Although Bhutan has done well compared with the countries in the region in terms of childcare and development, the issue of child growth, diet and food security, and care during pregnancy remains a public health challenge. As UNICEF observed, progress has been neither even nor fair. It has been found that the poorest children are more than six times more likely to be stunted than the richest, are more than thrice as likely to die before their fifth birthday than children in the richest quintile. Children whose mothers have no formal education are 63 percent more likely to be stunted compared to children whose mothers have a secondary or higher education.

About one in five children under the age of five in Bhutan still remain stunted. According to a recently published national nutrition survey, 21.2 percent of children aged 0 to 59 months are stunted. Because stunting, or low height for age, is caused by long-term insufficient nutrient intake and frequent infections, effects are irreversible. It affects a child’s motor development, cognitive function and school performance. Undernutrition is also a problem which leads to wasting. Nearly half of all deaths in children under 5 are attributed to undernutrition.

There are gaps we need to close.

Health records are revealing. It has been found that the number of antenatal care visits is closely related to wealth. Among the richest quintile, 39 percent of women made eight or more visits compared with 17 percent in the poorest quintile. Wealth and education are the determining factors.  Investing in children’s access to water, sanitation and hygiene enable them to be agents of behaviour change in families and communities. In Bhutan, poorest households’ (32 percent) access to improved sanitation is three times less compared with the richest households (95 percent).

Because reports from the health facilities and monitoring visits indicate that growth monitoring has not picked up as expected, the health ministry recently issued an executive order requiring all the health centres in the country to strictly monitor weight and height of all children under the age of five to reduce childhood acute wasting and stunting. If we have better data on the children’ vulnerability, we have the opportunity to design timely and appropriate interventions. Our challenge, in the face of lack of robust monitoring system in health facilities, is to advise parents, particularly in the rural areas, about the importance of giving nutritional food to children.

Growth monitoring should pick up because stunting and wasting is an economic burden for the country and widens inequality in the society. Shortage of food is not our problem. The problem is one of lack of nutritional food. If parents don’t come to health centres, health advisories should be taken to them. Reducing stunting and wasting cases will remain a challenge otherwise. Our health officials have some extra miles to tread.