Heightened concern for our country’s stunted children

During my nine years in Congress representing Davao City, our office regularly conducted various outreach programs (e.g., medical and dental missions, feeding programs, livelihood projects) for the benefit of underprivileged constituents who needed various forms of aid. Many parents participating in these programs frequently brought along their very young children, and during a lull in one of these activities I told a young mother that I found it remarkable that her one-year-old was walking so confidently at such a tender age.

Her answer surprised me: “Sir, ang bata sobra sa duha ka tuig ang edad.” (Sir, the child is over two years old.)

At first, I thought that I had done a poor job of estimating the child’s age; but after talking to volunteers and local leaders, I learned that it was fairly common for people to misjudge the age of children in their community.

“Cong, ang mga bata diri gamay sa ilang edad,” I was told. (Cong, the children here are small for their age.)

Pagkabansot

A common misconception is that Filipino children are naturally short – a myth that the National Nutrition Council (NNC) has worked to debunk the past several years. In fact, the NNC chose to highlight stunting when it marked National Nutrition Month in July last year, with the theme “Batang Pinoy, Sana Tall…Iwas Stunting Sama All! Iwas ALL din sa COVID-19.”

The decision to focus on this particular issue stems from data that show that one in three Filipino children below the age of five are considered stunted – an estimated 3.5 to 4 million children in the Philippines are stunted, one of the highest incidences of stunting in the world – a figure that should concern us all because of its far-reaching consequences.

What, exactly, is stunting?

According to the World Health Organization (WHO), stunting – or pagkabansot in Filipino – is the impaired growth and development experienced by children “due to poor nutrition, repeated infection and inadequate psychosocial stimulation.” Stunted children, simply put, are shorter than the average height for children their age.

Stunting: causes and effects

Stunting occurs when a child does not receive proper nutrition during the first 1000 days of life – a number that includes the nine months spent inside the mother’s womb, plus the two years of life as an infant and child. It follows, therefore, that a mother’s health and nutrition are critical factors in the growth of the child; if an expectant mother does not eat properly and is in poor health, the child in her womb will not receive the nutrients needed for proper development.

This is why Filipino mothers who belong to low- to middle-income classes are susceptible to bearing children who will experience stunting, due to the lack of access of these mothers to a diversified and nutritious diet, hindering them from being able to pass on the needed nutrition to the babies in their wombs, and even after they give birth and begin breastfeeding. Inadequate financial resources also make it difficult for mothers to find complementary feeding as a viable option to ensure their children gain enough nutrition during their first 1000 days of life.

It should be noted that the offspring of young, teenage mothers are also vulnerable to stunting, as the babies in their wombs compete for nutrients in the still-growing bodies of their mothers.

As infants grow, ensuring they have proper dietary diversity becomes a challenge among Filipino families in lower income households. While children may have access to food, they are still at risk of malnutrition or undernutrition if they do not consistently receive proper nutrition.

The ill effects of stunting do not end with lower than average height; its consequences are far graver than that, as it has long-term effects on the health of children as they become adults.

As children grow into adults, stunted children are more prone to non-communicable diseases such as hypertension and diabetes. They likewise have a greater risk of becoming overweight or obese compared to children who do not suffer from stunting. Stunting has also been observed to have an impact on the behavioral development of children; they display a tendency to be more apathetic, to display less exploratory behavior and to be more anxious. Stunted children are also more likely to experience depression and have lower self-esteem compared to non-stunted children.

Aside from these, studies also show that stunted children display reduced learning capacities that prevent them from achieving their full academic potential. This in turn affects their earning potential when they become working adults. There are estimates that show that stunted children can earn as low as 20 percent less as adults than their non-stunted counterparts.

Because evidence shows that stunting leads to poor educational performance, lost productivity, increased risk of developing non-communicable diseases (NCDs) and even death, the economic cost of stunting has been calculated to be equivalent to 1.5 percent to 3 percent of our country’s gross domestic product.

Interventions

Stunting is not a new problem, and several laws have been passed throughout the years to ensure early child care and development, as well as the welfare of mothers, to ensure they are able to provide for the nutritional needs of their children. Some of these include Republic Act 10028 or the Expanded Breastfeeding Promotion Act, Republic Act 11210 or the Expanded Maternity Leave Act, Republic Act 11037 or the Masustansyang Pagkain para sa Batang Pilipino Act and Republic Act 11223 or the Universal Health Care Act.

One of these laws, Republic Act 1148, also known as the Kalusugan at Nutrition ng Mag-Nanay Act or The First 1,000 Days Law, was passed during my last term as Davao representative; I was one of the principal authors of the measure in the House of Representatives. The measure was signed into law by President Duterte on Nov. 29, 2018.

The NNC, for its part, prepared the Philippine Plan of Action for Nutrition (PPAN), a five-year blueprint of the different interventions to be done by the government to ensure a holistic approach to address the problem of stunting. An integral part of the 2017-2022 Philippine Development Plan, the PPAN is consistent and dovetails with the Duterte Administration’s 10-point Economic Agenda, the Health for All Agenda of the Department of Health (DOH), the development pillars of malasakit (protective concern), pagbabago (change or transformation) and kaunlaran (development), and the vision of Ambisyon 2040.

The PPAN also factors in international commitments such as the 2030 Sustainable Development Goals; the 2025 Global Targets for Maternal, Infant and Young Child Nutrition and the 2014 International Conference on Nutrition.

On top of this, the President signed Executive Order No. 101, creating the Inter-Agency Task Force on Zero Hunger, a body which I currently chair that is composed of the heads of agencies and offices involved in government anti-hunger initiatives – including programs aimed at addressing stunting and undernutrition, such as community-based feeding programs and multi-sectoral efforts like Pilipinas Kontra Gutom (PKG).

Addressing stunting, maternal health and other issues involving the problem of hunger is the raison d’etre of PKG. Launched late last year, PKG is a multi-sectoral movement that brings together the government, members of the academe, non-profit organizations and some of the biggest private corporations in the country to collectively combat the issue of hunger.

Aside from organizing feeding activities, PKG has also been organizing a series of consultations with various sectors to come up with a sustainable and holistic approach that will ensure long-term success in addressing the problem of stunting. Representatives of Task Force Zero Hunger and PKG are optimistic that harmonizing the efforts of the different government agencies involved and learning how to optimize partnerships with organizations from different sectors will be able contribute immensely to efforts to improve early child care and development, and maternal health, as well.

It bears stressing that stunting cannot be cured – but it can and should be prevented. While it is an issue that currently does not hog the headlines, PKG believes that stunting is a serious, silent problem that deserves our attention and, more importantly, collective action. It is critical that we step up our efforts to address this concern so that millions of children can fulfill and maximize their potential – benefiting not just themselves and their families, but the whole country.

*      *      *

Cabinet Secretary Karlo Nograles is the chairman of the Inter-Agency Task Force on Zero Hunger. Prior to his appointment to the Cabinet in November 2018, the former House Appropriations chair served three consecutive terms in the House of Representatives representing the first district of Davao City.