The Impact of Climate Change and Limited Social Resources on Childhood Malnutrition in South Asia.

*The region of “South Asia” discussed in this paper includes the following countries: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka*

 The disparate nature of food and nutrient accessibility within the world food system is of great cause for concern, especially in developing countries. The causes of the disparity in accessibility are incredibly complex, with many social, political, economic, and environmental factors at play that intersect making it difficult to find effective and sustainable solutions. Reduced food accessibility in areas like South Asia leads to many negative outcomes but none is more devasting and detrimental to the overall health of citizens than the prevalence of malnutrition in the form of child stunting and wasting. The World Health Organization (WHO) defines child stunting as "the impaired growth and development that children experience from poor nutrition, repeated infections, and inadequate psychosocial stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median" (2015).  They [WHO] define child wasting as "a child who is too thin for his or her height and is the result of recent rapid weight loss or the failure to gain weight" (n.d.). Throughout this essay, I will address the issue of malnutrition in children in South Asia by highlighting the prevalence of this issue and its causes and will focus on a few solutions that could help combat this issue leading to better outcomes for children, their families, their communities, and their countries.

 It's hard to imagine a world in which any child goes hungry and experiences any kind of malnourishment, especially not while walking down the aisles of a food market or grocery store chain in the U.S. or other developed nations. A surplus of calories and nutrients is on full display making it feel as if there couldn't possibly be a shortage anywhere in the world. But sadly, adequate access to nutrition through food is incredibly limited in areas like South Asia and other developing countries. According to 2020 data reported by UNICEF, "nearly half of all deaths in children under five are attributed to undernutrition" (2023). While the overall prevalence of malnutrition has decreased globally, approximately 149 million children have stunted growth and 45.4 million children are considered wasted of which 13.6 million were considered severely wasted (UNICEF, 2023). South Asia represents a disproportionate number of these cases with nearly two in five being stunted and more than half of all children in South Asia being affected by wasting (UNICEF, 2023). Shockingly, "the number of severely wasted children in South Asia is three times higher than in Sub-Saharan Africa" (UNICEF, 2023). The causes of childhood stunting and wasting are not limited to a lack of food but also a lack of micronutrients, poor maternal health – especially during pregnancy, lack of access to healthcare, low birth weight, illness, poor hygiene, lack of clean water, maternal age, and education level, and poverty (Caulfield, et al., 2006). Malnutrition in childhood can lead to an increased risk of morbidity and mortality and negatively impacts neurodevelopment leading to future reduced cognitive ability, which can cause a reduction in academic achievement (Kirolos, et al., 2022).  Studies have also shown a relationship between childhood malnutrition and an increased risk of developing type 2 diabetes (Lontchi-Yimahou, et al., 2022).  Additionally, climate change exacerbates the rates of childhood malnutrition by making food less accessible after droughts or intense periods of rainfall (McMahon and Gray, 2021).  According to Saleemul Huq, a climate change scientist, South Asia is particularly vulnerable to the effects of climate change due to "climate and geography" (Wazir, 2022). Huq expands on this by stating that high population density, in countries like Bangladesh, and a lack of or poor-quality infrastructure also play a role in how climate change is affecting the region (Wazir, 2022). Longer more intense rainfall and flooding or high heat events and drought have wreaked havoc on this region in recent years. In 2022, Pakistan experienced a severe heatwave followed by immense flooding that claimed the lives of nearly two thousand people and caused an estimated $46.4 billion in damages and losses (World Bank, 2022). These extreme weather events are becoming more common and will continue to negatively impact agriculture in South Asia creating continued limitations on food and nutrient availability.

While the issues leading to malnutrition are complex, I believe that positive changes can be made by focusing on a few social and environmental solutions. My proposed solutions should overlap, in theory, to create sustainable and lasting improvements to childhood malnutrition rates in the form of stunting and wasting. For this proposal, I will focus on three main areas: education, healthcare, and the environment. While each of the countries within South Asia would need to make these proposed solutions a priority, help from developed nations will be necessary to make a larger and faster impact. I believe that change is possible and by making this a focus, South Asian countries will improve the health and well-being of their citizens and will experience greater economic growth in return, creating a positive feedback loop whereby citizens get healthier, more productive, and more innovative, which then creates positive economic growth that goes on to create more wealth, health, and so on.

