Swing both arms up and clap your hands. Arms down and up. Clap! Down and up! Clap! You are singing all the while or, in my case, humming as I move my hips to the beat of the song and the clapping and dancing. Every once in a while, the beautiful young Malawian woman next to me has to stop with laughter. Literally, she has to stop dancing so she can rest her hands on her knees, bend over, and laugh. She seems to be laughing both at me and with me – this grey-haired white woman clapping and dancing.
That October 2016, I was with the director and co-director of Soils, Food and Healthy Communities (SFHC), a nonprofit group working with this village in northern Malawi. Their goal is to reduce childhood malnutrition through sustainable agriculture. Laifolo Dakishoni, Lizzie Shumba and I had been met on a dirt road by some dozen women wrapped at the waist by the brightly coloured chitenge of southern Africa, and an equal number of men in trousers and shirts, all singing, clapping and dancing a traditional greeting.
On my part, I had been urged to join in. Join in, they had said. I love to dance. So I did.
In 2000, SFHC began as an alliance between staff members at the nearby Ekwendeni Mission Hospital and social scientists in Malawi and Canada. Malnutrition was distressingly high among this area’s smallholder farmers, who suffered from drought, the AIDS epidemic, and a withdrawal of government subsidies. The lack of government programmes, which had once included cheap chemical fertilisers and pesticides, could be traced to the International Monetary Fund’s demand that Malawi reduce social services so as to repay its international loans.
Malawi was and still is one of the poorest countries in the world. Some 80 per cent of the population grow their own food on small plots of land. More than 80 per cent do not have electricity. According to the World Bank, the annual GDP per capita is $637, compared with the world’s current annual GDP per capita of $10,918. But Malawi has also pioneered historic research in the prevention and treatment of childhood malnutrition and is home to many successful programmes like SFHC. I have been interested in the subject of hungry children for more than 30 years. This can be traced to the birth of my daughter, when I became the mother of all children, feeling that aggrandizement and joy. Surely if I have one job in life – if we have one job as a species – it is to feed our children.
Yet one in four of the world’s children under five are damaged physically and mentally due to a lack of food or nutrients. A quarter of the world’s children. We know this because the World Health Organization (WHO) makes a valiant effort to record the height and weight of children under the age of five. Almost all children, no matter their race or ethnicity, follow the same growth pattern in their first years of life. Genetic potential – what makes one person tall and one person short – kicks in later. Beginning in the womb, the body and brain grow rapidly and have a high need for nutrients. Without nutritious food, a period of faltered growth will result in a condition called stunting – below the standard of height set by WHO. Stunting is considered irreversible. A stunted one-year-old becomes a stunted 10-year-old becomes a stunted adult.
Stunting is shorthand for a range of problems: impaired immune system, impaired organ function, impaired cognition. Stunted children are sick more often. They may have learning disabilities or cognitive problems. They may have emotional problems. They do less well in school. They do less well at work. Later in life, they are more at risk for diabetes, heart disease, stroke and obesity.
A stunted child is too short for her age. A wasted child – another terrible term – is too thin for her height. Anyone can become wasted at any age if deprived of food. The body begins to cannibalise itself, eating up any remaining fat, eating muscles and parts of organs to feed other more essential organs, raiding vitamins and minerals from one part of the body to give to another. The body gets smaller. The heart gets smaller. The body begins to disappear.
In 2021, WHO estimated that 149 million of our young children are stunted and another 45 million wasted. (Some 39 million children under the age of five are overweight, which is now seen as a form of malnourishment.) Most undernourished children live in Africa or Asia. Most live in rural areas. Most live in relatively peaceful countries.
The problem isn’t enough food. The world has plenty of food. The problem is poverty, sexism, racism, tradition, disease, lack of sanitation, war, conflict, politics and more. The complexity of all that can seem overwhelming.
For every $1 spent on nutrition, society gets back an average of $16
And so familiar. Hunger has been with us forever. Four thousand years ago, someone made the striking comment on the tomb of the provincial governor Ankhtifi: ‘All of Upper Egypt was dying of hunger to such a degree that everyone had come to eating their children.’ In 585 BCE, the Biblical famine of Jerusalem made a vivid impression: ‘Their visage is blacker than a coal; they are not known in the streets; their skin cleaveth to their bones; it is withered, it is become like a stick.’ In the 19th century, an eighth of the people in Ireland starved to death or died of disease. In the 1980s, the world saw a series of famines highlighted on television, the images of skeletal children seared into our global consciousness.
That familiarity can work against our capacity for change. The good news is that the 21st century has seen a revolution in how we prevent and treat childhood malnutrition. After considerable trial and error, beginning with the efforts that followed the Second World War, we now know what to do and how to do it.
Putting aside our first visceral response – these are our children – we also know why we should. For every $1 spent on nutrition, society gets back an average of $16. Twice, in 2008 and 2012, economists at the Copenhagen Consensus declared that feeding mothers and children was our single best social investment. The World Bank, too, has done unnerving cost-benefit analyses that include the return in productivity when we give them Vitamin A and the economic boost of reducing anaemia in young women. Overall, reducing childhood malnutrition means significant savings in health costs and an uptick in GDP.
