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Understanding vulnerability in Bangladesh through the glaring nutrition picture


Published: Sunday, May 29, 2016

Published : 28 May 2016, 21:56:59

Understanding vulnerability in Bangladesh through the glaring nutrition picture

Naveed Ahmed Chowdhury

Bangladesh has made remarkable strides in poverty reduction over the last decade. The largest contributor to this phenomenon has been the country's resilient growth. In fact, gross domestic product (GDP) per capita has doubled and poverty rate has almost halved between 2000 and 2010. Despite this progress in poverty reduction, one of the main concerns is the vulnerability issue. A high proportion of the population hovering just above the poverty line is vulnerable to falling back into poverty.

Problems thus arise when we attempt to interpret poverty using conventional measures and ignore the vulnerability issue. Specifically, problem areas in vulnerability such as nutrition underscore the glaring issues for the poor in Bangladesh. In fact, undernutrition, stunting, underweight cases and other health issues plague the impoverished as a result of the lack of nutrition and dietary diversity. This write-up discusses some of the pitfalls of conventional poverty measures and highlights problem areas, viz. vulnerability with regard to nutrition.

SHORTCOMINGS OF CONVENTIONAL POVERTY MEASURES: The process of measuring poverty in Bangladesh has plenty of shortcomings. Generally speaking, poverty rates are calculated using per capita equivalence scales in Bangladesh. For example, when considering the case of children, the poverty rates of households with children are higher than if children were regarded as a proportion of an adult (for example, 0.5, as is the practice in the Pacific Region). As a result, per capita equivalence scales generate higher poverty rates for households with children than households with adults, in particular elderly.

The fall in poverty rates should not however disguise the reality that a very high proportion of the population of Bangladesh is either poor or vulnerable to falling into poverty. According to a 2012 report by the World Bank, the poverty rate would increase to 43 per cent if the poverty line were set at PPP$ 1.25 per day instead of the usual $1.0 per day. Moreover, around 84 per cent of the population in 2010 lived under the equivalent of PPP$ 2.0 per day. Therefore, there is a drastic change in poverty rate with small adjustments to the PPP line. Moreover, many argue that the poverty line is outdated and set too low.

Complications in poverty measures also arise when we attempt to pinpoint a direct divide between urban and rural areas. According to Household Income & Expenditure Survey (HIES) 2010, almost 36 per cent of rural population is poor according to the Upper poverty line (UPL) compared to 22 per cent of urban population. However, is the rural-urban divide with regard to poverty consistent across all scenarios in Bangladesh?

The World Bank (2012) notes that a different measure of poverty - using Direct Calorie Intake - indicates that urban poverty rates are 10 percentage points higher than rural poverty rates. Furthermore, UNICEF (2010) argues that living conditions in slums - where 5.0 per cent of the population reside - are worse than in most rural areas. High rates of continuing migration to cities are likely to exacerbate poverty in urban areas, in particular in the slums.

THE ROLE OF NUTRITION (OR LACK THEREOF): As demonstrated above, there is clearly a problem when basing vulnerability solely on poverty measures. To better gauge vulnerability, we need to focus on important issues such as nutrition where Bangladesh is lagging behind. Malnutrition and stunting remain key concerns in Bangladesh. Anthropometric measures are generally used to assess the nutritional status. However such measures are not available in Bangladesh and hence dietary diversity scores (DDS) has been used for this purpose.

Understanding vulnerability in Bangladesh through the glaring nutrition picture

J.H. Rah and N. Semba in collaboration with other authors noted in 'Low dietary diversity is a predicator of child stunting in rural Bangladesh' (2010) that good dietary diversity is strongly negatively associated with stunting among children aged less than five years. Similarly, John C. Waterlow and Beat Schürch, in their 1994 workshop 'Causes and Mechanisms of Linear Growth Retardation', maintained that low dietary diversity is often associated with higher prevalence of infections.

One can infer from the HIES 2010 data that improvement with regard to nutrition in Bangladesh has been sluggish and insufficient. Around 38 per cent of the population reported moderate food deficiency in 2010, dropping just 6.0 percentage points over the 2000 to 2010 period. Moreover, low dietary diversity, as measured by the Household Dietary Diversity Score (HDDS), has also been found a persistent problem in Bangladesh as noted by a World Bank paper series in 2013.  Accordingly, it has been concluded that Bangladesh is unlikely to meet the Millennium Development Goals (MDG) of reducing moderate food deficiency (access to fewer than 2,122 kilocalories per person per-day) to 24 per cent.

