The problem is particularly severe in the central highlands, though rates of stunting are high in other areas. Poverty is widespread across the country; over two-thirds of Madagascans live below the poverty line, surviving on less than a dollar a day.
However, poverty is not necessarily the key cause of the problem. Speaking to the news agency IRIN, a nutrition expert working with the United Nations Children’s Agency (UNICEF) explained that stunting rates among the very poor were generally lower because those families “eat the vegetables that they grow instead of selling them”. This suggests other factors are at play in Madagascar, for example, the heavy reliance on rice. A typical meal is mainly made up of rice, accompanied with some cassava or salty soup. Fatty meat will be included if the family can afford it. Many children are therefore not getting enough fresh fruit and vegetables to provide all the nutritional elements required for healthy development.
Poor diet also starts at babyhood and campaigns have been run to saturate communities with messages about the importance of breastfeeding, using health workers, printed materials and radio. According to the recent Save The Children report, ‘A Life Free from Hunger’, exclusive breastfeeding rates have risen in Madagascar – from 42% to 70% (between 2002-05). However, with many women working in the fields, it is common for children to be fed just two or three times a day, rather than receiving the eight feeds healthy babies need. And in some areas, mothers still give drinks of tea or coffee to infants as a supplement.
When mothers use breastfeeding exclusively, this also helps to reduce the risk of illnesses such as diarrhoea and pneumonia. Around one in ten under-fives suffer from these infections, which exacerbate malnourishment. The most critical period for stunting is from conception until a child is two years old.
With better education about breastfeeding and nutrition, attitudes are beginning to change. Whereas previously people thought height was purely genetic, locals are now beginning to appreciate that nutrition plays a key role. As the UNICEF spokesperson explained to IRIN “it’s only during the teenage growth spurt that genetic factors about height kick in”. With more mothers understanding the importance of including more fruit and vegetables in their children’s diets, health experts and non-governmental organisations hope to see many more Madagascan children growing up stronger and fitter in the future.