UNICEF focuses on the prevention and treatment of malnutrition and micronutrient deficiencies notably among pregnant women, lactating mothers and children. Preventing stunting is a particular concern and is addressed by a focus on the critical 1,000-day window of opportunity between conception and two years of age. Importance is given to improving the quality and use of the nutritional surveillance system as well as the intra/intercultural approach to improve infant feeding practices. During humanitarian emergencies, UNICEF assists the GoB to improve its capacity to provide for families.
Tiahuanaco under-five children
A long road ahead to fight malnutrition
By Silvia Pérez Zubeldía
On a hillside in the community of Huacullani in Tihuanacu, on the shores of Lake Titicaca, I meet 12-year-old Bertha, who is helping a newborn calf to stand up and walk while her mother Margarita milks the colostrum from a cow that has recently calved.
Bertha is the fourth of ten children and the eldest daughter. In spite of her tender years, she already behaves like a mother, carrying her one-year-old brother, Alex, on her back in an aguayo, or traditional woolen blanket, as well as keeping an eye on her other brothers and sister nearby. This is the morning of a school day, but all the children are at home.
We have come here from UNICEF to carry out a survey on nutrition on the high plateau in rural La Paz, in order to find out the prevalence of malnutrition among children and women, as well as other health information. The data will be used to evaluate the situation in these communities, improve the work being done here, plan new projects and compile up-to-date information on nutrition in this area that can be publicized and used for advocacy work within and outside Bolivia.
To begin with I ask Margarita to tell me the ages and names of her ten children, but she admits, with embarrassment, that she does not remember them exactly. Then Bertha, with her youthful shyness, helps us to draw up a list of all the members of her family. Freddy, her father (42), is away working in the city of La Paz, together with her three older brothers, Gonzalo (16), Edgar (15) and Hugo (14), and they will not return for another few days. Bertha is the next in age; after her are Saúl (10), Álvaro (7), Sonia (5), Grover (4), José (2) and Alex (1). As the oldest daughter, Bertha tells us openly that she helps her mother look after her brothers and sister, as well as assist with the housework, in the fields and taking care of the cows, but she doesn’t want to tell us how long it is that she hasn’t been going to school.
The next step in the survey is to weigh and measure the height of children under-five and women of fertile age. Obviously Bertha does not belong to either of these categories, but our presence interests her and she helps us by organising, lining up, and reassuring her brothers and sister so we can take the measurements. When we have finished the task, Bertha asks us to measure and weigh her as well, because this has never been done to her before and she is curious to know.
After assessing the information, we find that the three youngest children in the family, Grover, José and Alex, are suffering from severe chronic malnutrition, as evidenced by the fact that their height is lower than it should be for their age, and their growth is therefore stunted. This is undoubtedly due to poor nutrition as a result of bad dietary habits and low consumption of micronutrients, as well as insufficient health care by the family and health services, and recurrent infectious diseases caused by poor hygiene and unhealthy living conditions. It is also likely that their mother, Margarita, suffered from nutrition deficiencies before and during her pregnancies.
The chronic malnutrition that Grover, José, and Alex are suffering from will not only leave them shorter in stature but has also already damaged their brain development. This has consequences for their cognitive, physical, and motor skills development; their capacity for learning and study will be affected; their organism will be weaker and less able to fend off infectious and other diseases; when they are adults they will suffer from poorer health and be less able to work; and the economic development of their family and community will be reduced, among other impacts. Unless changes are made, these children are likely to become the parents of a new generation whom they will probably be unable to save from the same situation of malnutrition that they themselves are suffering now.
When we asked their mother, Margarita, if the children had ever had respiratory infections or diarrhoea in the last two weeks, she said that yes, all three had. We asked if she had been able to feed them with ‘Nutribebé’ (a supplementary baby food to complement breastmilk which is given out free in public health centres) and she confirmed that she had not. Margarita does not know if they were given iron supplements, anti-parasite treatment or Vitamin A. Neither was she able to show us their vaccination cards, and was unable or unwilling to say whether she had taken her children to the health centre for check-ups. Although Grover, José, and Alex may look healthy, and could even be said to be “chubby,” in fact they are suffering from what is called “hidden hunger.” 1
This is the reality for more than 20% of children under-five in Bolivia’s high plateau region. Public policies and government programmes on nutrition, amply supported by UNICEF, have managed to bring about a significant reduction in malnutrition at the national level in recent years. Unfortunately, the weaknesses that still affect public health and nutrition services, together with more structural causes such as the lack of education, especially among mothers, limited social protection systems, poor environmental health, and economic and social problems in households, mean that chronic malnutrition continues to be a reality in this part of the country, affecting the lives of children like Grover, José, and Alex irreversibly.
Bertha is now 12 years old, and although we can’t turn back the clock to find out whether she suffered from chronic malnutrition when she was under-five, we can infer that both she and her other brothers and sister are currently suffering the consequences of this malnutrition that has probably affected them from the moment of conception. Also, because she is a girl now approaching adolescence, the likelihood that Bertha has anaemia and a deficit of micronutrients is very high. If this is not detected and acted upon effectively, it is likely that Bertha, who has little formal schooling and lacks training and family support, will soon have as many children as her mother. She will try to look after these children as best she can with little knowledge of nutrition, and while having to bear the burden of all the household chores.
This is why it is essential to continue to support nutrition programmes, strengthen public services, and educate and empower communities – especially women – on the subject of nutrition, in order to improve the nutritional status of children like Grover, José, and Alex, break the cycle of malnutrition being passed down from one generation to the next in girls like Bertha, and finally to ensure that all children in Bolivia have a better future.
Before we leave, having taken photos of the whole family, Bertha asks me to take a photo of her on her own, without being surrounded by her brothers and sister or carrying them in the aguayo on her back. Finally, she is the centre of something, the protagonist of the story. As she poses for the photo, she smiles.
 “Hidden hunger” is the lack of essential vitamins and minerals in the diet. These micronutrients are needed to boost immunity and promote healthy development. Hidden hunger prevents children from achieving the full potential of their physical, intellectual and social development.