By Beatrice Montesi, Associate External Relations, GAIN
Malnutrition is a serious issue in Mozambique. Micronutrient deficiencies are widespread, representing a threat to the lives of many children across the country. Available data show that more than two out of five children under five suffer from chronic undernutrition and about 7 percent are severely malnourished.
Over the last few weeks, I had the opportunity to witness first-hand the extent of the problem during visits to several communities in the Sofala Province, near the city of Beira. When we think of malnutrition we usually think of people not having enough to eat. But the problem is much more complex.
Here are three things I learned about current malnutrition challenges in the country:
Malnutrition is not always the product of food insecurity
Malnutrition is not just about being hungry: malnourished children can be getting enough calories, but lack the essential nutrients, such as iron, vitamin A and iodine, they need to grow and thrive. This applies particularly in Mozambique where people rely on staple foods like cassava, maize, and corn for their diets. Xima, a porridge made with water and corn or maize flour, acts as a base for almost every Mozambican meal. However, this porridge lacks in many essential micronutrients and is widely eaten mostly because it is filling.
The families I visited in the Dondo area have various seasonal fruits in their “mashambas” (backyards) such as mangoes, bananas, coconuts, or other nutritious foods like peanuts, but in many cases they fail to integrate them in their daily diets. Let’s take the example of mangoes. In Dondo, I saw hundreds of juicy, ripe mangoes hanging from the trees and as many more going rotten on the ground. People do eat them, but only for the limited time they are available between December and January. Because the communities don’t have the capacity to store these fruits for the rest of the year, they lose an important source of vitamins and calories.
Other factors unrelated to food are also exacerbating the malnutrition problem, including early marriage, lack of clean water and sanitation, as well as high rates of HIV/AIDS among the population. Most of the mothers that I met are in their early twenties, have already two or three children, and are coping with HIV and antiretroviral treatments.
In order to improve the diets of these young children aged between 6 and 23 months, the Global Alliance for Improved Nutrition (GAIN), in partnership with the Ministry of Health, PSI, and Save the Children, is implementing a home fortification project that entails the distribution of sachets of multi-nutrient powders and promotion of optimal complementary feeding practices. Each sachet, called VitaMais, contains a colorless and tasteless powder of 15 essential vitamins and minerals that can be added to food that young children eat regularly. The use of micronutrient powders has been proven to prevent micronutrient deficiencies among children, while still promoting the use of foods available locally.
While this intervention helps to significantly improve nutrition during the 1000 days window, more needs to be done to inform families about good nutrition practices and ensure they improve their dietary habits. This brings me to my second point.
Lack of nutrition education seriously inhibits healthy dietary choices
Improving knowledge on feeding and health care is vital. When talking to mothers, I noticed that many of them have misconceptions about their food. For example, one of them told me that pregnant women and children should not eat eggs. Many of these ideas are embedded in traditional beliefs, and it requires the support of the entire community to ensure that people begin making healthy dietary decisions.
Community health activists involved in the home fortification project described above play a major role in communicating the importance of good nutrition and showing how mothers can make meals healthier with the foods they have available. They showcase recipes that combine xima and other locally available products, like orange sweet potato, coconut, papaya, and vegetables, in order to make traditional foods more nutritious and improve dietary diversity. In addition to cooking demonstrations, they use theatre to educate the entire community and involve fathers in the care of their children.
But more efforts are needed in order to reach a larger number of women with essential nutrition messaging. GAIN and the Ministry of Health have recently launched One Minute for Nutrition (Um Minuto Nutrição in Portuguese), a national campaign that uses TV and radio advertisements to promote breastfeeding, optimal complementary feeding, and healthy eating practices for children.
Making markets work for the poor is crucial to expand access to healthy nutritious foods
Once families gain this nutrition knowledge, it is important that they can access and afford the right foods in the marketplace.
I met Isabel, a 17 year old mom, while she was giving processed, sugar-heavy fruit juice to her one and half year old baby. When my colleague and I asked her, “Why are you giving this to your child when you could give him fresh, natural mango juice instead?” She shrugged and replied, “This is what I find at the market”.
Despite Mozambique’s impressive growth and potential, about 55 percent of the population lives below the poverty line. The majority of the population still lives in rural areas, but the number of people like Isabel living in urban and peri-urban areas is increasing at a rate of almost 4 percent per year. Most urban families do not produce their own food; they buy it and make choices based on what is available in the market at affordable prices. Even poor rural famers are net purchasers of food and, cruelly, these farmers are also some of the world’s most undernourished.
In this context, harnessing the role of markets and catalyzing small and middle-sized food enterprises is vital to improve nutrition. GAIN, with support from USAID and the Feed the Future Initiative, created the Marketplace for Nutritious Foods, a program designed to foster innovation and support promising businesses that produce healthy, safe and affordable food for low-income consumers. One of the businesses the Marketplace is supporting is the fish shop owned by Elizabeth Cavadias in Beira. This shop sells fish and seafood in small quantities, allowing poor consumers to buy what they need for their meals at low prices. Our support enables her to better preserve the quality of her product, scale up her activity, and keep costs low.
Mozambique has shown me how complicated it is to solve the problem of malnutrition for the most vulnerable communities. It is about what we eat, not just how much, improving consumer awareness, and – crucially – reshaping the market so that nutritious foods become more affordable for the population. To do this, we have to continue to work closely with the communities we serve.