According to the World Bank, "Education is a human right, a powerful driver of development, and one of the strongest instruments for reducing poverty and improving health, gender equality, peace, and stability" (2022). One of the drivers of the prevalence of malnutrition is a lack of education for children and women in South Asia. It is estimated that more than fifty percent of children in South Asia live in learning poverty (UNICEF, n.d.). One is considered in learning poverty if they are "unable to read and understand a simple text by age ten” (World Bank, 2022). While female literacy rates have increased in recent years, literacy in females 15+ in 2020 was at 65% compared to 81% of their male counterparts (World Bank, 2022).  Available research points to a positive correlation between women's education and a reduction in childhood stunting (Krishna, et al., 2018). The same correlation is noted between education and family wealth (Krishna, et al., 2018). One way to reduce childhood malnutrition in the form of stunting and wasting would be to focus on increasing access to education and by increasing the number of years spent receiving an education. This is especially important for girls who will eventually become mothers themselves. Focusing on educating children would have the added benefit of increasing the wage-earning potential for these children later in life, reducing the strain of poverty and its effects on food accessibility. The World Bank estimates that for every additional year of schooling, an individual increased their hourly earning potential by 9% (2022). These income increases can go a long way in improving access to the food and nutrients needed to combat malnutrition. Women in South Asia are by and large victims of a patriarchal society. Their autonomy, and ability to make decisions about their health, well-being, and futures are largely dictated by the men in their families, so expanding education for girls will be difficult (UNICEF, n.d.). To overcome this roadblock, I suggest a multi-level social campaign to show men in powerful positions of government, religions, and households that educating women will improve the lives of everyone through better health outcomes and the increased potential for family earnings and national economic growth. This focus could also have the added benefit of making their countries more competitive in a global market. This campaign would include developed countries discussing the need for gender equality and expanded education access through diplomatic efforts, NGOs working with various local organizations, and grassroots efforts, especially in poorer and more remote areas. This would also require increasing access to technology and internet services to make remote learning possible.

My second proposal would be to expand Community Health Worker (CHW) programs throughout the South Asia region, especially in remote areas that have little to no access to professional healthcare. Programs like this are well-known throughout the developing world and have been shown to improve health outcomes for people who need it most. In an Annual Review of Public Health in 2014, authors highlighted the effectiveness of CHW programs in Mozambique where they experienced a 1/3 reduction in childhood malnutrition in a large-scale program serving 1.1 million people. CHWs can be trained in the early detection of malnutrition and render care to reduce morbidity and mortality in children. Community Health Workers can also be trained to provide essential services like educating women on the importance of birth spacing and family planning, prenatal and post-natal education and care, midwifery, pediatric well-checks, immunizations, educating mothers on nutrition and breastfeeding, and giving lifesaving nutritious food supplements if malnutrition is identified. They could also act as a conduit between citizens and formal healthcare professionals when more advanced treatment is required. CHW programs have been shown to have positive results in other areas, like the prevention, maintenance, and treatment of diabetes (Alaofè, et al., 2017). Improving accessibility and early intervention using Community Health Workers could greatly reduce new cases of childhood malnutrition and allow families to act quickly and get the nutritional support they need before their child suffers from stunting, wasting, or other malnutrition-related health complications. Expanding CHW programs is shown to be a more cost-effective solution when compared to professional health facilities, so programs like this are a less expensive means for governments to improve health outcomes for their citizens (Vaughan, et al., 2015). 

Given the immense impact that climate change is having on the South Asian region, we must focus some of our attention here. It's important to note that while many of the countries within the South Asian region are some of the world's most populous, this region is only responsible for a combined total of roughly 7.9% of the world's carbon emissions (Worldometer, 2016). By comparison, China is responsible for 29.18% and the U.S. is responsible for 14.02% (Worldometer, 2016). My suggestion would be to create a farmer's cooperative group that would be funded by the world's biggest carbon emissions contributors – The U.S. and China. These large carbon emissions contributors would fund the entire project and would focus on bringing the brightest minds to these countries to identify sustainable and resilient crops that could increase yield and stand up to increasingly intense weather events, like drought and flooding. An additional focus would be on educating women working in agriculture practices to improve soil quality, increase yields, animal husbandry, pest control, crop resilience, and business development and growth. This would include making substantial financial investments in women-run farms.  Zonibel Woods speaks to the need for women-focused agricultural education and funding in her article, How Supporting Women Farmers Can Ease Asia’s Food Security Crisis. She highlights the fact that women make up roughly 43% of the global agricultural labor force, with that number being even higher in some areas, but that women lack the resources and benefits that are often afforded to men. If we were to focus our attention on this large female workforce and increase gender equality, great strides could be made to improve community health and prosperity as “involving women helped increase production, income, and household assets” (Woods, 2022).

By focusing on education, expanding healthcare through community health workers, and asking the world's highest carbon emitters to make things right through specific women-led agricultural investments in South Asia, we can make a big impact in reducing the number of stunted and wasted children in South Asia. By doing so, South Asians will enjoy a healthier more productive population that will go on to increase economic growth and long-term positive outcomes for their respective nations. If implemented, a byproduct of these proposed solutions would be women's empowerment through improved social standing, and autonomy, as well as sustainable farming that increases biodiversity and soil health – reducing the harmful effects of flooding and drought. I strongly believe that these proposed solutions are possible and that returns on initial investments would make these investments and changes worthwhile.

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