To help world's children reach fifth birthday, look to this Bangladesh program

Last month, in the poor Bangladeshi village of Kawabadha, a shy little girl named Morsheda turned five years old in a brand new red dress. Morsheda sang and danced with her friends and family and feasted on a traditional dessert made of rice and sugar. But unfortunately, Morsheda’s fifth birthday celebration is an event many children around the world will never experience.

Each year, 7.6 million children die before their fifth birthdays from preventable causes and diseases. These conditions are often worsened by the chronic malnutrition and food shortages. That is why last month USAID launched a public campaign called “Every Child Deserves a 5th Birthday” to help raise awareness and end these avoidable child deaths. The topic will enter the global spotlight this month as world leaders take on hunger at the G-8 Summit at Camp David.

For solutions, government and development sector leaders should heed the lessons of a massive-yet-innovative program that is not only helping children such as Morsheda reach their fifth birthdays but also ensuring they grow healthier, and in many cases, taller.

Called SHOUHARDO, a Bangla word for “friendship,” the program is run by the poverty-fighting organization CARE, USAID, and the government of Bangladesh. The first phase, implemented from 2004 to 2010, represented the largest non-emergency USAID food security program in the world.

But SHOUHARDO is about much more than food. It employs an integrated approach that addresses how people support their families and access nutritious meals. And it strikes at the underlying causes of malnutrition, including the deep inequities between women and men.

The results of SHOUHARDO have been phenomenal: Over the last four years, child stunting, the measure of the shortfall in growth due to malnutrition, has plummeted 28 percent despite natural disasters and spikes in food prices. The reduction came at twice the rate of the average US government funded project of its kind in Bangladesh.

Bangladesh has the one of the world’s highest child malnutrition rates, but the country’s active and supportive government has helped contribute to the program’s success. Bangladesh is also a country with many policies and laws that protect women, which gives many of the participants in the SHOUHARDO additional support.

SHOUHARDO is one of the most comprehensive and integrated food aid programs in the world. There are very few programs that combine economic capacity building, health, and nutrition education with women’s empowerment.

While women’s empowerment initiatives aren’t new, the idea of combining direct interventions (such as giving pregnant women rations of food) with indirect interventions (such as addressing the disparity between women and men) is one of the program’s signature aspects. SHOUHARDO used a 360-degree approach, which resulted in a bigger impact on the lives of women and their families.

Morsheda is one of more than 2 million people who have benefitted from SHOUHARDO. Morsheda’s family calls her a “nutrition baby” because her mother Hanufa received nutritious food while she was pregnant until Morsheda was two years old. More importantly, Hanufa actively participated in the many health groups that enhanced her understanding of her rights as a woman and educated her on proper childcare.

One distinctive finding from the SHOUHARDO program, documented in a recent paper published by the Institute of Development Studies, was how women’s empowerment played a key role in reducing stunting rates compared to just giving food packages alone.

Women who participated in empowerment interventions to help them fight sexual harassment, move about their communities more freely, and gain a greater say in household decisions were less likely to have stunted children than women who received only nutrition interventions such as regular food rations.

In other words, the children of empowered women actually grew taller.

The reasons for this are quite simple. In Bangladesh, the woman of the household is usually the primary caretaker of the child. As the woman becomes more empowered, she is able to negotiate with her husband to determine the types of food to grow and to buy. Over the past few years, we saw women introduce more nutritious diets into their households. Health and hygiene practices also changed as well, which resulted in healthier children.

The fight against global hunger is complex and challenging. But SHOUHARDO demonstrates an integrated approach combining women’s empowerment with other nutrition and health focused initiatives can help ensure children reach their fifth birthdays and beyond. With dedication, effective management, and planning, the lives of the poorest of the poor can be radically, and sustainably, changed for the better.

The SHOUHARDO program has been extremely effective in empowering women, but the program still has areas for improvement, particularly around engagement of men and boys. Breaking the traditional conservative attitudes about women was indeed a challenge, but with the combination of interventions in SHOUHARDO, women began to gain more decision-making power.

In a follow up survey, we found women had more say in their families over the use of savings and loans. Women were able to sell major household assets and decide on personal expenditures for their children. And women also grew more active in the local village courts.

Parts of SHOUHARDO, such as the economic and women’s empowerment component, have been implemented in other parts of the world as well. For the past 20 years, CARE has worked to promote savings groups in sub-Saharan Africa. As with similar initiatves in Bangladesh, the savings group programs typically bring together women to help them gain confidence and the power to make decisions. In many of these communities, women have become political leaders and successful entrepreneurs.

Although Morsheda’s family no longer receives direct support from SHOUHARDO, they still use the tools and knowledge they learned from the program. Today they are able to feed their children three meals a day and send Morsheda’s older siblings to school, a possibility that was once unimaginable. As the family became more economically secure with the lessons and support from SHOUHARDO, they were no longer constantly worried about feeding their children.

They could even afford a little luxury – a red birthday dress for Morsheda.

“Today, nearly five years later, I am proud to say that my daughter is still healthy and happy,” Morsheda’s father Abu said at the birthday party. In that way the family wasn’t just marking time that had passed – they were celebrating a brighter future. 

Faheem Khan is the head of the SHOUHARDO program and works for CARE Bangladesh. Founded in 1945 with the creation of the CARE Package, CARE is a leading humanitarian and development organization fighting global poverty. CARE is hosting an event at the National Press Club in Washington today to explore the findings of SHOUHARDO.