Ending hunger in the developing world is a major priority for many global charities and organisations, and for good reason. Globally, despite international awareness and encouraging signs of reductions in certain regions, levels of under-nutrition remain unacceptably high: over 3 million children still die of malnutrition every year, with 155 million children affected by stunting and 52 million by wasting. In 2016, more than half of all wasted children lived in South Asia (UNICEF, 2016).
Insufficient nutrition for children under 5 leads to serious, permanent health issues caused largely by stunting (low height for age) and wasting (low weight for height). Malnutrition is still a contributory factor in almost half of deaths in children under age 5. Families become trapped in a vicious cycle where young girls who suffer from stunting become malnourished women whose children are born undernourished, and grow up stunted.
The Vicious Cycle of Malnutrition and Poverty
The Effects of Malnutrition
Not only are stunting and wasting physically painful and life threatening, they also have a significant impact on the brain. For years scientists have been aware of the connection between nutrition and brain development, and Guatemalan research in the 1990s helped confirm the theories that stunting inhibits brain growth; boys who grow up malnourished generally have lower incomes and women are less likely to finish their education. They also studied cerebral development in very young infants (2-3 months), and found the stunted babies had significantly less grey matter in the brain than non-stunted babies. Seeing the effects of malnourishment taking place at such a young age is especially worrying, as the earlier the brain is affected, the worse the long-term damage will be (C.Storrs, 2017).
Not only does malnutrition play a part in almost half of child deaths (WHO, 2011), but it also has long lasting physical and mental effects on the lives of all people affected. Even those who survive childhood face further challenges in education and the workplace. It is a drain on human life and human possibility.
This is why zero hunger sits atop the priorities of the Global Goals at number 2: “by 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons”. At first glance, this goal to end malnutrition in all its forms in 15 years seems like an impossible utopian fantasy. In fact, a lot of progress has been made in the previous 25 years due in a large part to the millennial development goals that managed to almost half the proportion of undernourished people in developing nations. With another 15 years and a more targeted goal, surely large-scale eradication of hunger can be achieved?
What Can Be Done?
Malnutrition is a complex multi-faceted issue that revolves around far more than the simple question of whether or not people have access to food and water. Food quality, distribution, price, reliability and environmental sustainability all affect people’s long-term health and the likelihood of malnutrition. India is a nation affected by many of these factors, with huge economic inequalities and disparities in people’s access to food resources, as well as issues associated with the quality of available food. Although India is a regional power and has the third largest economy in the world, it continues to lag behind some of its neighbours in terms of social development. In spite of improvements in India’s poverty levels, a score of 28.5 on the 2016 Global Hunger Index leaves India at a “serious” level. Despite a 7.5 jump from 2008, it remains one of the worst scores in the region, and prevalence of stunting in under-5-year-olds is significantly high at 38.7% (The Global Hunger Index, 2016). Nobel Prize winner Angus Deaton argues that India has a complicated issue when it comes to feeding its huge growing population and that the prevalence of undernourished children and stunting are due in part to a dietary reliance on carbohydrates rather than protein and fats, as well as overarching social inequalities leading to sparse access.
Deaton’s analysis also found that inadequate sanitation was a major contributor to India’s high levels of malnutrition. The issue of sanitation is often overlooked in the context of health and nutrition, but in fact it has a significant impact due to its effect on people’s health and wellbeing. When communities do not have access to safe sanitation, untreated faecal waste, which transmits a variety of diseases but most significantly diarrhoea, is released into the immediate environment and is found in the water table, the air and the ground. Even when communities have access to adequate food and water, their health remains in decline because outbreaks of disease are impossible to control. Around half of undernourishment cases are associated with recurrent onsets of diarrhoea (Action Against Hunger, 2017). Diarrhoeal diseases inhibit the body’s ability to absorb nutrients and maintain a healthy body weight, which is especially dangerous for young children, adolescent girls, pregnant and lactating women and elderly people. There is a significant link between WASH and under nutrition, and one particular study conducted in a diverse range of contexts specifically found sanitation access for families with young children reduced cases of stunting in children under age 5 (Dearden, K. et al., 2017). As well as stunting, wasting and limitations to brain development, malnourishment inhibits the immune function increasing the likelihood of people contracting infections and being less able to successfully fight them off. This is another vicious cycle where people get sick from lack of sanitation and cannot absorb the nutrients they need to recover, leading to malnutrition, a weakened immune system and a greater likelihood of becoming ill again. Although there are many contributing factors to the hunger crisis, access to sanitation can be shockingly effective in the way it improves overall health.
Without Toilets: Vicious Cycle of Poverty// With Toilers: Breaking the Cycle
The Global Goals has categorised these issues into distinct groups in order to set and meet targets in a broad range of specific areas, however a holistic approach in which many issues can be solved with targeted solutions may be a more effective way to meet these targets. The issue of stunting and wasting in children, for example, evidently comes under goal 2, yet evidence suggests that achieving goal 6 with universal sanitation, clean and afforable water for all and ending open defication would go a long way to helping achieve goal 2 (Action Against Hunger, July 2017).
As ever, women tend to be disproportionally affected by many of the issues associated with lack of sanitation, and sickness and malnourishment are sadly no exception. Women in India are often so embarrassed or afraid to defecate outdoors due to shame, harassment and assault that they deliberately limit their food and water intake all day in order to avoid needing the toilet, especially in urban areas and at school. During pregnancy it is essential that women maintain a healthy body weight for the sake of the child as well as themselves. This is often made impossible in areas without toilets due to intestinal parasites transmitted through skin absorption when walking barefoot on ground where open defecation is rife. Parasitic worms limit the body’s ability to absorb nutrients, often leaving the sufferer malnourished and/or anaemic. For pregnant women the impact is doubled, as the mother and the foetus are both unable to absorb nutrients, meaning the baby is born undernourished, and a severely malnourished mother is often unable to produce quality milk to feed her already undernourished baby. This leads to stunted child development and continues this vicious cycle.
So to what extent can sanitation end the hunger crisis? Although often completely overlooked in relation to this issue, there is a lot of evidence showing the relationship between hunger, poverty and toilets. Providing effective, sustainable toilets helps to break these pernicious cycles of ill health and poverty. By removing faecal waste from the environment, people contract disease less frequently meaning the body can recover and absorb the nutrients it needs. Children are less likely to grow up malnourished and mothers are more likely to give birth to healthy children and produce quality milk. The complexity of this issue does mean that it cannot be solved in isolation. Sanitation may not be the lone answer to the issue, but it is certainly one simple, effective and often overlooked part of the solution.