From birth to two years, a child’s physical and mental development depends on their diet and the rate of food intake. Foods are classified according to age-specific nutritional needs. There are eight types of foods approved to ensure the nutrition of children aged six to 23 months, with instructions on how often to eat these foods. However, only 28.7 percent of children in the country within that age range are receiving the minimum acceptable food for proper nutrition. Compared to four years ago, the percentage of children receiving adequate nutrition has decreased, leading to concerns among nutrition and public health experts about extreme nutritional insecurity during their development.
The deterioration of infant and young child feeding (IYCF) has been reported by the government itself, as highlighted in the latest ‘Bangladesh Demographic and Health Survey 2022’ published by the National Population Research and Training Institute (NIPORT) of the Ministry of Health and Family Welfare this year. The organization states that the Fourth Health, Population, and Nutrition Sector Program (HPNSP) have set a target of 45 percent of children receiving minimum acceptable food.
According to the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the list of acceptable foods for children aged six to 23 months includes at least eight food categories. These include breast milk, grains, white or pale edible plant roots, tubers, or leafy plant roots (such as potatoes, radishes, greens, etc.), bananas, beans, peas, lentils, nuts, seeds, dairy products (fresh, packaged, and powdered milk, curd, and cheese), meat, fish, poultry, eggs, vitamin A-rich fruits, vegetables, and other fruits and vegetables. Consuming at least five of these types of food is considered a varied diet. There is also variation in daily food intake between children who are still breastfeeding after six months and those who are not. These foods should be given at least twice a day for children aged six to eight months and at least three times a day for children aged 9 to 23 months.
According to NIPORT’s survey, in 2017-18, 35 percent of children aged six to 23 months received minimum acceptable food, but by 2022, this percentage dropped to 28.7 percent. Similarly, the number of meals a child should receive per day according to their age has also decreased compared to four years ago. In 2017-18, 81 percent of children received regular meals, whereas in 2022, it decreased to 61 percent. The rate of children receiving a varied diet has seen no significant improvement, remaining at 39.1 percent in 2022, compared to 38 percent five years ago.
UNICEF recommends introducing food to babies at six months of age when breast milk alone is no longer sufficient to meet their nutritional needs. At this age, children are developmentally ready to eat solid foods and show interest in trying new foods.
Meanwhile, although the rate of stunted children under the age of five in the country has decreased, the rate of underweight children has increased. According to the government survey, 24 percent of children are stunted for their age, compared to 31 percent four years ago. However, there has been no improvement in reducing the rate of underweight children, which remains at 22 percent. Additionally, the proportion of children engaged in agricultural work has increased from 8 percent to 11 percent over the same period. The survey conducted by NIPORT collected information from over 30,000 households in urban and rural areas of the country.
Nutritionists emphasize the critical importance of early childhood nutrition, as nutritional deficiencies during this period can hinder a child’s mental and physical development. Children should be exclusively breastfed for the first six months, with no water introduced during this time. After six months, a variety of foods should be introduced to meet their nutritional needs. However, a majority of children between the ages of six and 23 months in the country lack a varied diet, leading to nutritional deficiencies during early childhood.
The Bangladesh Breastfeeding Foundation (BBF) conducts awareness activities on maternal nutrition, infant feeding practices, and breastfeeding. Professor Dr. SK Roy, Chairman of the organization, told Banik Barta, “Currently, there are approximately one and a half crore children under the age of five in the country, with 3.8 million babies born every year. BBF previously worked on IYCF until 2019 and also focused on breastfeeding. This work is now fully undertaken by the National Nutrition Service (NNS). During our involvement, the breastfeeding rate was 65 percent, but it later declined. The NNS would be better equipped to provide information on their recent efforts. Approximately 22 ministries and departments of the government are involved in nutrition-related activities, highlighting the need for better monitoring of these initiatives. Mother support groups are formed to ensure a varied diet for children, as without diverse food options, children may remain malnourished.
According to the sources of the National Nutrition Service and the Bangladesh National Nutrition Council (BNNC), 13 of the 22 government ministries dealing with nutrition are actively engaged in combating malnutrition through direct nutrition activities. These activities include programs such as direct feeding, provision of vitamins, calcium, iodine, MINT powder, and minerals, particularly targeting children and women. Direct activities also involve treatment. In contrast, indirect activities entail multifaceted programs such as meetings, seminars, training, and awareness campaigns conducted in coordination with various ministries or independently. Around 300 programs are currently operational across the country in the field of nutrition, encompassing both government and private initiatives. Among them, there are 31 operational plans (OPs) of the government, with 19 OPs being implemented by the Ministry of Health and Family Welfare. Every year, the government allocates significant funds for nutrition activities, with the NNS program operating in coordination with several multifaceted nutrition schemes of the government.
A publication released by BNNC at the end of 2021 analyzed government expenditure on nutrition for the three fiscal years 2014-15 to 2016-17. It stated that the government spent approximately 23.5 billion rupees on nutrition-related activities in the fiscal year 2016-17. Out of the three fiscal years, direct nutrition activities accounted for only 2 percent.
Public health experts emphasize the necessity of strict monitoring of nutritional activities alongside the implementation of various government programs. They argue that rising commodity prices are hindering food diversity for children aged between six and 23 months, apart from mother’s milk. The escalating prices of daily commodities are leading people to forego some ideal foods and rely more on sugary foods. Additionally, many parents lack knowledge about the variety, timing, and quantity of foods to provide to their children.
Professor Dr. Mizanur Rahman, Program Line Director of the NNS, told Banik Barta, “The COVID-19 pandemic has adversely affected nutrition activities, resulting in a decline in the rate of breastfeeding, which was previously at 65 percent. However, there are some concerns regarding Niport’s survey. We are not the sole authority on nutrition within the government; 22 ministries and departments are involved in this area. Furthermore, there are a few observations worth noting regarding the information provided by Niport on food variety. We do not distribute food; rather, we focus on ensuring that the food provided to infants is nutritious and advising on its preparation and feeding. Only 2 percent of the government’s expenditure on nutrition is allocated to the health sector. Our primary goal is to raise awareness.”
Professor Nazma Shaheen, from the Institute of Nutrition and Food Science at Dhaka University, commented that social security would be disrupted if there is uncertainty regarding the nutritional food intake of children. She told Banik Barta, “A significant number of children in the country are not receiving the minimum acceptable food. Research is needed to understand the resulting harm or impact. All children should have access to a varied diet. It is challenging for families below the poverty line to ensure that children have a diverse diet. Improving nutrition will not be effective if children are not provided with the necessary foods. A child’s access to a nutritionally diverse diet depends on the economic status of the family. Moreover, there is a lack of household knowledge about food. Greater emphasis should be placed on government programs. Currently, the global economic crisis persists, and the government should initiate new activities. Families should be able to afford food within their means.