[Individual articles from the Winter 2017 issue of Intersections will be posted on this blog each week. The full issue can be found on MCC’s website.]
Many people assume that household food insecurity is the main driving force behind childhood malnutrition and stunting. Simply put, the common assumption is that children are underweight because their families lack access to sufficient amounts of healthy food. However, a research study conducted by the Brethren in Community Welfare Society (BICWS) in the southern plains region of Nepal on the socioeconomic and cultural barriers to good nutrition found a more complicated picture. The study’s findings imply that while improving household food security may be necessary, it alone is insufficient to improve the nutritional status of children. The results suggest that malnutrition and stunting in this context are the result of interconnecting socioeconomic, educational and health-care factors. This study, alongside other research, suggests that an integrated strategy that improves the overall socioeconomic well-being of families, maternal education and knowledge of infant and young child feeding practices will be more effective and sustainable in improving the nutrition of children living in poverty.
BICWS operates as the service arm of the Brethren in Christ church conference in Nepal, based in the southeastern city of Biratnagar. Since many families in BICWS’ working area are rural landless households facing malnutrition, BICWS and MCC worked together to develop a food security project funded by MCC’s account at the Foods Resource Bank that included supplementary food for malnourished children as one of the project components, coupled with kitchen gardening and support for commercial vegetable and fish production.
Despite the short-term effectiveness of the supplementary food seen in many of the project participants, some malnourished children showed inadequate growth over the year of nutrition support, necessitating their re-enrollment for another year. BICWS conducted a research project in 2015 aimed at discovering the socioeconomic and cultural barriers and risk factors to healthy childhood development and recovery. The study involved in-depth interviews with participant households whose children did not recover from malnutrition and with participant households whose children recovered quickly.
The results of the study suggest that the initial hypothesis of food insecurity as the main driving force behind childhood malnutrition holds true, though only for the most extreme cases of households experiencing poverty and debt. It stands to reason that significant debt and related financial insecurity are major risk factors for childhood malnutrition. Families burdened by large debt payments have little or no financial security during periods of stressors, such as strikes, illnesses or disasters. In 2015 Nepal underwent a number of concurrent stressors, including a devastating earthquake, nationwide political unrest, strikes and an economic blockade from India. Health was one of the first things to deteriorate. Instead of a significant drop in caloric intake, affected families chose instead to drop many types of nutritious foods while keeping the amount of food consumed the same. Lack of dietary diversity contributes to malnutrition. While 80% of interviewed families stated that they normally had enough money for food, only 36% of families consumed the minimum daily nutrition requirements, showing a large gap between perceived food sufficiency and actual nutrient sufficiency.
For the non-extreme cases of malnutrition, however, the study discovered that the low level of mother’s educational attainment was connected with the incidence of malnutrition in children. That is, in families where the mother was more educated, children exhibited fast recovery. Other research projects in Nepal support this finding. This result suggests that women’s low educational attainment is linked to community malnutrition and that encouraging education is a strong potential long-term solution.
Nutrition-specific knowledge is also important. The study found that even some educated women lacked knowledge about health care, nutrition and sanitation. Lack of knowledge limited their application of good nutrition practice. However, BICWS found that educated women were more likely to take ownership of supplemental food received and to practice new nutrition skills than women with lower educational levels, despite the fact that both educated and uneducated women demonstrated low levels of nutritional knowledge before the project started. It makes sense that women’s education is likely to have an impact on family nutritional status, given the fact that in this community women normally serve as the center of the nuclear family and generally decide on and prepare daily meals. In response to these findings, BICWS has implemented a new strategy aimed at reaching three thousand households with nutritional education, equipping families (in particular women) with the knowledge of what nutritional strategies contribute to healthy development and overall well-being.
The BICWS research suggests that women’s education can be a cushion against stressors that lead to poverty and malnutrition. Women’s education and empowerment must be emphasized, especially as women in rural Nepal are often marginalized, with limited access to education and authority. Any long-term plan for community improvement should consider increasing women’s access to education as a key strategy. At the very minimum, this study suggests that nutritional education should be emphasized in any population suffering from malnutrition.
Derek Lee was on a SALT assignment with BICWS in 2015-16. Shemlal Hembrom is the program director of BICWS and General Secretary of BIC Nepal.
Dhungana, Govinda Prasad. “Nutritional Status of Under 5 Children and Associated Factors of Kunchha Village Development Committee.” Journal of Chitwan Medical College 3/4 (January 2014): 38–42.
Osei, Akoto, Pooja Pandey, David Spiro, Jennifer Nielson, Ram Shrestha, Zaman Talukder, Victoria Quinn and Nancy Haselow “Household Food Insecurity and Nutritional Status of Children Aged 6 to 23 Months in Kailali District of Nepal.” Food and Nutrition Bulletin 31/4 (December 2010): 483–94.
Singh, G.C. Pramood, Manju Nair, Ruth B. Gruibesic and Frederick Connell. “Factors Associated with Underweight and Stunting among Children in Rural Terai of Eastern Nepal.” Asia-Pacific Journal of Public Health/Asia-Pacific Academic Consortium for Public Health 21/2 (April 2009): 144–52.