Environmentally, a healthy Earth requires healthy children. Reducing child death and malnutrition is directly related to reducing population growth: when parents know their children are going to survive and flourish, they tend to have smaller families. Moreover, helping smallholder farmers feed those families is all about a sustainable agriculture that mitigates rather than increases the climate crisis. Biodiversity is also connected to malnutrition; wildlife thrives only when the people living next door to wildlife are thriving, too. The goals of the humanitarian and the environmentalist are aligned.
Of course, the COVID-19 pandemic has made everything worse. Suddenly, we have more hungry children now. But the pandemic has also taught us the importance and relative ease of spending money on global health. The pandemic could, if we choose, be a catalyst for change.
After the dancing, three smallholder farmers took Dakishoni, Shumba and me into the fields to show off their pigeon peas, a legume that SFHC encourages the villagers to plant along with their traditional maize. Legumes such as pigeon peas, cowpeas, groundnuts and soybeans are a nutritious food for the family and for the soil, the stalks and leaves turned in as a natural fertiliser. One lean farmer spoke slowly, seriously, about how rotating pigeon peas with maize had increased her yields. She had also begun intercropping, planting different crops in the same field, which meant better ground cover, fewer weeds, and less risk that disease or pests would destroy her entire harvest.
With Dakishoni translating from Chitumbuka to English, this farmer was lecturing us on the value of agroecology – agriculture in the context of a larger ecology. Agroecologists study the interactions of multiple interdependent systems. Plants and soil. Plants and insects. Insects and soil. Humans and soil. Insects and birds. Plants and birds and humans and soil and goats. Although agroecology is not limited to any one practice, balancing productivity and sustainability usually requires organic and permaculture methods of farming. The farmers in this village were actively engaged in enriching their soil and growing more crops through composting and judicious planting. Meanwhile, they had become less dependent on expensive chemical fertilisers and pesticides.
A four-year study supported by the United Nations and World Bank estimates that a paradigm shift toward agroecology could not only feed the world’s population but also make agriculture carbon neutral. Practices like no tillage and diverse crops build healthy soils that store carbon. The report denounced the ‘persistent belief’ that industrialised farming is more efficient than the small farm. In fact, largescale farming is simply more productive per ‘unit of labour’ and more competitive in the world of big markets.
The sun burned higher in the sky as another farmer now began talking about the climate emergency. More than 80 per cent of Malawian farmers depend on rain for their crops, and now, he said, those rains either came less often or with an intensity that caused flooding. A nearby spring seemed to be drying up due to hotter day temperatures and hotter nights. With the help of SFHC, he did what he could: planting more drought-tolerant crops, planting trees and shrubs to shade his crops, and creating soil that held in water.
They walk a mile to get water from a well. They worry about the costs of sending their children to school
The climate crisis is pertinent to any discussion of international aid, which might better be called reparation. In 2018, according to the World Bank, Malawians were responsible – on average, per person – for 0.1 metric tons of carbon dioxide emissions a year. Americans were responsible for 15.2 metric tons of CO2 emissions per year. Australians, 15.5. The Netherlands, 8.8. United Kingdom, 5.4.
Hot and thirsty, we all walked to the headman’s house for lunch. But first, people had some things to discuss with Dakishoni and Shumba. I was invited on a tour of the village compound. The animals, the cooking huts, the composting bins.
I was pleased to see so much I recognised. Look, chickens! Look, little pigs! Decades ago, my husband and I had been ‘back-to-the-landers’ in rural America, wanting to connect more directly to life – to root into place like a plant into soil. We had built our house out of mud or adobe bricks. We had a mostly organic garden, two home births – a daughter and son – too many goats, and too much goat cheese. Today, I felt a resonance with the village latrine. How cold those mornings had been, under the glittery stars, taking our children to the outdoor toilet.
But growing our own food hadn’t lasted long before we wanted money for other things: a refrigerator for the goat cheese, a reliable car, health insurance. I started teaching writing skills at the college in a nearby town. My husband began a series of jobs, most of them pleasant and meaningful to his sense of self. We were white, educated, healthy and young. Those were our choices: we could struggle as smallholder farmers or we could find other interesting work.
In Malawi’s economy, of course, most villagers don’t have that choice. They don’t always have enough food in the house. They might walk a mile or more to get water from a well. They worry about the costs of sending their children to school.
‘Decolonising aid’ is the newest buzz phrase and the next phase of international development. Decolonising aid means giving up the power of decision-making to the people most affected by the problem that the ‘aid’ is trying to solve. In the headman’s house, the men and women of this village were now discussing what they wanted and how to get it with Dakishoni and Shumba. I would and should give money to SFHC to support their work. Other than that, I needed to stay out of the way. Patiently, I waited for lunch and admired the guinea fowl.
After SFHC introduced a more sustainable agriculture, the staff did home visits to see if these methods had helped to significantly reduce childhood malnutrition. They hadn’t. The legumes were still not a favoured food in the family. The women complained that the new crops had only increased their workload. And any extra money from selling these crops did not necessarily benefit the women or children.
