Undernutrition in South Asia: Persistent and emerging challenges

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Indian Bengali tribal mother is feeding her baby on her lap in a rural background. Indian rural lifestyle
Indian Bengali tribal mother is feeding her baby on her lap in a rural background. Credit: Abir Bhattacharya/ Shutterstock

Childhood stunting—or being too short for one’s age—is one of the most significant barriers to human development and affects about 162 million children under five across the world. 

The good news is that several countries in the region, Nepal, India and Sri Lanka, are progressing towards meeting the 2025 World Health Assembly target of reducing the number of stunted children. 

But overall, South Asia remains home to about 62 million stunted children .

In this context, it’s critical to confront failures that impede progress toward better health and nutrition in the region. Even more so since some undernutrition challenges persist, and new ones are emerging.

One persistent challenge is the inadequate diets young children receive, especially in their first two years .

This starts early in a child’s life as breastfeeding rates remain low. Though early initiation of breastfeeding has more than doubled to 40 percent between 2000 and 2016, more than 20 million infants are still not being breastfed within the first hour of birth.

Progress is also uneven across the region: breastfeeding initiation ranges from 18 percent in Pakistan to about 90 percent in Sri Lanka.

Also worrisome is that exclusive breastfeeding in the first six months of life has improved by a mere five percentage points to 52 percent across South Asia. 

Further to that, the diets of infants over six months continue to be one of South Asia’s biggest and most persistent challenges.  

Only 12 percent of South Asian children receive the minimally acceptable diet they need to grow healthy .

Poor Indian girls on the street eating a piece of watermelon.
Poor Indian girls on the street eating a piece of watermelon. Credit: AJP/ Shutterstock

This is a low number explained in part by the delayed introduction of semi-solid foods in children’s diets as well as the low quality, variety, and quantity of their food intakes.

In Afghanistan, Bangladesh, Bhutan, India, and Pakistan, only one out of four children is fortunate to get a minimally acceptable diet.  

Maldives and Sri Lanka far better as more than 50 percent of children get the recommended diets .

Socio-cultural practices and poor maternal education are some of the factors behind such poor nutrition practices. 

An emerging challenge that could jeopardize or slow down progress is the rapid urbanization in South Asia and the social transformation that comes with it, especially for mothers working outside the home.  

As women seek—and rightfully so—work outside the home in increasing numbers —they find it harder to adopt or maintain optimum infant and young children feeding practices. 

With about 26 percent of working-age females in South Asia being economically active - a rate varying from 22 percent in Pakistan to about 51 percent in Nepal – their contribution to the economy in both formal and informal sectors is considerable. And engagement in economic activities also contributes to women’s empowerment, a key factor underpinning better nutrition outcomes .

But for working women, moving from a rural area to a city also brings added stress such as the lack of housing, and access to water and sanitation, let alone the loss of familiar community support or alternate child care systems, and impairs their ability to feed their young children appropriately.
 
Women in the informal economy are further disadvantaged as they have less access to resources, information, and services .
 
For those lucky enough to have a formal job with benefits, maternity leave has helped to increase nutrition benefits for young children—even lower infant mortality in some countries—and boost breastfeeding rates by 52 percent.
 
Unfortunately, while some South Asian countries provide maternity leave, this benefit is not equally available across the public, private, formal and informal sectors .
 
No doubt, further investments, and actions are needed to curb malnutrition. Yet, the constraints that working urban women face are not well understood, let alone solutions to address them.

What’s clear, however, is that improving infant and youth child feeding provides tangible benefits.

In India alone, universalized breastfeeding could reduce 156,000 child deaths each year, decrease at least 3,436,560 respiratory infections and 3,900,000 episodes of diarrhea, particularly in young children.

To understand emerging challenges and critical failures, the South Asia Food and Nutrition Security Initiative (SAFANSI) has invested in efforts to improve childhood nutrition in the region.

A study is now underway to identify and address challenges to proper child nutrition and improve infant feeding practices among working women  (in both the informal and formal sectors) living in cities. It will help them better understand the issues involved and how they might address them themselves.

SAFANSI is also supporting efforts to understand the reasons for the diminishing coverage of Baby Friendly Hospital Initiative (BFHI), an effective initiative to enhance breastfeeding practices, in several South Asian countries.

Over the past few years, policies and programs to improve infant and young child feeding have brought hope to babies in South Asia.

Now, these efforts must continue to further improve child nutrition and give all children a chance at a healthier future .

Authors

Ashi Kathuria

Senior Nutrition Specialist

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