I’m the regional nutrition adviser for UNICEF in East Asia and the Pacific. I recently visited the small, young island country of Timor-Leste, to get a better understanding of the nutrition situation and UNICEF’s work on nutrition there. During the visit I went to the district of Ermera.
The rough, muddy road to Ermera winds up the steep, exuberantly green mountainside. The scattered houses exemplify impoverishment, and the small plots of maize, albeit very tall, do not suggest a robust foundation of agriculture. As we climbed further up this road, and the rainclouds closed in, now and then we came across groups of school children walking slowly along, very far from any village or school.
In this district, a staggering 62 percent of the children suffer from stunting, a form of undernutrition where children are too short for their age. Stunting means not only that children are too short for their age, but that their futures will be blighted by increased risk of ill-health, poor school performance and lower earnings as adults. The economy of Timor-Leste will lose 1 percent of GDP annually due to undernutrition, according to a recent analysis supported by UNICEF.
Ermera’s rate of stunting is higher than the national average of 50 percent, which puts Timor-Leste among only four countries in the world where more than half of the children are stunted. Timor-Leste managed to reduce stunting from 58 percent in 2010 to 50 percent in 2013, but still has a very long way to go.
|The treacherous mountain road to Ermera district
© UNICEF EAPRO/2015/ Christiane Rudert
Reasons for stunting
In Ermera, we met district nutrition coordinator for Ermera district, Mateus. He is one of a growing cohort of nutrition coordinators which UNICEF supports the Ministry of Health to recruit and train. I asked Mateus why the stunting rate was so high. ”People here have limited access to health services, poor water and sanitation, and very little agriculture activity takes place,” he replied.
Mateus told us that, while many households do have a range of foods available, including meat and dairy products like chickens, eggs, pigs and goats that are vital for young children to grow, small children are often not given these foods. “Households often have very low knowledge about the appropriate way to feed infants and young children,” he explained. “They apply many traditional practices, and they often reserve the meat and the available cash for ceremonies in the community, which leaves less nutritious food for the children.
Next, we visited a clinic in Ermera district. I wanted to hear what the mothers had to say. We talked to Emilia, 20, with seven-month-old baby Sebastiao bouncing on her lap. Sebastiao was the epitome of good health and nutrition. Emilia told us that she had fed him only with breast milk for the entire first six months of his life, not even giving him any
water. Her midwife had explained to her that this was the best way to feed her baby.
As a result, Sebastiao has grown very well and has never had diarrhea. UNICEF is supporting the training of midwives, nurses and other health and nutrition staff on infant and young child feeding counseling so that they can support and advise mothers like Emilia. Timor-Leste has been very successful in increasing its exclusive breastfeeding rate in infants less than six months, which rose from 52 percent to 62 percent over the past four years, one of the highest rates in the region.
The situation of child feeding from six months up to two years of age, the so-called “complementary feeding” period, is much less positive in Timor-Leste, with only 17 percent of children in this age group fed often enough and receiving a sufficiently diverse diet to grow properly. This extremely important period lies at the heart of the effort to prevent stunting, and is the most vulnerable time for growth faltering and stunting. A child who is stunted at age two has little chance to recover. It is indeed very striking how short everyone in Timor-Leste is.
Even well-nourished babies like Sebastiao are at risk of losing much of the gains of the first six months if they are not fed adequately after that. Emilia told me that she and her husband have a small shop selling food, so they do have an income. They also have chickens but they only eat them for ceremonies. They are only feeding Sebastiao rice and vegetables.
|Joao is leader of the mother support group in his village
© UNICEF EAPRO/2015/ Christiane Rudert
After the clinic, we headed up further into the mountains to meet Joao, village head and leader of the mother support group. Established in 2008, the mother support group comprises 15 people (ten women and five men). It was explained that a mother support group in Timor-Leste can consist of both men and women – it is broader than a “mother-to-mother” peer support group.
Members of the support group aim to ensure that the people in the village have access to information on health and nutrition. Joao visits at least two households each week, focusing on preparing pregnant women for birth and care of their newborn, especially first time mothers. “There are now no more newborn or maternal deaths in the village,” he told us proudly. “In the past, such deaths were a regular occurrence.”
Joao emphasized that more needs to be done on nutrition. ”We need more communication by the elders, who people listen to, and involving the church is also important,” he said. ”The health staff, church and elders should work together, not just on conveying messages about proper feeding and care of children, but also on the financial management and priorities in the household, to ensure that the foods children need are always available.” He rightly believes that birth spacing, family planning and preventing teenage pregnancy are very important to address stunting.
UNICEF is working with local NGOs and the Ministry of Health to expand these mother support groups in Timor-Leste. They are a vital resource to reaching remote communities and improving their health and nutrition practices. Back in Dili, UNICEF Timor-Leste’s head of nutrition emphasizes that the Government has increased its understanding and awareness of nutrition, and that there have been improvements in some areas. Efforts are underway to increase and improve nutrition services but this is still at the early stages.
There is a long way to go, but I am confident that Timor-Leste can reduce its stunting rate well below 50 percent in the coming years. This is crucial if the children of Timor-Leste, and the young country itself, are to start meeting their full potential.
Christiane Rudert is Regional Nutrition Adviser for UNICEF East Asia and Pacific