4 March 2013

Mozambique: Malnutrition Persists Alongside Economic Growth

Maputo — Mozambique has seen economic growth between seven and eight percent during the last two decades, yet over half the population continues to live below the poverty line. Rates of stunting and chronic malnutrition among Mozambican children have shifted little in the past decade, falling from 48 percent in 2003 to 43 percent today.

The country's children die less from acute malnutrition than they did 10 or 20 years ago, but their quality of life remains poor.

Carlos Castel Branco, an economist and researcher at the Institute for Social and Economic Studies (IESE) in the capital, Maputo, said that while long-term, significant and sustainable improvements in nutrition and poverty levels are difficult to achieve without economic growth, they will not necessarily result from economic growth either.

He pointed out that over the past decade, food production per capita in Mozambique has not increased; it has actually declined slightly, and food prices have increased. Food inflation impacts the poor more than other groups since a higher percentage of their income is used to buy food.

Little investment in food

According to Castel Branco, less than 1 percent of all private investment in the last decade was allocated to basic food production for the domestic market, compared to the 85 percent allocated to minerals, forestry, primary commodities for export markets and associated infrastructure. The remainder was distributed between banking, construction and tourism.

"Why is it so? Because that is what foreign capital is interested in, that is where domestic capital sees its future, and that is what is supported by the state, with its close links to domestic and foreign capital," he said.

Twice in the last three years, Mozambique's capital has experienced riots in response to the rising prices of food and basic services.

The reaction of the state has been to appreciate the domestic currency to make imports cheaper, explained Castel Branco. But such monetary measures worsen the ability and incentive to invest outside the dominant extractive sectors, and they minimize the government's ability to mobilize domestic resources to diversify food production for the domestic market.

A more diversified economy and higher taxes - used in the right way - could address the various poverty-related indicators that affect children´s nutritional status.

"Not just about food"

"It is not just about food," said Maaike Arts, a nutrition expert at the UN Children's Fund (UNICEF) in Mozambique. "It is about health, hygiene and sanitation.

Diarrhoea and worms affect the child´s uptake of nutrients; malaria reduces the levels of iron in the blood. In Mozambique, many women marry and get pregnant ... as teenagers. There is a significant correlation between mothers' age and the nutritional status of the children."

Eighteen percent of Mozambican women marry before they reach age 15, and 52 percent before they turn 18. Not only are these adolescents' bodies still developing during pregnancy, but young mothers are less likely to know how to adequately care for their young children.

Levels of chronic malnutrition are highest in rural areas, where parents often spend all day working in fields far from home and most families only eat twice a day. Lack of opportunities to earn an income in the countryside also correlates with high malnutrition rates, according to Edna Possolo, head of the nutrition department at the Ministry of Health.

"We need to give children a more varied diet. Many families breed chicken and goats, but they only eat meat on special occasions. Why? Because they need to sell the animals to buy soap, sugar, salt, school materials and other basic goods," Possolo said.

A child's first 1,000 days - from conception until they reach age two - are crucial. If the child is malnourished during this period, the damage that can result from stunting is permanent. It can affect not only the child's size, but also their brain's development, and can lead to heart disease and diabetes later in life.

According to a World Bank study, children who are stunted grow to become adults who earn lower salaries than their non-stunted counterparts. In this way, widespread stunting can affect a country's economic development.

Chronic malnutrition in Mozambique has been estimated to result in productivity losses of between 2 and 3 percent of GDP, translating to between US$300 and $500 million annually, according to figures in the government's national strategy for reducing malnutrition.

Government plans

Addressing chronic malnutrition has moved up the government's agenda in recent years, according to Arts. For the first time, the government has a plan that aims to reduce chronic malnutrition in children under five years old to 30 percent by 2015 and 20 percent by 2020.

But there are obstacles to implementation.

"The government scaled-up their commitment in 2010, but the formal commitment at a senior level is still lacking. There is not much pressure from above for the ministries to keep their targets," said Arts. She says there is poor understanding of the issue's complexity, and fears it has been simplified to "we need to tell people how to eat".

Possola agreed. "We can spend floods of money educating people [on] how to eat without changing anything," she told IRIN. "There is a lack of understanding of the question at a political level, and we need to create this understanding. Very little is done at a macro level to deal with the high levels of chronic malnutrition.

"We know how to treat the immediate effects of malnourishment, and we have formulated a range of good policies to deal with the structural issues, but we don´t really know how to implement them."

The greatest difficulty, according to Possolo, is implementing the multi-sectoral approach outlined in the government's plan. Malnutrition is commonly believed to be purely a health problem that should be dealt with by the Ministry of Health, and many donors prefer to fund projects dealing with the symptoms of malnutrition rather than structural approaches that take longer to achieve tangible results.

"I would prefer a single financing mechanism, a common fund. That would make it easier for us to prioritize and to coordinate the efforts in this area," said Possolo, who added that she sees some steps being taken in the right direction.

The fact that the president is talking about malnutrition in different forums and participating in the international "Scaling Up Nutrition" initiative suggests he is taking it seriously, she said. And more donors are involved in the area today than five years ago.

Even so, Possolo does not have much hope that the current boom in Mozambique's coal and gas sectors will diminish poverty or chronic malnutrition levels. According to Castel Branco, doing so will require changes in monetary and exchange rate policies and greater mobilization of domestic resources to diversify consumer services and goods - especially food - and to make them accessible to everybody.

"If the economy continues to grow on a narrow, extractive and speculative path, short-term and narrow improvements in poverty and nutrition can be achieved by short-term measures like humanitarian aid, but without any significant and sustained structural change in the long run," he said.

[This report does not necessarily reflect the views of the United Nations.]

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