Bangladesh also faces risks in the case of unborn children receiving inadequate nourishment due to their mothers' deficient diet. Indeed, Nazme Sabina in 'Impressive Achievements - But Stunting Remains a Challenge' (2012) states that 40 per cent of rural families are unable to afford a minimum-cost nutritious diet and it is common for women to eat less well than their husbands. Children - and mothers - are also put at risk when they are unable to receive adequate pre-natal care or give birth with the help of medical personnel.

In addition, according to the 'National Institute of Population Research and Training (NIPRT) in collaboration with Mitra and Associates and ICF International (2013), only 26 per cent of Bangladeshi women have at least 4.0 antenatal visits while only 32 per cent give birth with the assistance of someone with medical training. Post-natal care from a medically trained provider within 2.0 days of giving birth is received by only 27 per cent of women. According to the Report on Sample Vital Registration System 2013, the under-five mortality is high at 41deaths per 1000 live births, although it has improved from 94 per 1000 in the late 1990s. Around 86 per cent of young children receive a full complement of vaccinations, with only 2.0 per cent receiving no vaccinations at all.

A high proportion of young children suffer from undernutrition, which impacts their cognitive development and affects them throughout their lives. Figure 1shows the progress on stunting and underweight children between 2004 and 2014.  Stunting rates, estimated at 68 per cent in 1990, fell to 36 per cent in 2014. Indeed, the World Bank in 2013 argues that Bangladesh has made "remarkable" progress in reducing stunting. Even so, it is evident that the challenge remains significant, especially in rural areas where stunting levels - at 43 per cent - are significantly higher than in urban areas (at 36 per cent)as mentioned in HIES 2010.

The causes of stunting are complex but, in the past 20 years, there appears to have been a strong negative correlation between poverty reduction and improved nutrition, suggesting that higher incomes are helping reduce under nutrition. Contrarily, there appears to have been little progress in tackling wasting. However, these wasting rates may be related to seasonality and thus reflect challenges in areas such as sanitation and health services.

The above argument of higher income reducing undernutrition is further supported by the fact that the highest rates of stunting are among poor families. The Demographic and Health Survey (DHS) 2014 indicates that the stunting rate in the poorest quintile is 50 per cent and 21 per cent in the richest quintile. However, wealth in the DHS is measured using an asset index which will have a relatively weak correlation with income and expenditure.

Given this probability, one cannot ascertain the actual stunting rate among expenditure (income) quintiles; it is entirely possible that stunting rates among the better off are lower than those found in the DHS. Furthermore, low incomes are likely to impact negatively on nutrition since due to restricted dietary options and subsequent increase the proportion of rice in the diet. By continuing to tackle poverty and improve family incomes, Bangladesh will consequently attain improvement in nutrition among young generations. However, since undernutrition is caused by multiple factors, it will be important to ensure that public policy actions address these multiple factors in order to improve nutrition.

CONCLUDING REMARKS: In this analysis, we argue that relying on poverty measures alone in order to understand vulnerability of the poor paints an incomplete picture. This is because standard poverty measures may be unreliable given the calculation procedure. Rampant fluctuations occur with small adjustments to the poverty line. Moreover, the conventional wisdom on location differences in poverty become questionable when we use Direct Calorie Intake as an indicator. Similarly, UNICEF points out that city slums are worse off poverty-wise when juxtaposed with rural areas. Hence, poverty indicators alone do not justify or accurately reveal the vulnerability problems of the impoverished.

It is crucial that social protection programmes develop a circumspect view of poverty and vulnerability. Existing social protection programmes are certainly lacking in impact. Simply put, it is not enough to rationalize existing programmes by extending coverage and improving target mechanisms- it is time to rethink social protection in Bangladesh to better address problem areas, such as nutrition.

[Naveed Ahmed Chowdhury is a Research Associate at the Policy Research Institute of Bangladesh (PRI). He can be reached at naveed.chy@gmail.com]