Academic journal article International Perspectives on Sexual and Reproductive Health

Is Unwanted Birth Associated with Child Malnutrition in Bangladesh?

Academic journal article International Perspectives on Sexual and Reproductive Health

Is Unwanted Birth Associated with Child Malnutrition in Bangladesh?

Article excerpt

Despite the substantial progress made during the past decade in reducing its prevalence, child malnutrition is still a major public health problem, especially in resource-poor countries. Malnutrition is related to macronutrient deficiency and is characterized by stunting, wasting and underweight. Stunting, defined as insufficient height for age, is an indicator of chronic undernutrition, and is the result of prolonged food deprivation or of disease or illness; wasting, or insufficient mass for height, is an indicator of acute undernutrition, and is the result of relatively recent food deprivation or illness; and underweight, or insufficient weight for age, is a composite indicator that reflects both acute and chronic undernutrition, although it cannot distinguish between them. (1) Globally, an estimated 165 million children younger than five (26%) are stunted, 52 million (8%) are wasted and 100 million (16%) are underweight. (2) Malnutrition is responsible for 35% of the burden of disease in children younger than five, and 11% of the disability-adjusted life years (healthy years of life) lost worldwide. (3)

Bangladesh has one of the highest rates of child malnutrition in the world, (4) and malnutrition is the country's leading cause of child morbidity and mortality. (5) Two of every five children in Bangladesh suffer from moderate-to-severe underweight, (6) and roughly two-thirds of deaths among children younger than five are attributable to un dernutrition. (7) Despite the importance of early child nutrition for survival and long-term development, the international nutrition community has had difficulty reaching a consensus on how to combat child undernutrition. (8,9)

An ample body of research has examined the biological, (10,11) environmental, (12,13) and socioeconomic (14,15) correlates of child malnutrition, but researchers have only begun to investigate many aspects of the social environment. Moreover, research indicates that maternal education, (16) maternal autonomy, (17) maternal body mass index (BMI), (18) maternal height, (19) household wealth, (20) urban residence, (21) and having a safe source of drinking water and hygienic toilet facilities (22) are positively associated with child nutrition. A psychological factor that might influence a child's risk of malnutrition is whether the pregnancy was unintended--either unwanted (the parent did not desire any, or any more, children) or mistimed (the pregnancy occurred earlier than desired). (23) A parent's feelings toward a child born as a result of unwanted pregnancy may adversely affect the child's health if these feelings contribute to conscious or unconscious neglect of the child, resulting in inadequate provision of nutrition, lack of parent-child bonding and inattention to the child's health care needs. (24) Researchers have attempted to model the associations between maternal pregnancy intendedness and child survival and health outcomes. Barber and colleagues hypothesized that various pathways link unwanted childbearing, child health and mother-child relationships, and suggested that children who had been unwanted at the time of conception may suffer more neglect and abuse than those who had been wanted. (25) Women whose pregnancies are unwanted tend to initiate antenatal care later than do women whose pregnancies are wanted. (26,27) In a study of postnatal outcomes, rates of infant mortality (death during the first 28 days of life) were higher following unwanted pregnancies than following other pregnancies. (28) In an analysis of Demographic and Health Survey (DHS) data from five developing countries, Montgomery and colleagues found that unwantedness was linked to child malnutrition in the Dominican Republic, but not in the other four countries. (29) Unwanted pregnancies have also been linked to adverse outcomes and behaviors--including low birth weight, neonatal mortality, absence of breast-feeding and poor parental care--in several U.S. studies. …

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