Bangladesh

Bangladesh has a land area of 143,960 square kilometers and a population estimated at 117 million in 1993; it is among the world's most densely populated countries, with more than 740 people per square kilometer. The population is estimated to be growing at 2.1% per year. This intense population pressure on a relatively narrow resource base, together with the frequent natural disasters, presents formidable challenges to poverty alleviation efforts in Bangladesh.

The nutrition situation in Bangladesh was previously reported by the SCN in the Update Report, 1989 (ACC/SCN, 1989, p. 106-111) and, with trends to 1990, in the Second Report on the World Nutrition Situation (vol.II, p.16-20; ACC/SCN, 1993).

Recent Trends in Nutrition

Since 1990, trends in the nutritional status of children in Bangladesh were monitored through the Nutritional Surveillance Project (NSP), a collaborative effort by the Government and by NGOs, and coordinated by Helen Keller International. Every other month, the system collects nutrition and socio-economic data from 7,000 to 9,000 children between ages 6-59 months nationwide. These children are sampled from 5,000 to 7,000 households scattered over 26 sentinel points in the country corresponding to the 20 sub-districts and 4 slu-mareas in urban centers. The nutritional surveillance system is one of the most comprehensive system in existence, and the 24 rounds of data collected so far provide the most recent trends in the nutrition of the country.

Since data are available on a bi-monthly basis, trends in nutrition in Bangladesh could be related to important changes in the economy, public policy and natural disasters such as cyclones, which affect the country periodically.

Prevalences estimated as shown in Figure 1 indicate that the nutrition situation did not change much between 1990 and 1992, but improvements were observed in 1993. The bi-monthly trends in the prevalence of underweight children over the last four years (1990-1993) indicate strong seasonality effects. There are two main crops, one harvested in December (Aman) a second harvested in June (Boro). As shown in Figure 1, the proportion of underweight children rises during the period before the rice harvest and improves right after each harvest. The highest levels of underweight prevalence were observed around June to October just before the Aman crop harvest, and lowest around December to February/April, just after this harvest. Highest values in the last few years were 72-74% in 1990-1992, improving to around 70% in 1993. Lowest values were 69% in 1991-1992, falling to 65% in 1993.

Figure 1. Bangladesh: Relationship Between Price of Rice and Prevalence of Underweight Children, June 1990-December 1993

Source: Bloem (1994).

There are strong differences in regional nutritional situations. Figure 2 shows the mean SD score of weight for age of children 6-59 months by sub-district for the period between April 1990 to December 1993. Since this is an average of the entire period, the data provide a relative ranking of chronic nutrition problems. Thus, it is clear that the areas most in need include Daudkhandi, Chilmari, Raigonj, Kazipur, Rajoir, and Matlab, whereas the/better off areas of the country include Pirganj, Moheskhali, and Teknaf. The average SD score for the worst off areas are below -2.5, with over 85% of children in these areas underweight. An analysis of the NSP data for the 1990-1993 period indicates that the problems of malnutrition were observed to be highest amongst landless and marginal farmers, and farmers with small holdings (<2.5 acres).

Figure 2. Bangladesh: Underweight (mean Weight-for-Age SD-score) in Children Aged 6-59 Months by Sub-Districts, April 1990-December 1993

Source: Bloem (1994).

Factors Affecting Trends in Nutrition

Economic Factors. With an estimated per capita GNP of US$220 in 1993, Bangladesh is one of the lowest income countries of the world. Vulnerability to national disasters and heavy reliance on annual rains make Bangladesh economic growth erratic.

In 1992/93, agriculture accounted for 34% of GDP as compared to 40% in 1986/87. It provides employment for the majority of the workforce and, in many rural areas, is the only source of employment. About 60% of person-hours worked in Bangladesh are spent in agricultural production, and mostly in rice production.

Despite the country's erratic climate, agriculture has been the principal driving force of economic growth, particularly as large sectors of industry rely on the crop and fisheries sectors as a source of inputs. Recent signs of stagnation in agricultural growth have, therefore, serious implications for overall growth prospects.

The economy is heavily dependent on foreign aid. Bangladesh has a low rate of national savings - only 6.4% of GDP in FY91, and 8.3% in FY92; foreign earnings were 4.0% of GDP in FY91, and fell to 2.2% in FY92, of which overseas worker remittances accounted for approximately half. Investment in the economy remains at the low level of 11% relative to GDP. Despite these structural weaknesses in the economy and repeated disruptions by natural disasters, Bangladesh has made significant economic progress over the past decade. Stabilization policies reduced external and fiscal deficits, reduced the inflation rate, promoted non-traditional exports, and achieved a modest growth rate. The inflation rate fell to 5% in 1992, the lowest rate in more than 10 years.

