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Born Disadvantaged

Jan 16 2017 - At the age of around three, the daughter of a domestic worker in Karachi started to inexplicably lose weight. After months of ignoring the issue, the mother finally approached her employer, whose first question was whether the child got enough to eat and if her diet was a balanced one.

Hajrah Mumtaz

Hajrah Mumtaz

The mother explained that the child more or less got enough lentils and vegetables, though there was little meat because of the cost — and that even when there was meat, such as on Eid, it tended to go to her sons, because they were older and “needed it more”. The girl was born with low birth weight, and in the first couple of years of her life, when the mother was unemployed, did not get enough to eat because the family was struggling financially. Things were better now with her current job.

Upon being taken to a doctor, it was revealed that the child was suffering from various deficiencies, including vitamin and iodine. The medic also explained that the girl was probably a victim of intergenerational malnutrition given that this was the case with the bulk of the poor in the country. The vitamin deficiencies could be compensated for, he said, but the adverse effects of malnutrition that had already impacted the child in utero and in the crucial first two years of her life — physical stunting, slower cognitive development etc — were permanent.

Over 9m Pakistani children experience chronic malnutrition.

This country’s shocking figures on malnutrition and high rates of stunting have been in the headlines for several years now. Even so, there seems to be little understanding of the problem and the scale at which it is putting successive generations at a significant disadvantage.

Intergenerational malnutrition occurs when the effects of chronic malnutrition play out over successive generations: undernourished girls become undernourished mothers whose children are therefore also undernourished, both during pregnancy and later because of poverty. Of these, the girls — already born and raised weaker than their potential — will go on to become malnourished mothers. The effects are compounded and aggregate.

On top of this is not just the discrimination girls face food-wise at the hands of the male members of the family (‘the boys need it more’ logic), but also the fact that many girls are married off far too early and have little say in when they should bear children.

According to the World Food Programme, globally malnourished mothers give birth to somewhere around 17 million underweight infants every year. Of these, the ones that survive infancy face compromised health and cognitive development all through their lives. The same source says that at a worldwide level, maternal malnutrition accounts for 20 per cent of child stunting. Referring specifically to Pakistan, the National Nutrition Survey 2011 tells us that 44pc of children in the country suffer stunted growth — according to the UN the third highest number in the world.

This translates into 9.6m Pakistani children that have experienced chronic nutritional deprivation in utero or during early childhood. Stunting and slow cognitive development translate to persons less able to work to their full potential later in life, thus deepening the poverty cycle. The effects of in utero malnutrition can be compensated for to some extent in early life, but after age two or so, by when some 80pc of the brain’s capacity has already developed, the deficiencies have become permanent.

If this presents a frightening lens through which to view the predicament in which millions of Pakistan’s poor find themselves, consider an old bit of research on poverty of which I was recently reminded. In 2013, the prestigious Science magazine of the American Association for the Advancement of Science carried a ground-breaking lens through which to study financial stress.

It showed that poverty, in and of itself, significantly hurts people’s ability to make well-thought-out decisions and, as a single factor, imposes a mental burden comparable to losing a dozen IQ points.

In other words, the stress of it is such that people’s ability and judgement to decide wisely is significantly impeded, because the short-term gains are so urgently needed and long-term ones seem so impossible. Poverty, as the article notes, directly impedes cognitive function. One of the authors of the study, Eldar Shafir, commented in an interview back then that “All the data suggests it is not the person, it’s the context they are inhabiting”.

Put these pieces of research together and the future looks grim indeed: on the one hand, there are millions labouring on despite poor cognitive development; on the other, the very context of poverty could be leading to poor decision-making. Hence, perhaps, the very slow pace of success in Pakistan’s intervention initiatives — and there have been several over the decades — to lift millions out of poverty and improve lives.

The writer is a member of staff.
Published in Dawn, January 16th, 2017

This story was originally published by Dawn, Pakistan

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