Double burden of malnutrition among Bangladeshi women of reproductive age: time to reassess the country’s maternal and child health programs and policies

Dhaka, 16 August 2022

Today, icddr,b and Data for Impact (D4I) jointly organised an evidence sharing session with journalists at icddr,b’s Mohakhali Campus that discussed about the double burden of malnutrition among Bangladeshi women of reproductive age and how and why it is important to reassess the country’s maternal and child health programs and policies. Recent evidence based on secondary analysis of BDHS datasets for last one decade along with policy synthesis, were presented in the seminar which indicated a major shift of nutritional status of women of reproductive age in the country.

Between 2007 and 2017, in addition to improvements in many human development indexes, the proportion of undernutrition (BMI <18) among Bangladeshi ever-married women aged 15–49 declined sharply from 30% to 12%, while the proportion of overweight/obese (BMI ≥25) women increased from 12% to 32% during the same period. In addition, despite remarkable progress in reducing undernourishment among women, the share of well-nourished women remains unchanged, 58% in 2007 and 56% in 2017-18. In terms of numbers, it means that currently in Bangladesh, 17 million women (aged 15-49 years) are malnourished — five million are underweight, and 12 million are overweight/obese). If this trend persists, linear projections indicate that about 46% of ever-married women of reproductive age will be overweight/obese by 2030.

Increased weight among women of reproductive age is a concern because, in Bangladesh, there are about 3.4 million births occur annually and currently, around 0.9 million of these births occur to overweight/obese women, and 0.5 million births occur to underweight women. If the current trend in malnutrition continues, pregnancies/births among overweight women will increase. Both forms of malnutrition pose a greater risk for maternal and child health: underweight mothers are at risk of having anaemia, antepartum/postpartum haemorrhage, and premature rupture of membranes.

On the contrary, maternal obesity increases the risk of perinatal complications such as gestational diabetes, gestational hypertension, and caesarean deliveries. Maternal obesity also has implications for breastfeeding, with decreased rates of initiation and reduced breastfeeding duration. All these complications have potentially serious implications for infant survival, growth, and development, as well as intergenerational implications. 

An analysis of the three main government policy documents related to nutrition, the Bangladesh National Strategy for Maternal Health 2019–2030, the National Nutrition Policy 2015, and the Second National Plan of Action for Nutrition 2016–2025, show that current policies concerning maternal health and nutrition are fragmentary and mostly address the issue of underweight. The call of the hour is for national policies to address the double burden of malnutrition among women of reproductive age across pre-conception, pregnancy, and post-natal stages to ensure optimum maternal and child health.

Dr Kanta Jamil, Senior Research, Monitoring, Evaluation and Leaning Advisor, USAID; Ms Saiqa Siraj, Country Director of Nutrition International; Dr Shams El Arifeen, Senior Scientist, Maternal and Child Health Division (MCHD), icddr,b attended the session as technical experts and exchanged their views with journalists on ways to overcome this challenge.

Dr Kanta Jamil from USAID said – “We see there is a gap in policy, however, we also have to keep in mind that, while the crossover from underweight to overweight among ever-married women of reproductive age started around 2012, the gap is more visible from 2017-18 BDHS. Now we must plan the next programs and rectify the policies if required to meet this new challenge”.

While answering the questions from the journalists, Ms Saiqa Siraj, Country Director of Nutrition International said – “The effect of overweight obesity is not a far-fetched issue that will harm the elderly population only. It is affecting our mothers and our children and creating an intergenerational challenge. Nutrition itself is a very complex issue, which requires multi sectoral holistic approach. Therefore we need to focus on “low hanging fruits” and start solving the puzzle one piece at a time.”  

Dr Mizanur Rahman, Country Lead of D4I, thanked USAID Bangladesh for supporting such works and requested the members of the media houses to be more vocal on this issue. 

The experts stressed on addressing the challenge by i) tracking and addressing both forms of malnutrition from adolescence, ii) introducing targeted and segmented antenatal care programs, iii) taking effective universal interventions to reenforce promotion and protection of appropriate Infant and Young Child Feeding (IYCF), iv) regulating junk/packaged foods and beverages marketing and v) providing healthy meal options at schools and workplaces.

The event was jointly organised by Data for Impact (D4I), a data driven initiative of the University of North Carolina at Chapel Hill; and icddr,b; and was supported by the United States Agency for International Development (USAID). The findings were presented by Shusmita Khan, Knowledge Management and Communications Specialist of Data for Impact (D4I), University of North Carolina at Chapel Hill and M. Moinuddin Ahmed, Associate Scientist, Health Systems and Population Studies Division (HSPSD), icddr,b.

The presentation was based on a technical brief developed by the United States Agency for International Development (USAID)-funded Data for Impact (D4I) Project and icddr,b (https://www.data4impactproject.org/publications/the-double-burden-of-malnutrition-among-bangladeshi-women-rethinking-the-countrys-maternal-and-child-health-programs-and-policies/). 

For further information, please contact: Shusmita Khan, Knowledge Management and Communications Specialist of Data for Impact (D4I), University of North Carolina at Chapel Hill. shusmita@email.unc.edu or 01713209091