutrition, but the problem is not limited to the poor. A quarter of 
the children under age 5 in the richest fifth of the population are 
also underweight and nearly two-thirds are anemic, the report says.

"Think of the power of India if all these kids were not malnourished 
and could participate fully," Ms. Shekar said.

Nutritionists say the implications of the large body of research that 
informs the bank's report is clear: countries must intervene before 
children turn 2.

"If you miss that period, the damage is irreversible, especially in 
cognition, but also in growth," said Marie Ruel, director of the 
division of food consumption and nutrition at the International Food 
Policy Research Institute.



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In solidarity

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