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A battlefield for vitamin sources

In the poor, rural villages of India, critics find that too much attention is paid to artificial nutrients and not enough to the growing of green leafy vegetables, carrots and tomatoes

By John Stackhouse
First published Feb. 6, 1993

New Delhi

Every year, Unicef releases a glossy booklet stating in unyielding terms that the world can save a child from hidden hunger for pennies a day.

For "as little as five cents each," vitamin A capsules can save children from blindness and even death, the 1993 report says. Iron and iodine sufficiency can be bought for just as little. In total, half the world's population could be saved from the scourges of micronutrient malnutrition for the cost of a few fighter jets.

In the impoverished farming hamlet of Biharipur, about eight hours by bumpy road from New Delhi, some of the failures of the global war on hidden hunger can be seen by almost anyone - except a 5-year-old boy, Hariom, who has been blind since he was 3.

For Hariom, the glossy reports and media messages have amounted to little. The vitamin A capsules, iodized oil injections and iron tablets - the "magic bullets" of international development - have not made it to his village gate. Nor have the health workers who are supposed to form the front line.

Paradoxically, Biharipur may not need much outside help. With its fertile soil, it should be possible to grow tomatoes, carrots and green leafy vegetables for vitamins and minerals.

But in waging their high-profile war, Unicef (the United Nations children's organization) and the World Health Organization have paid little attention to such natural solutions, many critics charge.

Indeed, their action, which has ignited a furious debate among academics, has taken the battle against hidden hunger to the core of development. Should developing countries rely on foreign technical solutions, or can they find more sustainable answers on their own ground?

So far, donors have leaned toward technology.

Even with high-tech health weapons, said Richard Young, a Canadian who is Unicef's chief of child development and nutrition in India, "the nutritional community has yet to make an indent. We think as scientists, technicians and doctors we have the solutions. People trying to survive have a different point of view."

Biharipur's daily diet consists of beans, rice, potatoes and onions - adequate foods for protein but not for vitamins and minerals. The better- off families have green leafy vegetables once a week.

Tomatoes reach the village maybe once a month. And most of the milk production is sold to another town nearby.

Across Asia and Africa, such diets have created profound micronutrient deficiencies. Vitamin A deficiency claims the eyesight of at least 250,000 pre-school children a year - about 42,000 of them in India - through night blindness, conjunctival lesions and corneal damage. Nutritionists believe it may also contribute to as many as 400,000 child deaths annually.

Other micronutrient deficiencies affect up to half the world's population, causing such afflictions as goitre and anemia. The WHO says a lack of iodine causes 20 million cases of mental illness worldwide.

Iron deficiency is even more pervasive, causing anemia for seven out of 10 Indian women. In Biharipur, almost every woman is anemic.

Armed with such statistics, donors remain committed to fighting the hidden hunger with the weapon they know best - artificial micronutrition. At a WHO conference in December, the world community pledged to end the major three causes of hidden hunger by increasing the supply of vitamin A, iodine and iron.

Ideally, both artificial and natural methods can be used to increase vitamin and mineral consumption. In dozens of developing countries, the reality proves otherwise.

"If you say do both, naturally most countries take the soft option and neglect the hard one," said Vinodini Reddy, director of India's National Institute of Nutrition.

India has provided vitamin supplements for more than 20 years, but little has been done about improving diets. Now, desperately short of public money, India cannot afford either the magic bullets or the army to fire them.

Indian health officials cut vitamin A supplements last year to one- third the level they say is needed.

A health worker is supposed to visit Biharipur every month with inoculation kits, vitamins, iron supplements and contraceptive pills. But the worker has not come in half a year.

"We're going too much for targets and not enough to improve the process," said Michael Gurney, the WHO's leading micronutrient expert in South Asia. "You aim at hitting the target rather than developing the skills of the bowman. It's part of the problem with development in general."

Many Indian nutritionists resent the fact that such targets are set in Europe and North America.

C. Gopolan, India's most outspoken critic of the Unicef approach, is at one extreme. He believes donors have been taken in by the manufacturers of synthetic micronutrients who would stand to lose major markets if village diets were improved. In India, a subsidiary of the Swiss pharmaceutical giant Hoffmann-LaRoche supplies 60 per cent of the synthetic vitamin A market.

"There is no money in green leafy vegetables," Dr. Gopolan said. "There is money in synthetic vitamin A."

India's drive for food self-sufficiency has relegated vitamin-rich vegetables to the farming fringe.

Slowly, though, India is looking to the example of southeastern Asia, where horticulture has become central to the food strategies of Thailand and Malaysia. The tropical southern states of Kerala, Andhra Pradesh and Karnataka are trying to cultivate red palm oil, which is rich in carotene, a precursor of vitamin A. There also is research into propagating carotene-rich pumpkins, carrots, spinach, sweet potatoes and cassava.

But most rural Indians live in deep poverty, unable to buy such foods in the market and unable to spare any land to grow them.

Inadequate agriculture extension services and low-quality seeds mean India's fruit farms are only one-third to one-half as productive as South America's. Because India processes only 2 per cent of its produce, as much as one-quarter of its fruit is lost to damage during transport and storage.

Dr. Reddy said commercial production, which usually caters to urban markets, is not the answer. "It's only possible through home gardening."

While home-gardening projects in the past have stressed water-intensive, seasonal crops such as spinach, a new program by the nutrition institute aims to teach villagers how to propagate easier crops such as pasella, a drought-resistant creeper with the nutritional qualities of spinach; agathi, a wild bush with carotene-rich leaves; and fast-growing papaya.

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