Stephen Jay Gould once remarked; “Few tragedies can be more extensive than the stunting of life, few injustices deeper than the denial of an opportunity to strive or even to hope, by a limit imposed from without, but falsely identified as lying within.”
Every 16th day of June, governments, NGOs, international organizations, and other stakeholders across the African continent gathered to discuss the challenges and opportunities facing the full realization of the rights of children in Africa. Of the very many that are not yet realized by Uganda are the rights to health and adequate living which has, in turn, led to stunting.
Stuntedness can be defined to mean low height-for-age and is usually a result of growing under the limited provision of food, health, and care. A child is considered stunted when his/her height is below a defined cutoff point. The right to health is a fundamental part of our human rights and of our understanding of a life in dignity. The right to the enjoyment of the highest attainable standard of physical and mental health, to give it its full name, is not new. Internationally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The preamble further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
Article 25(1) of the Universal Declaration of Human Rights (UDHR)1948 is to the effect that everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing while Article 11 of the International Convention on Economic Social and Cultural Rights obligates States Parties to recognize the right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing, and housing. The right to health is also recognized as a human right in the 1966 International Covenant on Economic, Social, and Cultural Rights. The right to health is relevant to all States and every State has ratified at least one international human rights treaty recognizing the right to health, Uganda inclusive. In 1996, Heads of States and Governments gathered in Rome at the World Food Summit at the invitation of FAO and the right of everyone to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger.
Article 12 of the ICESCR intimates that the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. With these general comments sharing an interconnected focus on nutrition, the Committee ESCR finds the right to food and the right to health to be intersectional rights—interdependent and interrelated and encompassing an array of underlying factors that impact health, with specific state obligations to address food insecurity as a means to adequate nutrition.
However, according to the World Health Organization (WHO), in children aged 5 and below, 155 million are stunted, 52 million are wasted, 17 million are severely wasted and 41 million are overweight and/or obese. In Africa, around 58.5 million children are suffering from stunting and it is the only continent where the number of stunted children has increased over the last two decades: 58.5 million in 2018, up from 50.3 million at the turn of the century creating an adverse impact on the continent’s economic potential. Additionally, 39 percent of the world’s stunted children and 28 percent of the world’s wasted children are in Africa, and contrary to global trends where the number of stunted children has been declining over the last 25 years, in Eastern and Southern Africa the number of stunted children has risen from 23.6 million to 26.8 million in the same period due to slow rates of stunting reduction and a quickly expanding child population. These children are prone to inhibited intellectual and physical growth, and sometimes even premature death while economically, stunting costs Africa $25 billion annually and the cost of malnutrition is too huge for Africa to ignore.
Damage caused by stunting is irreversible and has many adverse consequences for child survival and long-term well-being. It also has far-reaching consequences for human capital, economic productivity, and national development overall. These costs stem from the need to deal with an increased disease burden and other physical and mental problems related to malnutrition and the enormous reductions in human potential and economic productivity throughout life caused by hunger and malnutrition. Additionally, malnourished children suffer from irreparable stunted physical growth, and it has been proven that hungry children make poor students and are prone to drop out of the educational system. Hungry and malnourished adults on the other hand are unable to be fully productive workers and are more likely to be ill, increasing the strain on often overburdened health systems.
Stunted women on the other hand give birth to low-birth-weight babies, transferring the broad economic disadvantages of malnutrition in their own lives to the next generation, and Children who suffer from stunting or wasting are more likely to suffer poor health and be at risk from disease and diet-related conditions. But stunting doesn’t only affect a child’s health, it also inhibits their future development. Children suffering from stunting may never grow to their full height or develop their full cognitive potential, and they are at elevated risk of poverty because of stunting. Stunted children earn 20 percent less as adults than their non-stunted counterparts while mothers affected by undernutrition are more likely to have children who suffer from stunting or wasting, perpetuating the cycle of poverty and undernutrition.
Unfortunately, the stunting problem is not even given that much attention given that it is not even tracked in Uganda. Even the only statistics done by Uganda are based on the Uganda Demographic Health Survey which is done every five years. And even the mother-child health card does not provide for the same.
Uganda’s National Objectives and Directive Principles of State Policy Nos XIV, XXI, XXII, and XXI provide for general social and economic rights, medical services, food security and nutrition, and clean and safe water respectively. The National Integrated Early Childhood Development Policy Action Plan of Uganda (2016-2021) on the other hand recognizes that Children all around need holistic needs which consist of nutrition, health, nurture, protection, stimulation, and training. The policy recognizes that improving maternal, infant, and young child nutrition and health to increase the likelihood of healthy pregnancy and infancy and proper physical and mental growth, and addressing the nutritional needs of infants and young children will arrest a lifetime of problems that malnourished children face and will reduce the burdens they impose on the household, the community, and the nation. Finally, the National Development Plan III (NDP III) recognizes that a country that invests in its human capital secures its future as well-educated, skilled, and healthy human resources are essential to facilitate development. The availability of appropriate and adequate human capital facilitates the increase in production, productivity, and technological growth. , therefore, investing in population health; nutrition, early childhood development, sanitation, and hygiene basic education, and tackling vulnerabilities helps set the foundation for the required human capital.
The key results to be achieved over the next five years according to the above policy were; the reduced prevalence of under 5 stunting from 28.9 percent to 19 percent, increased access to safe water supply from 70 to 85 percent (rural), and from 74 percent to 100 percent (urban), increased access to basic sanitation from (improved toilet) 19 to 40 percent and handwashing from 34 to 50 percent, and increased proportion of the population accessing universal health care from 44 to 65 percent. To make matters worse, a Human Capital Index (HCI) of 38 percent implies that, with the current state of education and health, a child born in Uganda is expected to achieve only 38 percent of their productive potential at age 18.
However, 29% of all children under five in Uganda are stunted, Human Capital is characterized by low labor productivity (38 percent), and low human development (HDI at 0.516) all of which is mainly attributed to; a weak foundation for human capital; poor population health and safety; food and nutrition insecurity, insufficient coverage of social protection, among others. The above findings scream the need to get back on the drawing board. Article 24 of the Convention on the Rights of the Child obliges States Parties to recognize the right of the child to the enjoyment of the highest attainable standard of health and to take appropriate measures to combat disease and malnutrition through the provision of adequate nutritious foods, clean drinking water, and health care. Read together with her constitutional obligations, the Government ought to start spending and implementing preventive programs within the agriculture and health sectors, training and equipping health system volunteers in communities and health workers stationed at low-level clinics to identify the signs of chronic undernutrition and addressing them which would go a long way in addressing this predicament.
The importance of the intervention cannot be overstated as the first 29 months of life carry the highest risk for future stunting and addressing the challenges can break the cycle of stunting, malnutrition, poverty, unproductivity, wasting among others. The manifestation of malnutrition and its effects is multifold, but the paths to addressing prevention are key and include exclusive breastfeeding for the first 2 years of life, diverse and nutritious foods during childhood, healthy environments, access to basic services such as water, hygiene, health and sanitation among others. Other important interventions may include promoting appropriate nutrition and healthcare services at the health center level, including the review of the mother-child health passport; promoting advocacy for the realization of the right to health, food, and nutrition through improving maternal, infant, and young child nutrition and health care interventions at health center level; and addressing the nutritional needs of infants and young children. Also, to build the capacity of stakeholders in respecting and protecting the rights of children to health, food, and nutrition through health care intervention to prevent lifetime morbidities caused by malnutrition, wasting, and stuntedness and enhance human capital development.
