Letter on 'invisible emergency' in Bangladesh, by Lovely Amin

Dear Field Exchange,

Patients at the Women's Training Centre clinic, Kamlapur slum, Dhaka, Bangladesh. (Pieternella Pieterse / Concern)

I find it very interesting to see that Field Exchange is publishing a lot of informative articles on nutrition interventions in emergencies. At the same time it sets me thinking about 'the invisible emergency' that is going on back home in Bangladesh and raises questions in my mind about 'when is an emergency an emergency.'

Bangladesh is a country of 128 million people with a land size approximately two times that of Ireland. Although, Bangladesh is not in the grip of what is topically called a complex emergency, the fact is that the nutritional status of the Bangladeshi population is amongst the worst in the world. In Bangladesh more the 50% of women are stunted while 50% of infants are born with low birth weight (less than 2500g)¹.

Stunted growth amongst the women of Bangladesh is due to lack of adequate caloric intake throughout the course of life. The average daily calorie intake of Bangladeshi people is 2085 Kcals (88% of RDA)¹. Amounts for those poor households below the average are therefore by definition less while status of individuals within the family also leads to a reduced intake. Culturally women have lesser status in the family. Furthermore, their economic contribution to the family is not very visible so that intra-house hold food distributions favour men and male children. This is an everyday fact for women in Bangladesh.

The 1996-1997 Bangladesh Demographic and Health Survey revealed that over half (52%) of mothers are acutely malnourished (i.e. BMI<18.5)2 while 17% were less than 145cm tall. Women's low height is associated with reduced pelvic growth which increases the risks of difficult childbirth and higher maternal mortality. In Bangladesh the maternal mortality rate is 4.5 per 1,000 and is one of the highest in the world³. Smaller women are also at higher risk of giving birth to low birth-weight children².

These statistics are very disturbing. Equally disturbing is the impact of inter-generational malnutrition on the physical and intellectual growth of future generations which has in turn ramifications for national economic development and the cycle of poverty.

In Bangladesh there is not enough food for everyone but with proper interventions the prevalence of maternal malnutrition could be reduced. Globally, the problem is not lack of food but equity and appropriate intervention.

There is a pervasive tendency to ignore this type of invisible crisis and it's underlying causes. Media attention will only be sparked by catastrophe. I also believe that acute emergencies must be addressed before chronic ones and am aware that the main focus of this publication is emergency nutrition interventions. However, while the type of widespread maternal malnutrition evident in my homeland may not fall into a conventional emergency category in my mind it is an undoubted emergency (albeit invisible) with a massive impact affecting the entire country.

Yours etc.

Lovely Amin
Policy Development and Evaluation Directory (PDED)
Concern Worldwide, Dublin
E-mail: lovely.amin@concern.ie

¹Human Development Report, 2000

²Bangladesh Demographic and health survey, 1996-1997

³The State of the World's Children