Food Security. The overriding objective of agricultural policy and development efforts in Bangladesh is to achieve self-sufficiency in foodgrains. Foodgrain output has risen, but self-sufficiency remains elusive. Rice output has tended to increase, but suffered from the 1987/88 floods and subsequent drought. In 1989/90, the crop reached a record 17.9 million MT, a figure matched in 1990/91, and exceeded in 1991/92 with a new record of 18.3 million MT - due primarily to a bumper boro harvest, which was up by 7% to 6.8 million MT. The per capita food production index has increased from 96 in 1986 to 110 in 1993 (base is 1979-81=100).

To ensure an affordable food supply for poor consumers, the government manages a variety of food distribution programmes and open market sales operations to help stabilize foodgrain prices. The objectives of price stabilization policies are to protect poor consumers from sharp price increases, protect poor farmers from a postharvest price collapse and achieve foodgrain self- sufficiency. Public food distribution programs provide approximately 13% of all foodgrains consumed in the country.

BANGLADESH

(Estimates in 1993)

Population	: 117 million
Population Density	: 779 per sq. km.
Population Growth Rate	: 2.0% per annum
Urban Population	: 18%
IMR	: 94
GNP US$ (Per Capita) (WB Atlas Methodology)	: 220
PPP estimates of GDP ($ Per Capita, in 1991)	: 1160

CHILD GROWTH AND SURVIVAL

Underweight preschool children (Percent below -2 s.d. weight for age)

Infant mortality rate (Per 1,000 live births)

ECONOMICS

GDP per capita (1987 Mkt. prices, Takas / capita)

Debt service ratio (Debt service/exports)

FOOD

Food production index (Per caput, 1979-81=100)

Dietary energy supply (Kcals/caput/day)

Consumer price index (1980=100)

FPI/CPI ratio (1980=100)

HEALTH

Immunization coverage (Percent)

Access to local health care (Percent)

PUBLIC EXPENDITURES

Education and health expenditures (US $ per capita)

Education and health expenditures (Percent of government expenditures)

The public food distribution programmes (PFDS) include disaster and famine relief, seasonal food-for-work development projects and year-round rationing.

Many food distribution programmes and food policies have recently been restructured, reformed or eliminated. For example, in August 1992, the government allowed private sector imports of foodgrains for the first time. In May 1992, the government abolished the rural rationing programme because of the high costs of maintaining it (an estimated $60 million per year) and large leakages (between 70% and 100%). The rural rationing programme had provided an outlet for half of all government rice stocks. Its elimination resulted in a large buildup of government stocks and prompted several additional reforms in procurement policies.

Effects of Falling Rice Prices. Surveys by IFPRI indicate that roughly 85% of households are net purchasers of rice. Rice accounts for 40% of total spending by rural households in Bangladesh. Because of this, the price of rice is a powerful determinant of real income, consumption, and nutrition of the poor. This is clearly demonstrated in Figure 1 by the strong association of the trends in prevalence of underweight children from the nutritional surveillance data and the average price of rice during the period from 1990 to 1993. As shown in the graph, there are strong seasonal and interannual correlations between the price of rice and malnutrition.

The effect of changes in food price on food consumption and nutrition was also independently confirmed in another survey carried out by IFPRI during the same period in various areas in the country. The 20% fall in rice price from the lean season of 1991 to the lean season of 1992 offers a rare window for viewing the effects of rice price on consumption and nutrition of the same households. The surveys found that the 20% fall in the price of rice increased household consumption of rice by 38%, as well as other foods such as milk, meat, and eggs. Overall calorie consumption improved on average by 12% (10% for adults, 20% for children under 5).

Conclusions

Food security indicators in Bangladesh have improved steadily over the past several years. However, Bangladesh's per capita income has remained stagnant as efforts to reduce widespread poverty meet substantial obstacles. Access to health services and antenatal care is increasing, although per capita government expenditures are among the lowest in the world. Calorie availability in Bangladesh was estimated to be 2019 in 1992, as compared to 1936 kcals/caput/day in 1986.

GNP per capita, per capita calorie availability, under-five mortality rate, foreign exchange earnings per capita, and domestic food production per capita nonetheless indicate that nutrition in Bangladesh is improving, particularly in the last year (1993), in line with the nutritional surveillance results.