Sustainable development requires investments in human capital as well as direct measures to accelerate economic growth and alleviate poverty. Some cash-poor countries, India for example, borrow from the World Bank to fund programs for children in anticipation of future productivity gains. I have assisted in designing these programs in India and elsewhere and feel strongly that this is wise.
What is the evidence that investments in children make economic sense? Much comes from studies of children growing up under adverse conditions. In poor countries, poverty-related factors lead to inadequate diets and high rates of infection, twin forces that interact to produce high rates of malnutrition, killing 10 percent or more of young children in the process. Malnutrition has its greatest impact during a narrow window of time: intrauterine life and the first three years. Extremely small maternal sizes, poor diets during pregnancy and heavy workloads are among the main causes of poor fetal development. About 30 percent of newborns in countries like India are severely growth retarded, although most are born full-term. Pronounced growth failure also occurs until about 3 years of age, and by then, most children in many countries will be nutritional dwarfs when compared to better off children.
Why are young children vulnerable? One reason is their greater nutritional needs per unit of weight, in part because of rapid rates of growth. Ideally, young children need frequent and nutrient-dense feedings, but all too often, weaning foods used in poor countries are bulky and of poor nutritional quality. As few as two meals per day may be given to toddlers in some countries and, in urban areas, breast feeding may be offered for only a few months to infants or not given at all. These children are also exposed to an overwhelming array of agents of infection, respiratory and gastrointestinal, at a time when their immune systems are developing; older children, on the other hand, will have acquired considerable immunity and will be sick much less often. Infections lead to poor appetites and their metabolic effects result in substantial energy and nutrient loss.
The long-term effects of malnutrition on human function are profound. Growth failure in early childhood leads to women who are very short and have narrow pelvic inlets; this places them at great risk of delivery complications and death. A stunted physique means a reduced muscle mass and limited physical work capacity; in demanding jobs, such as cutting sugar cane, stunted men will be less productive than larger ones and earn less. Manifestations of malnutrition are associated with impaired learning and low school achievement. Low birthweight is associated with significant degrees of learning impairment; even in the United States, I.Q. is about six points lower in school children born small compared to normal controls. Stunted children in developing countries may differ by as much as 15 I.Q. points compared to non-stunted children of similar socio-economic background.
Also, anemia and iodine deficiency are common nutrition problems with profound effects on intellectual development. The societal significance of these effects cannot be overstated; a vast body of literature links intellectual performance and school achievement to income levels, even in agrarian societies.
Together with colleagues at Emory, the University of California at Davis and the Institute of Nutrition of Central America and Panama, I have been involved in long-term studies of about 2,000 rural Guatemalans who participated as newborns and young children in studies done in the '60s and '70s. In villages receiving a nutrition supplement and medical care, the prevalence of low birthweight and severe postnatal growth failure were reduced by half compared to what occurred in villages receiving only medical care. Subjects exposed to the nutrition supplement grew up to be taller adults with improved muscle and bone masses and greater work capacities. Ongoing studies show that the babies born to women whose nutrition was improved in early childhood are only half as likely to have low birthweight, compared to those of women whose diets were not improved. Tests of general knowledge, vocabulary, reading and numeracy indicate that, for the same level of schooling, subjects receiving the nutrition supplement outperformed those who did not. Effects on intellectual performance were greater among those whose families were poorer and became larger with increasing years of primary education.
Our findings are the first to assess the long-term value of child nutrition interventions and have been cited frequently by advocates of these programs in developing countries. While nutritional problems are not common and not as severe in the United States, they do occur in pockets of poverty. More widespread is lack of adequate intellectual stimulation in disadvantaged families. Studies of psychosocial stimulation in early childhood show lasting beneficial effects into school age.
The rationale for maternal and child nutrition programs can be approached from two perspectives. The first is the subject of this essay; nutrition and health programs aimed at mothers and children lead to enhanced human potential and are therefore long-term economic development strategies. The second is that adequate nutrition and health are basic human rights. Governments have an obligation to meet the needs of their poor, particularly the nutritional needs of children. The United Nations' Convention on the Rights of the Child, signed by the United States and most governments, holds them to "recognize the right of the child to the enjoyment of the highest attainable standard of health..." and "to combat disease and malnutrition." The current legislative drive in the United States to curtail social, health and nutritional services to immigrant families and children, in some cases regardless of legal status, will exacerbate existing levels of malnutrition and poor health and is a violation of these moral principles.
Reynaldo Martorell is Woodruff Professor of International Nutrition, Rollins School of Public Health.