Bibek Debroy, Bjorn Lomborg, Aditya Sinha
Of all the Sustainable Development Goals (SDGs) the world is likely to fail to achieve by 2030, and there are many, the most tragic and disappointing is the lack of progress towards ending hunger and malnutrition. This is all the more depressing because in contrast to the more ambitious goals of eradicating poverty and providing employment to all, it seemed quite possible to achieve. After all, all the rich countries of today have been free from this problem of malnutrition in the 20th century itself. By the year 1900, six out of every ten children in Japan were malnourished. But by the year 2000 the situation had improved a lot. China has been able to drastically reduce malnutrition in the last 20 years. It also decreased in India, Ethiopia and the Philippines. But in the poorest and most vulnerable countries, malnutrition is not declining at all. In countries like Burundi, the situation of malnutrition remains the same.
Our failure can be gauged from two facts. One, there are 2.5 crore children this year who could not develop properly. That is, they are malnourished to such an extent that their height is less than other children of their age. Keep in mind, being a dwarf also affects the availability of other opportunities throughout life.
In the year 2015 itself, governments around the world had decided that by 2030, like other promises in the list of SDGs, they would get rid of the problem of stunting. Half the term is over, but we are far from halfway there. Going by pre-Covid-19 trends, the world will be able to achieve this target only by 2116, ie 86 years behind schedule.
One of the smartest ways we can address malnutrition is to focus on pregnant women. Calcium and other nutrients can be made available to pregnant women in the form of pills at a nominal cost. During pregnancy, there is often a deficiency of important nutrients in women because they have to meet the needs of the child growing in the womb from their own food. As a result, both mother and child become malnourished. Most countries already provide iron and folic acid to pregnant women as per WHO recommendations to prevent anemia in mothers and neural tube defects in babies. This means that with a little training and education in the healthcare sector, pills with more micronutrients can be delivered to those in need. This will lead to a very minor increase in the expenditure of the government. Every year more than 90 million people are born in low and lower middle income countries. This effort can benefit 3.6 crore pregnant women and their babies.
These new pills are already in mass production. They contain 13 vitamins and minerals such as zinc, copper, iodine and selenium, along with vitamins A, B1, B2, D and E, apart from iron and folic acid. The low cost of this can be understood from the fact that the total cost for a single mother for the entire 180-day period is a little over a dollar. This means that even if all items like healthcare training are added along with pills to 36 million women in a year, the total expenditure comes to only 84 million dollars.
Multi-micronutrient supplements can save 7% of the 700,000 unborn babies every year. If children are not of low weight at the time of birth, then the productivity of these children is high. With these measures, the cases of low birth weight babies can be reduced by 21 per cent. In other words, it will help 14 lakh children achieve higher productivity. If we calculate financially, then the benefits of this sit 37 times more than the expenditure on it.
Calcium Tablets is delivered separately. They are quite big. In the last 20th week of pregnancy, two tablets have to be taken daily. The cost of this comes to $ 5.96 per pregnancy or a total of about $ 216 million. These can prove to be twice as effective as micro-nutrients. Equally, they can prevent premature birth and low birth weight babies. Not only this, it also reduces the cases of calcium exemplia and pre-exemplia. It is a rare but serious condition that can manifest as high blood pressure during pregnancy or delivery. Simply put, this means that calcium could prevent 8,500 maternal deaths every year. Overall, the benefits outweigh the costs (about $4 billion) by 19 times.
However, changing the mix of micronutrients given to pregnant women is not a panacea for malnutrition. There is a need to work hard to provide complementary food to the infants and ensure that they are supplied with nutritious food for the first 1000 days. In view of the long-term goal of ensuring the production of surplus food, measures have to be taken to increase the yield of agriculture and ensure a wider variety of crops. But given how far the world has fallen in addressing malnutrition, we have to start somewhere, and ensuring a supply of nutritious food to pregnant women is a simple approach that has tremendous potential to save lives.
(Vivek Debroy is the Chairman of the Economic Advisory Council to the Prime Minister, Bjorn Lomborg is the Chairman of the Copenhagen Consensus and Aditya Sinha is the Additional Private Secretary (Research) in the Economic Advisory Council to the Prime Minister)
Disclaimer: The views expressed above are the author’s own.