Bangladesh:

Bangladesh is one of the world’s most densely populated countries, with approximately 163 million people living within a relatively small landmass (FAO 2016; World Bank 2018b). Considered a lower-middle-income country - it had a per capita GDP of $1,517 in 2017 - Bangladesh experienced rapid GDP growth of 4–7 percent a year between 2000 and 2016. During that period, the country’s poverty rate plunged from 34.8 percent to 14.8 percent.

However, poverty reduction in 2010–2016 was slower than in 2005–2010 (World Bank 2018b). Since 2016, the Bangladeshi economy has faced formidable challenges, including above-average flooding that has been detrimental to agriculture, increasing rice prices, governance issues around the banking sector, and the influx of Rohingya refugees from Myanmar, of whom nearly 900,000 are now in Bangladesh (UNHCR 2018b; World Bank 2018a).

Because of its densely populated, lowlying coastal landmass, it is also considered one of the world’s most vulnerable countries to the effects of climate change and rising sea levels (Karim and Mimura 2008).

The economy is fairly diverse: the service sector accounts for 56 percent of GDP, while industry and agriculture account for 29 and 15 percent, respectively (World Bank 2018b). Agriculture is an important source of livelihoods, representing 42 percent of total employment (FAO 2016).

However, farmers face numerous challenges, including a lack of access to resources and services, especially for women farmers; destructive weather events linked to climate change; and population pressure that limits many farmers’ access to arable land (FAO 2016; World Bank 2016).

Poverty has declined primarily in rural areas, especially for rural households involved mainly in industry or services rather than in agriculture. Indeed, growth in agriculture contributed less to poverty reduction in 2010–2016 than it did in 2005–2010 (World Bank 2018a).

Although it is improving, Bangladesh’s hunger and undernutrition situation remains troubling. Its 2018 GHI score is 26.1, considered serious, down from a 2000 GHI score of 36.0, considered alarming. Since 2000, its rates of undernourishment, child stunting, and child mortality have all declined. Its child wasting rate, which is subject to seasonal variation, has fluctuated since 2000, and the latest data show that it is higher than it was in 2000 (Figure 4.2).

Bangladeshis consume a diet that centers on rice, from which they receive about two-thirds of their calories. In 2012, the country achieved self-sufficiency in rice, producing enough rice domestically to meet its consumption needs (FAO 2016), yet poor access to food is an ongoing problem: 15.2 percent of the population is still considered undernourished, with insufficient access to calories (Compact2025 2016; FAO 2018d). Besides rice, vegetables and fish are important components of the diet for some people, yet for many others, dietary diversity is low and micronutrient deficiencies are widespread (Osmani et al. 2016).

While child stunting has decreased in recent years, it is still a pressing concern (Table 4.1). The nutrition status of pregnant mothers may be a factor. In 2015, 22.6 percent of Bangladeshi babies were born with low birth weight (NNS 2017), and there is evidence that this condition contributes to child stunting. Stunting begins even before birth; for example, according to a study of children in the urban slums of Bangladesh, the length of babies at the time of birth and socioeconomic status independently influenced stunting at age 12–24 months, whereas dietary diversity and exclusive breastfeeding did not show significant effects (Islam et al. 2018). Similarly, a study in an urban borough of Mirpur in Dhaka showed that a child’s size at birth and the mother’s weight were strongly associated with the child’s height at age two (Donowitz et al. 2018). The problem is exacerbated by a high rate of teenage pregnancy, which puts nutritional strain on the developing fetus because the mother’s body is still growing and has elevated nutrition needs. In 2014, 31 percent of 15- to 19- year-old women in Bangladesh had already given birth, down just slightly from 33 percent in 1993–1994 (Osmani et al. 2016).

Diets are commonly inadequate for children under the age of two, a period when proper nutrition is considered critical to healthy development. According to the 2014 Demographic and Health Survey for Bangladesh, 77 percent of children under the age of 24 months receive age-appropriate breastfeeding, but just 23 percent of children aged 6–23 months were fed the “minimum acceptable diet”—a standard that combines minimum dietary diversity and minimum meal frequency and has different recommendations for breastfed and non-breastfed children (NIPORT et al. 2016).

The health status of children also influences their nutrition. Studies have shown a potential connection between childhood stunting and environmental enteropathy, a condition involving abnormal intestinal function due to exposure to environmental pathogens. A study in Tangail district, Dhaka division showed that E. coli bacteria were commonly found in soil, that nearly 30 percent of children were reported to have consumed soil within the preceding week, and that these children were twice as likely to be stunted as other children nine months later (George et al. 2015). Evidence from other parts of rural Bangladesh also suggests that environmental contamination characterized by poor water, sanitation, and hygiene conditions in the household causes faltering growth by means of environmental enteropathy (Lin et al. 2013).

