Healthier mothers for a brighter future

Bangladesh has had incredible success fighting hunger. In 1990, almost two-thirds of children younger than five were underweight, but less than one-third are today. Recently, Bangladesh even received a "special recognition" award from the UN's Food and Agriculture Organisation for outstanding progress in fighting hunger and poverty.

National rates of malnutrition, however, are still very high, and stunting is a particular concern. When children are chronically undernourished or have to fight many infections early in life, they can become shorter than normal for their age. Stunting decreases cognitive development, leads to worse health outcomes and school performance, and lowers productivity throughout adult life. It is especially harmful to Bangladesh, because about 6 million children under age five are stunted.

What are the best strategies to combat malnutrition and its dangerous effects? New research by Jonathan Rose, a research advisor with the South Asian Institute of Advanced Legal and Human Rights Studies, examines programmes to fight malnutrition by delivering nutrients and micronutrients to young children and pregnant mothers.

The proposals analyse various strategies that target these vulnerable populations, including education about breast-feeding, energy-packed and high-protein foods, iodised salt, and supplements of vitamin A, zinc, or other micronutrients. The majority of these are already included in Bangladesh's National Nutrition Service strategic plan but have not been fully implemented due to capacity and staffing constraints.

Delivering the nutrition-focused improvements costs roughly Tk. 9,800 per child. If delivered to everyone, the greatest effect from the bundle of education, nutrients, and micronutrients would be on the rate of stunting, which would fall from 36 percent to an estimated 29 percent – averting stunting in roughly 450,000 children. Stunting has many deleterious effects: it hinders mental development, lowers school performance, and leads to worse health outcomes and more diseases later in life. But one of the most well documented outcomes is that stunted children have lower lifetime earnings because of these problems. Thus, a significant measure of the impact of better nutrition is the higher incomes these children will likely have. In total, this amounts to about Tk. 20 million  over the course of their working careers (According to Rose's paper, this is with the 5.13 percent growth scenario; if we use the 3 percent growth scenario then the lifetime benefits per child are over Tk. 8 million).

The research shows that each taka spent on the nutrition efforts would do about 19 takas of social good.

In a related analysis, Rose looks at how nutrition could also help pregnant women. In Bangladesh, we have seen great improvement in maternal health - the maternal mortality rate has fallen by more than 40 percent over the past decade. But there is still much to be done, especially because a mother's nutrition carries over to her newborn. Providing nutrients to the mother can be a very advantageous proposition.

Energy and protein supplements decrease the chances of stillbirth and undersized-infants. Calcium reduces pre-eclampsia during birth, which can be fatal for mothers. And iron and folic acid can lower anemia for mothers, a cause of maternal deaths, and also reduce infant birth defects. In addition, all three supplements fight a troubling issue: low birth weight. Newborns with low birth weight face significantly higher rates of infant mortality, are more likely to suffer complications or chronic disease later in life, and are predisposed to stunting. The analysis conservatively estimates that 15 percent of births in Bangladesh are low birth weight.

Giving pregnant women energy and protein could yield great benefits, especially for fighting low birth weight. But the supplement is logistically challenging and costly to deliver - it's more than four times more expensive than the iron-folate supplement. It is estimated that each taka spent will do 17 takas worth of good.

Calcium supplements, on the other hand, are less effective at preventing low birth weight infants, but they can reduce pre-eclampsia by more than 50 percent. In total, each taka spent will do 12 takas worth of good.

Iron-folate supplementation turns out to be most promising, particularly because significant benefits come from costs of just 591 takas per pregnancy. Providing all pregnant Bangladeshi women with iron and folic acid would decrease the risk of anaemia in mothers by 69 percent and reduce low-weight births by nearly 3 percent. The majority of the benefits would come from avoiding lifelong productivity losses that arise from low birth weight. But it would also reduce infant and maternal mortality and lower healthcare costs for children later in life. One taka of spending toward this effort does a striking 27 takas of good.

Each of these supplements could benefit pregnant women, but the analysis shows that iron and folic acid is by far the most cost-effective strategy, allowing more people to be helped, given limited resources. Where would you choose to spend valuable resources if you were in charge and wanted to do the most good for Bangladesh? Contact us at https://copenhagen.fbapp.io/ nutritionpriorities. Let's continue the conversation about how to do the most social good for Bangladesh with every taka spent.

The writer is president of the Copenhagen Consensus Center, ranking the smartest solutions to the world's biggest problems by cost-benefit. He was named one of the world's 100 most influential people by Time magazine.