Have I fed my child well?

This realisation was reaffirmed at the end of UN's Millennium Development Goal (MDG): there are still about 795 million undernourished people around the world. True, that undernourishment has declined from 23.3 per cent in 1990–92 to 12.9 per cent presently. Nourishment levels have risen in Latin America, East-SE-Central Asia, and even in North and West Africa. Apparently, about 72 nations (out 129) of the developing world are believed to have successfully attained the MDG target: "Half the proportion of the total population suffering from hunger." But unfortunately, there are other accounts that show how far we still are from the 'real' target. Even now about 45 per cent children around the world are dying of hunger (about 3.2 million) annually. About 66 million primary school children are attending school being hungry daily. In Sub-Saharan, Eastern and Middle Africa about 23 per cent, 31 per cent and 41 per cent of total population are in the grips of undernourishment. In Southern Asia, this tally goes up to 15.5 per cent. The case prevalent in Asia and Africa is often termed as "hidden hunger" – marked by a striking lack of micronutrients, leading to varieties of malnutrition, such as iron-deficiency anaemia, vitamin A deficiency.

Perhaps the most appalling and comprehensive realisation of undernourishment comes through estimates of stunted growth among children. The estimates of WHO reveal that in 2010, 39.7 per cent of children-under-five (171 globally, 167 million in developing countries) were stunted. This tally is expected to 'improve' by 2020 to 21 per cent (142 million). But, that would still mean vulnerability for one-fifth of the global infant pool. In Asia, stunting accounts were around 28 per cent in 2010. It seems like, by 2020, Asia and Africa will potentially have similar figures for stunting: 68 and 64 million respectively, even if the conditions keep improving for Asia. According to WHO, about 23 per cent children in the developing world would still be stunted in 2020. Not a small number by any means!

But why go nuts over stunting? Stunting is an irreversible phenomenon. Once it sets in, there is practically no turning around. Also, the aftermath on the children could be catastrophic for their overall development in later years – morbidity, mortality, infection, reduced brain development, disrupted education, depression, lack of social skills, reduced employment, the list can be endless. A major question to be raised at this is if stunting genetically transmitted.

What leads to stunting? The question is quite dicey as multiple factors converge over multiple scales, taking into stride both issues pertaining to pre/post-natal development of the child, as well as the health-hygiene conditions and socio-demographic status of the mother. Birth weight, mother's educational status, maternal occupation, living in a rural area, family size, number of children under five years of age in the household, cooking with charcoal, housing material (wooden/straw housing, poor floors), duration of exclusive breastfeeding, the time of initiation of complementary feeding, all may significantly cause stunting. Thus, appropriate nutritional intervention programs considering these determinants and the dissemination of knowledge at the population level related to undernutrition are necessary to address stunting along with other nutritional challenges.

But there are also certain additional facets that often slip down the crack – poor WaSH practices (water-sanitation-hygiene leading to diarrheal diseases), frequent illnesses in early childhood, and intergenerational poverty (leading to low nutrition, low literacy, and work abuse), all may lead to causing malnutrition-related hazards, including stunting. The latter two are characteristic traits of developing nations - South and Southeast Asia and Sub-Saharan Africa in particular - where the girl child is forced to drop out of school and compelled to take up manual labour outdoors to support familial expenses. Simplistically, it translates into an early loss of childhood, less nutrition, potential exposure to diseases besides reduced health care and lesser education for our future mothers. Of course not to mention, high risks of physical and mental abuse that eats slowly at the sense of dignity and cripples the psychological makeup.

The global resolve to make food systems deliver on a healthy diet requires all stakeholders to work together to achieve the global goal of reducing stunting. But it would absolutely require the authorities to put in place targeted policy interventions that would first create a conducive environment. In 2012, WHO established a global target of reducing stunted population by at least 40 per cent by 2025. It basically translates into a 3.9 per cent reduction per year - from 171 million in 2010 to about 100 million in 2025. Unfortunately, it seems that given the current rate of progress, potentially there will still be about 127 million stunted children in 2025. That is, over 27 million more than the set target (achieving only a 26 per cent reduction, falling way short of 40 per cent).

Just recently, the World Health Assembly (WHA) has announced the global nutritional guidelines for the coming years. Besides the target related to reduction in stunting, other priorities for international authorities include (1) 50 per cent reduction of anaemia in women of reproductive age, (2) 30 per cent reduction in low birth weight, (3) no increase in overweight children-under-five, (4) increase in the rate of exclusive breastfeeding in the first 6 months up to at least 50 per cent, and (5) reduction in child wasting (low-weight-for-height) in children-under-five to below 5 per cent of the population. These guidelines incorporate both the nutritional issues of the child as well as the mother in a holistic framework that appeals for a balanced diet in addition to adequate available quantity. Incidentally, these guidelines may also be adopted to reduce child mortality owing to malnutrition or hunger.

No doubt, it is going to be a steep uphill trek in the days ahead, especially in the developing world where ensuring nutritional qualities of food and feed is a mouthful. Incorporating the global targets into national counterparts needs to consider existing nutrition profiles, risk-factor trends, demographic differentials and changes therein, experience with developing and implementing nutrition policies curtailed to regional traits/challenges, and economically feasible healthcare development.

How do we achieve that? Nutrition interventions alone might be insufficient and will require the development of evidence-based, multi-sectoral plans at a sub-national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, education, poverty, clean energy systems, and reduction of other factors that accentuate risks of malnutrition-related hazards. And more importantly, most of these measures need to be preemptive, for in many cases, impacts of malnutrition are irreversible. This means we cannot wait until the thunder sends us down under.