Vivek, a tiny one-year-old who lived in a village of mud huts and diminutive people, had fallen victim to India’s great scourge of malnutrition.
His parents seemed to be doing all the right things. His mother still breast-fed him. His family had six goats, access to fresh buffalo milk and a hut filled with hundreds of kilograms of wheat and potatoes. His mother said she took him four times to doctors, who diagnosed malnutrition. The family even had electricity.
So why was Vivek malnourished?
An emerging body of scientific studies suggest that Vivek, and many of the 162 million other children under the age of five in the world who are malnourished, are suffering not so much a lack of food than poor sanitation.
Like almost everyone else in their village, Vivek’s family has no toilet, and the district where they live has the highest concentration of people who defecate outdoors. As a result, children are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat.
“These children’s bodies divert energy and nutrients away from growth and brain development to prioritise infection-fighting survival,” said Jean Humphrey, a professor of human nutrition. “When this happens during the first two years of life, children become stunted. What’s particularly disturbing is that the lost height and intelligence are permanent.”
Two years ago, Unicef, the World Health Organisation and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organisations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problem.
This research has quietly swept through many of the world’s nutrition and donor organisations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?
A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planets poorest countries. Stunting afflicts 65 million Indian children under the age of 5, including a third of children from the country’s richest families.
This disconnect between wealth and malnutrition is so striking that economists have concluded that economic growth does almost nothing to reduce malnutrition.
In Sheohar, for instance, a toilet-building program between 2001 and 2011 decreased the share of households without toilets to 80 percent from 87 percent, but population growth meant that exposure to human waste rose by half.
“The difference in average height between Indian and African children can be explained entirely by differing concentrations of open defecation,” said Dean Spears, an economist at the Delhi School of Economics.
Not only does stunting contribute to the deaths of a million children under the age of 5 each year, but those who survive suffer cognitive deficits and are poorer and sicker than children not affected by stunting. They also may face increased risks for adult illnesses like diabetes, heart attacks and strokes.
India is an increasingly risky place to raise children. The country’s sanitation and air quality are among the worst in the world. Half of India’s population, or at least 620 million people, defecate outdoors. Parasitic diseases and infections like tuberculosis, often linked with poor sanitation, are most common in India. More than 1 in 4 newborn deaths occur in India.
Other developing countries have made huge strides in improving sanitation. Just 1 per cent of Chinese and 3 per cent of Bangladeshis relieve themselves outside compared with half of Indians. Attitudes may be just as important as access to toilets. Constructing and maintaining tens of millions of toilets in India would cost untold billions, a price many voters see no need to pay a recent survey found that many people prefer going to the bathroom outside.
India’s government has for decades tried to resolve the country’s stubborn malnutrition problems by distributing vast stores of subsidised food. But more and better food has largely failed to reverse early stunting, studies have repeatedly shown.
In the meantime, as Dr. Stephen Luby, a professor of medicine at Stanford University puts it, “I think we can all agree that it’s not a good idea to raise children surrounded by poop.” — New York Times News Service