Underweight child prevalences improved considerably during 1985-90, with a reduction of around 1 percentage point (pp) per year (see Panel 3B). For 1990-95, however, the regional rate was only about a quarter of this, with particularly poor results in 1990-93. Although comparable national data are scarce, this pattern can generally be seen in Table 3; examples of trend data from India and Sri Lanka are shown in Figure 4.
Calculations of poverty levels in South Asia show a reduction from 1985/87-90 (of about -0.5 pp per year), but this ceased in 1990-93. The estimated poverty levels were: 1987, 45.4%; 1990, 43.0%; 1993, 43.1%. The malnutrition and poverty data are thus consistent.
The GNP in this region has generally been rising slowly, but a downturn with negative growth occurred around 1988-93, followed by some recovery reported in 1993-5. In part this is attributed to unfavorable weather affecting agricultural output, but economic problems, especially in India, went far beyond this. Moreover, conflicts in Afghanistan and Sri Lanka have been damaging to the economy. The population growth rate has slowed to around 2.3% per year, compared to about 3.3% in the 1970s; still, population growth remains a major issue.
Figure 4. Trends in prevalence of underweight children from repeated national survey results, 1985-1995
Aside from occasional setbacks due to drought, the average food availability (dietary energy supply, in kcals/caput/day, from Food Balance Sheet data) has risen up to 1992, which is the most recent data available. Nonetheless, dietary energy availability is the lowest here aside from Sub Saharan Africa of any region, and indicates a low level of household food security, contributing to persistent malnutrition. Indeed, for a substantial number of poor and landless people, access to enough food is an overwhelming need, and enhancing food security is crucial before nutrition can improve.
The regional IMR has continued to fall, reportedly reaching around 80 per thousand live births by 1994. This improvement has taken place in most countries in the region, the likely exception being Afghanistan.
Health indicators give a somewhat inconsistent view, (see Panel 3F & 3G). Access to health care was considered to increase until 1990; immunization rates were reported to increase, faster in fact in 1990-5 than earlier. Access to safe water, on the other hand, is reported to have dropped since 1990, but sanitation has apparently improved.
Secondary school enrollment for girls is increasing slowly (panel 3H), but remained below 40% in 1993. Total fertility rate has fallen to about four projected births per woman, not as low as South East Asia, but welcome progress.
Not shown in these statistics are data on direct programmes intended to improve nutrition, like the Integrated Child Development Services in India. As these gain wider coverage, the results can be expected to show up in the prevalence estimates; indicators such as outreach and expenditure should begin to be included in future in assessments such as this.
PANEL 3. SOUTH ASIA
A. Million, log scale
CHILD GROWTH AND SURVIVAL
B. Underweight preschool children (Percent below -2 s.d. weight for age)
C. Infant Mortality Rate (Per 1,000 live births)
ECONOMICS AND FOOD
D. GNP per capita (Atlas US dollars)
E. Dietary energy supply (Kcals per caput per day)
F. Immunization coverage (Percent)
G. Access to health services and potable water (Percent)
WOMEN'S STATUS AND CARING CAPACITY
H. School-age females in secondary school (Percent)
I. Total fertility rate (Births per woman)