In the 1980's rapid improvement in nutrition took place in a number of countries in SE Asia - Thailand in particular, as well as Myanmar, Indonesia, and probably Malaysia. In the Philippines improvement only started after 1992. From Vietnam the data are less clear; probably nutrition improved in the 1980s but perhaps less in the 1990s. Thailand, having reached 13% prevalence in 1990 is bound to show slower rates of decrease as the prevalence tends to near zero. Improvement in Indonesia may have slowed recently, although the reasons are unclear. Some of these results are shown in Figure 5.
The average trend results here (see Panel 4B) do less than justice to the diversity in the region. Overall, the high mean rate of underweight prevalence change in 1985-90 of -1.1 percentage points per year slowed to -0.4 pp/year in 1990-95. These general trend directions are largely consistent with poverty changes, which are estimated to have dropped by 1.9 pp/year in 1987-90, then by 1.3 pp/year in 1990-93. It should be stressed that poverty incidences are derived from household surveys, independently from nutritional estimates. Estimates of poverty levels for East Asia (excluding China) are: 1987, 23.2%; 1990, 17.6%; 1993, 13.7%.
Figure 5. Trends in prevalence of underweight children from repeated national survey results, 1985-1995
Economic expansion has been rapid in many countries in the region, rising on average from US$650 per caput GNP in 1985 to around $1100 US in 1994. Growth in the region has been particularly marked in Indonesia, Malaysia and Thailand, but some have yet to achieve sustained growth - such as the Philippines - and others remain extremely poor, like Cambodia, Laos, and Vietnam. Overall growth faltered in 1992-94 (see Panel 4D), but seems to have restarted recently.
Food availability measured as kcals/caput/day (DES, see Panel 4E) increased somewhat in the region, providing for a reasonable degree of food security. Interestingly, the rapid improvement in nutrition in Thailand in recent years occurred with an almost unchanging dietary energy supply, while Thailand became a major food exporter.
Infant mortality rates have fallen steadily, now reaching around 50 deaths per 1000 live births on average. The range is quite wide, Malaysia for instance reported an IMR of 12 for 1995, similar to many industrialized countries, while Myanmar reported a figure of 78. Health indicators showed some continuing improvement in the 1990s (see Panel 4F & 4G). The immunization programmes for children reached greater than 80% coverage, and thus cannot increase much more, which could account in part for the slower decrease in underweight since most of the benefit from immunization has now been achieved. A similar situation is thought to apply to decreases in IMR, which tend to slow down as the most readily preventable deaths are reduced.
As measures of the role and status of women - as well as being important in their own right - the indicators of girls secondary school enrollment and total fertility rates showed continued improvement in the 1990s. Total fertility rate is now below 3 on average for the region. Reduced TFR tends to improve nutrition, but will also flatten out presumably around two, another reason that further improvements in nutrition may become harder to achieve.
PANEL 4. SOUTHEAST 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)