July’s column described two Nicaraguan boys with severe malnutrition. Miguel had kwashiorkor, caused by lack of protein. Poor Van’s problem was inadequate food energy; he died from marasmus.
There is hunger even in Durango. Before the Manna Soup Kitchen, poor people had no place to go for a free meal. Years ago The Durango Herald ran a haunting story about a woman who had been living in the stables at the fairgrounds on Main Avenue. Her emaciated body was found at the end of winter. There were decreasing numbers written on the wall that appeared to be her weight at different times; she had starved to death.
What can we in the United States do about world hunger? Why should we care?
The second question is easier to answer than the first. We in rich countries should care because we are all part of the human family because the world is smaller so we know more about suffering in far-off lands, because we have strong spiritual beliefs. Perhaps we should care most because we have seen our own children suffer and know how much it hurts parents who cannot provide for their kids.
I do know that the worst way to help with hunger in poorer parts of the world is to send food. Gifts of food are typically distributed in cities. Hungry people move away from their farms so food production decreases, causing people to become more and more dependant on handouts.
Childhood hunger is a complex problem, not just caused by lack of food. Hunger is the contributor to most of the deaths of children in poor countries. Male preference may be a factor; boys are often given more food than girls when there are limited resources. Furthermore, in some cultures, boys are more likely to be taken to the doctor when they are sick than are girls. Sometimes, there are just too many mouths to feed. We do know that children are healthier when their mothers are educated and when pregnancies are spaced at least 24 months apart. Smaller family size helps make sure that everyone has enough to eat.
Of the estimated 17,000 children who die daily, about 4,000 die because of polluted drinking water. Many agrarian societies have poor sanitation and unsafe water supplies. Water is often contaminated with micro-organisms, leading to diarrhea and dehydration. For an adult this is a nuisance. For an infant or child, an intestinal upset can be life threatening – especially if nutrition is already borderline. In many places, especially in the tropics, parasites sap kids’ nutrition and energy.
Breast-feeding an infant is the best protection against intestinal problems. Unfortunately, commercialism has made artificial formula seem healthier than breast milk for infants. Wanting to do the best for their infants, parents are duped into buying what they cannot afford. The expense of formula can suck away a significant portion of a family’s income. Made with contaminated water, the artificial formula will sicken the baby. All too often, formula kills babies.
It is typical in a pre-industrial society to have many children die. With improved sanitation and clean water, with better nutrition and health care and with educated parents, children are much more likely to survive. It seems paradoxical that child survival should slow population growth, but it is true. When people know that their children will grow up to be healthy adults, they choose to have smaller families.
This change in a society’s makeup, caused by better living conditions and nutrition, is called the “demographic transition.” The transition is from high fertility and high death rates to fewer deaths and lower fertility. A society’s population grows rapidly while it is making this transition, when child survival is high but before the birth rate drops. It took two centuries for England and Western Europe to complete this transition; fortunately, now many societies make the transition more quickly.
Access to birth control is a prerequisite for the drop in fertility, however. Modern contraception has been available for less than a century, so presumably coitus interruptus (withdrawal) was the primary method in the past.
Perhaps the best we can do to save children is to hasten the demographic transition. This means supporting programs for sanitation, clean drinking water, education and especially family planning. There are many aid organizations that provide all these services to people in poor countries; we should support them in preference to ones that just supply food.
Richard Grossman practices gynecology in Durango. Reach him at firstname.lastname@example.org. © Richard Grossman MD, 2013