Patna district, Bihar, India. ©Bill & Melinda Gates Foundation/Prashant Panjiar

Malnutrition is an Outrage

As someone who has worked on global nutrition issues for more than 30 years, people often ask me what they can do. My answer is always the same: be outraged and channel your outrage into action.

As a nutritionist, outrage is a feeling with which I’ve become all too familiar. An example of when I felt outrage was two years ago when I met two young girls — Shanvi and Mishty — who lived across the road from each other in a village in Uttar Pradesh, India. At the age of five, Shanvi was barely taller than her neighbor, Mishty, who was just 28 months old.

Being so small and thin for her age, Shanvi suffered from stunting — an issue that affects 48 million Indian children. But the effects of stunting extend beyond a child’s height. Stunting threatens children’s cognitive development and ability to fight common illnesses, such as diarrhea and pneumonia. Compared to Mishty, Shanvi was more likely to struggle in school and earn less income as an adult.

Shanvi, 5-years-old (left) and Mishty, 28-months-old (right), India. Photo credit: Austin Meyer

That any child can suffer such stunted physical and mental growth is an outrage: Our failure to get children the right nutrition puts them at a disadvantage for the rest of their lives. As the World Bank’s president Jim Kim has said, poor nutrition early in life means: “inequality is baked into children’s brains.”

Knowing that Shanvi’s situation was preventable became my next source of outrage.

Mishty’s mother had been advised to go to a health clinic when she was pregnant, where she received prenatal care and learned about the importance of breastfeeding, starting within the first hour of Mishty’s birth and exclusively until she was six months old. Shanvi’s mother, on the other hand, received none of this advice. She wasn’t aware of the critical importance of prenatal supplements. She adopted the local practice of initiating breastfeeding when Shanvi was 10 days old rather than at birth, and breastfed her irregularly until her first birthday.

If Shanvi’s mother had had access to the same support that Mishty’s mother did — a package of services that cost around $10 annually — there is a good chance that Shanvi’s life would have turned out dramatically different.

I will be thinking of Shanvi this weekend when I head to the Global Nutrition Summit in Milan. The halls of Milan may seem far from the villages of Uttar Pradesh, but the reason we’re meeting is because Shanvi’s circumstances are not unique — malnutrition still drives nearly half of all child deaths and causes irreversible damage to 155 million more children who suffer from stunted growth.

Milan is where this outrage needs to translate into action. Throughout my career, I have seen sheer outrage fuel the resolve needed to drive incredible change. I think of leaders I knew in Niger in the late 1990s — a country often in the news for drought and food crises. Driven by pure outrage at the obscene numbers of Nigerien children whose lives were threatened by malnutrition, Nigerien officials made Niger the first sub-Saharan African country to ensure two annual doses of Vitamin A. This wasn’t enough to end Niger’s crisis, but it was a concrete, tangible action to make a considerable dent in it.

Dosso Region, Niger. © Gates Archive/Sam Phelps

It’s these types of targeted programs that we will focus on in Milan next week. I’ve been lucky to meet a handful of national leaders leading these programs. People like Abdoulaye Ka, the national coordinator of Senegal’s Fight Against Malnutrition Unit, and Bertine Ouaro, the director of nutrition at the Burkina Faso Ministry of Health. Abadoulaye helped reduce stunting from 33 percent to 19 percent in the past 20 years and turned Senegal into a bastion of success in a region facing some of the world’s worst rates of malnutrition; and Bertine is working to do the same in Burkina Faso today.

When I think of Abadoulaye and Bertine, I think about them as the most effective army in the world, but without any weapons. They are standing at the front lines with their battle maps, ready to fight for the future of their countries and for children like Shanvi — but with little to no resources to get the work done.

Many times, that’s because the people holding the purse strings haven’t yet felt that outrage.

A plea to my colleagues heading to Milan this week: when you hear local leaders like Abadaloye and Bertine speak practically about the programs they hope to implement and the targets they’ve set for their countries, know that behind that focused pragmatism, they are fueled by outrage. And I can tell you firsthand that it is an outrage that is incredibly powerful, because it is driven by meeting children like Shanvi every day.

Channel their outrage and then commit to action. Together, we can be the most powerful army in the world.

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