Bangladesh’s steady decline in child stunting in recent decades has been a remarkable success. A 2015 study sought to identify the reasons behind this decline at the national level (Headey et al. 2015). Using data from 1997 through 2011, the study attributed the decrease primarily to rising household wealth associated with pro-poor economic growth and gains in parental education, as well as health, sanitation, and demographic factors. The authors conclude that success in this area can be achieved with economic growth and attention to “nutrition-sensitive” sectors such as education, sanitation, and health, even without the successful implementation of large-scale nutrition programs.

Compared with many other low- and lower-middle-income countries, Bangladesh is the subject of a relative abundance of literature on the impact of interventions on food and nutrition security. This is in part because several innovative development and food security programs have been fostered in Bangladesh.

Agricultural and home gardening projects have demonstrated some success in improving food production, consumption, and nutrition. According to data from 1996–2011, the increased rice yields associated with the Green Revolution helped raise calorie availability and boost children’s weight; however, no effect on children’s height was found, and improvements in dietary diversity were limited (Headey and Hoddinott 2016). Bangladesh was the site of many early home gardening and homestead food production projects. In Barisal, Faridpur, Jessore, and Patuakhali districts, a home gardening project led by the World Vegetable Center and implemented by BRAC that provided women with nutrition education and gardening training enabled households to produce and consume more vegetables and raised their supply of micronutrients (Schreinemacher, Patalagsa, and Uddin 2016). A review of homestead food production programs - which combine nutrition education, fruit and vegetable gardening, and livestock production—suggested that the programs increased households’ production and consumption of micronutrient-rich foods, contributed to their dietary diversification, improved women’s status, and increased income (Iannotti, Cunningham, and Ruel 2009).

Aquaculture and fisheries projects—relatively common in Bangladesh given the country’s vast waterways and the importance of fish in the national diet—have also produced some positive results. A project providing aquaculture extension services to fish farmers was shown to increase income and fish consumption among beneficiaries in Mymensingh, Comilla, Magura, and Bogra districts more than among control groups (Jahan, Ahmed, and Belton 2010). Another project trained farmers in integrated agriculture and aquaculture techniques, such as how to use the byproducts and excess resources from fishing for farming and vice versa, and it was shown to increase the consumption of fish and other foods by project farmers relative to control farmers (Jahan and Pemsl 2011).

Broader antipoverty programs have had effects on food security as well. The Bangladeshi NGO BRAC developed a program known as “Challenging the Frontiers of Poverty Reduction: Targeting the Ultra Poor,” which has been implemented at large scale in Bangladesh and replicated in about 20 countries (Banerjee et al. 2015). Carefully targeted to the poorest households, the program provides an income-generating asset (most commonly livestock or poultry), business development training, enterprise management assistance, a subsistence allowance, health services, and a social support network. The BRAC program, which originated in Rangpur, Kurigram, and Nilphamari districts, was shown to have reduced beneficiaries’ perceived food deficits and increased household food consumption when measured two years after the program had been completed (Ahmed et al. 2009; Emran, Robano, and Smith 2014).

Microfinance is another approach that originated in Bangladesh and has spread well beyond its borders. The effects of microcredit— a type of microfinance—on poverty are hotly debated (see Pitt and Khandker 1998; Roodman and Morduch 2014; Pitt 2014). Regarding the effect of microfinance on food security and nutrition specifically, Pitt et al. (2003) found that women’s participation in microcredit programs in Bangladesh increased children’s height-forage and arm circumference. A recent study of participants in Bangladeshi microcredit programs using data from 13 districts found that participation increased calorie availability, did not affect dietary diversity, and had mixed effects on anthropometric measures among participants (Islam et al. 2016).

Because of the high prevalence of low-birth-weight babies in Bangladesh and the association of low birth weight with child undernutrition, some interventions have aimed to improve pregnant women’s nutritional status and increase children’s birth weight. A nutrition education program in Dhaka city targeted to women in the third trimester of pregnancy increased mothers’ weight gain and decreased the incidence of low birth weight (Akter et al. 2012). A randomized trial in Matlab subdistrict, Chandpur district, had ambiguous results. The sons of women given early food supplementation had lower stunting rates than those of women given later food supplementation; stunting was higher among boys whose mothers were given multiple micronutrient supplementation rather than just iron and folate. However, no difference was found in the weight or height of babies at birth (Khan et al. 2011). In the same project, infant and child mortality rates were lower for children of mothers given early food supplementation and multiple micronutrient supplementation compared with those of mothers given later food supplementation and just iron and folate (Persson et al. 2012).