CHINA

Nutrition survey results show generally good progress in reducing the prevalence of underweight children in China. The reduction is estimated as about -1.0 percentage points (pp) per year in the '80s, then -0.6 pp/year in the '90s. At such rates the prevalence will reach nearly zero in the next 15-25 years. Other data have shown differential trends in urban and rural areas, with the problem of malnutrition becoming primarily one of rural areas. In fact, stunting (but not underweight) is reported to have actually increased in rural areas in nine provinces where repeated surveys were carried out in 1987 and 1992.

With geographical and economic diversity, prevalences of underweight children vary substantially by province. Results analyzed by the Chinese Academy of Preventive Medicine are shown in Figure 6.⁶ Prevalences by province are reported to range from less than 2.5% in some urban areas, to 40% or even 50% in some rural areas, notably in the southwest.

The determined population policies have by now actually reduced the total numbers of preschool children in China, so that the numbers underweight have fallen faster, from around 23 million in 1985 to 17 million in 1995.

Infant and child mortality rates have continued to drop, with perhaps some faltering in the early '90s, to around 40 deaths per 1000 live births, a comparatively low figure considering the GNP, for example - as is the underweight prevalence. China's extensive health care access contributes to both these achievements.

China's economy has grown rapidly in the last ten years, averaging about 8% in GNP/caput terms from 1986-1993, in part responding to market-oriented economic reforms. Food production and availability have continued to increase, food production reaching record levels in 1994, with a dietary energy availability of around 2800 kcals/head/day.

Health services are extensive, with very high immunization rates for children, although tetanus immunization rates for mothers are reported to have declined. Access to safe water is reportedly high and being maintained. On average for the country, about half the girls are enrolled in secondary education, and the proportion continues to increase. The total fertility rate is about two births per woman, itself an important driving force for improving nutrition.

While in a country as vast and populous as China there are disadvantaged areas and people, overall China seems set to largely eliminate malnutrition in the foreseeable future.

Figure 6. Prevalence of underweight preschool children under five by province in China, 1992*