Dirección

Basic causes of malnutrition relate to the availability and control over human, economic and organisational resources within a society. The control of these resources is influenced by various interrelated factors:

 Political factors affect the structure and function of the state and include labour law, trade, political stability, goods and services.

 Economic factors include economic growth, distribution of assets, aid dependency, inflation and exchange rates.

 Cultural factors are a set of customs and traditions which are unique to each society. They include religion, beliefs, ethnic heritage and cultural norms.

 Environmental factors include agriculture, seasons, natural disasters and geography.

The unequal distribution or a lack in these basic resources offset and influence the nutritional outcome during pregnancy (Bellamy, 1998).

Influencing factors on potential basic resources in Bangladesh

Population and geography: Bangladesh is one of the world’s most densely populated countries and is situated on a flat plain above the world’s largest river delta. The southern areas are at extreme risk of cyclones and are estimated to be losing 1 percent of agricultural land each year due to rising sea levels caused by climate change

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(Bender, 2004; Feed the Future, 2011). Every year, 20 to 30 percent of the country’s land mass is flooded from monsoon rains and flash floods which destroy crops (Feed the Future, 2011; Thorne-Lyman, et al., 2010). When food crops are destroyed, nutritious food becomes less available and accessible to most vulnerable groups therefore increasing the risk of malnutrition. Demographic trends estimate that by the year 2050 the population will have reached 220 million and is likely to exceed food production (Feed the Future, 2011). This rapid population growth is putting a strain on the land and the food sources it can provide to adequately feed its population; most of whom are already living below the poverty line and consuming a basic diet based on rice (Devadas, 1970).

Industrialization and urbanization: Like most developing countries, Bangladesh is undergoing rapid urbanization with people moving from rural areas to the city in search of better jobs and opportunities. Urbanization has converted arable land into housing and businesses, thereby reducing the amount of land and people available to grow crops. There has also been a growth in cash-crops to produce money and feed the urban communities which further depletes the soil and reduces food variety (Feed the Future, 2011). Industrialization has brought with it a growth in transportation and communication facilities which have in turn brought new foods from distant countries influencing the Bangladeshi people’s food consumption habits (Devadas, 1970).

Political situation: Bangladesh was formally known as East Pakistan until it won its independence in the Bangladesh Liberation War in 1971 after many years of political and economic suffering (Bender, 2004). Since its liberation, Bangladesh has continued to struggle with violence and corruption throughout its political and governance systems, affecting both economic growth and social development (Roy, 2005). The Bangladeshi Government commits approximately 4.4 percent of the national budget to health each year (Director General Health Services, 2009). This amount is well below the level of investment required for a developing country. It is estimated that health expenditures should be between 10–15 percent of the national budget to achieve significant gains in the health status in Bangladesh (Howlader, et al., 2012).

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Ethnicities: Bangladesh’s colourful history has resulted in it being home to a wide variety of religions and ethnicities. Bangladesh was part of the British Raj and geographically split from India and into East Pakistan in 1955 on terms of religion. This has led to the majority of the population following the Islamic religion (89%), with 46 Adivasi groups throughout Bangladesh who are indigenous to the land but not part of the Islamic majority (known as Bengali) (Bender, 2004). The Adivasi groups make up around 1.5 percent of the total Bangladeshi population and have their own languages and culture (Besra, 2006). Like many minority groups, the Adivasi’s have often been subjected to violence, discrimination and persecution (L. Karim, 1998). The government has refused their right to self-identification and passed a law for them to be universally known as ‘Bengalis’. Discrimination against Adivasi groups has led to low literacy rates and cultural practices of communal land ownership have resulted in most Adivasi families losing their land and consequently increasing their level of poverty (Besra, 2006; Minority Rights Group International, 2008). Landlessness and discrimination of Adivasi communities has resulted in less opportunities and rights which causes greater poverty and higher malnutrition rates in these groups compared with the wider population.

Culture: Culture is a set of patterns of human behaviour, including customs and traditions, within a society or a societal group (Jerome, Kandel, & Pelto, 1980; Mennell, Murcott, & van Otterloo, 1992). Bangladeshis have strong cultural traditions which stem from a rich heritage and are distinct from those of neighbouring countries. Cultural customs and traditions influence all aspects of food choice and behaviour. Culture defines the what, how and why certain foods are consumed (D. Lee, 1957). These customs are learnt from a young age and indicate what food items a society will accept or reject and what are considered as socially acceptable eating behaviours (D. Lee, 1957; Lowenberg, et al., 1974). Cultural practices evolve over time and have the potential to change under new circumstances (Kuhnlein & Receveur, 1996; D. Lee, 1957).

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Religion: Religion defines several aspects of culture by influencing behaviours, beliefs and customs (D. Lee, 1957). Bangladesh is a Muslim dominated society with smaller proportions of Hindu, Buddhist and Christian communities. The Muslim religion is conservative and possesses a strong influence on dietary behaviours in Bangladesh. Muslim religion is often associated with the restriction of certain foods, such as pork, and the observation of fasting during Ramadan (Ahmad, 1984; Piechulek, et al., 1999). Other religions have their own unique beliefs which dictate certain practices and rules about foods that can and cannot be consumed. Religious celebrations are often centred around symbolic foods, therefore influencing their consumption and defining cultural practices (Devadas, 1970).

Social status: Women in Bangladesh generally have a lower social-economic status than men and are often socially discriminated against in terms of education, access to food and resources, income and rights (Balk, 1994). Bangladesh has a very high rate of child marriage, which is often followed with frequent pregnancies from a young age; increasing the risk of malnutrition in both the mother and the child (Haseen, 2005). Studies have shown that women, and especially young girls, receive fewer kilocalories than other members in their household and are often the last to eat (Carloni, 1981; Chen, Huq, & D'Souza, 1981; Devadas, 1970). Women have to work longer hours to receive the same wages as men which negatively impacts their health and education, resulting in a greater risk of chronic malnutrition (Lipton & Ravallion, 1995). Family attitudes and customs towards the feeding and health of women, especially during pregnancy, often directly relate to a higher prevalence of malnutrition in females which therefore spreads throughout future generations (Chen, et al., 1981; Devadas, 1970).