I would find this true throughout my time in Malawi: almost nothing works to end childhood malnutrition unless you empower women. Empowerment includes healthcare, education, employment opportunities, voting rights, property rights, accessible family planning, and protection from sexual exploitation and domestic violence.
For many smallholder farmers, women also need to be relieved of the double burden of doing half the farming chores and all the cooking and childcare chores. Childhood malnutrition can start when a mother is too exhausted to breastfeed her infant or to feed her small children more than twice a day. When she is gone to market or in the field and no one cooks or cares for the children at home. When she has no power in the home.
In the capital of Lilongwe, urban women told me the same thing. They went to work and came home to work. ‘Always!’ they said. ‘We are always busy!’
‘We tell them – don’t let the man take and eat that egg. Give that egg to the child!’
During the home visits made by SFHC, the men tended to disappear, perhaps because feeding children and cooking for the family was still ‘women’s work’ and not of much interest to them. So the women suggested a more joyful approach – public events where people could exchange cooking techniques. Recipe Days! This would involve the traditional forms of celebration, clapping and singing and dancing. No one wants to miss a party. Over time, the men began to participate, competing over who could grind the most soybean flour or produce the best dish, joking and tasting the food while they cooked.
Discussions were animated and revelatory. A form of community theatre evolved in which husbands and wives talked to each other, about farming, of course, but also about ‘family cooperation’ and the equal share of household chores. In a research paper published by SFHC, one villager said: ‘Like now, I’m here at the clinic, maybe my wife is here at the garden, so when I go home, I cannot sit and wait for her. I can prepare a meal, eat my share, and when she gets back, she can eat. I cook nice meals!’ He went on to confess: ‘Before the project, I’d say: “I want you to go to the wells and draw three buckets of water, and then do this and this.” I was in charge. I appreciate that life has changed …’
Women’s care groups are another form of communal education that begins with clapping and singing and dancing. Sitting in a circle, mothers talk about the importance of exclusive breastfeeding for six months. They are sometimes surprised to learn that their toddlers need more than the traditional bland porridge. Small children should be fed the same vegetables, fruits and nuts eaten by the rest of the family. Their small stomachs also require small meals many times a day.
In her cubicle in a large unairconditioned building, I sat across from Theresa Banda, who unrolled a food chart on her desk. Banda worked for one of the organisations leading women’s care groups. She pointed vigorously to the coloured pictures of food. ‘We want the mother to grind up a few nuts, here, and put that in the porridge. Take some pumpkin leaves here and put that in the porridge. A little bit of soy milk, here. Put these in the porridge!’
I wondered out loud if poor people could afford such a diverse diet. ‘Yes, of course they can,’ Banda exclaimed. ‘A chicken lays an egg. The family has an egg. We tell them – don’t let the man take and eat that egg. Don’t take that egg to market. Give that egg to the child!’
I asked about gender equity.
‘Things are improving in Malawi for women,’ Banda affirmed. After a moment, she added: ‘Much of that may be more perception than reality.’
Speeding through Old Town Lilongwe, my taxi hurtled past food stalls, brown fields, a huge grey stadium and flat-topped trees flowering red. Billboards campaigned for the current president and advertised the best universities or new products, such as Vitamin-A-enriched vegetable oil. The streets jostled with cars, pedestrians, bicyclists, goats. Suddenly, we spun through a terrifying roundabout. More miles of mud-brick homes, food stalls, little stores, little stores, little stores, until we entered the gate of a mud-brick compound and thankfully stopped. I had an appointment here with Andrew Chinguwo, manager of this small factory making ready-to-use therapeutic food, more commonly known as RUTF.
The revolution of RUTF began at the end of the 20th century when researchers developed a tasty, calorie-dense paste – peanut butter, skim-milk powder, sugar and vegetable oil – fortified with the right vitamins and minerals that a severely malnourished child needs to recover. The paste can be stored for months without refrigeration in a foil packet and then eaten directly without the need for clean water. Part of the revolution was this safe convenient packaging. Part was our new understanding of how vitamins and minerals work in the human body. Part was giving out these foil packets to parents, who could then care for their sick children at home instead of taking them to hospitals where they were exposed to disease and died at surprisingly high rates.
These life-saving nutrition packets are available to roughly a quarter of the children who need them
Precisely fortified food is the cure for malnutrition. Fortified food, in general, is a fast and cost-effective way to prevent malnutrition. Versions of RUTF could next become nutritious inexpensive ‘snack food’ that uses the power of the marketplace to reach parents and their children. Fortifying staples such as flour and salt with nutrients such as iron and iodine is a great way to reach large populations. In biofortification, crops such as Vitamin-A-enriched sweet potatoes and zinc-enriched rice are bred naturally, not only for more nutrients but to be more drought-tolerant and pest-resistant.
Chinguwo was particularly excited about a new product his factory had developed, one that used locally grown maize, soybean and sorghum instead of imported dried milk and sugar. Since then, research by the organisation Valid Nutrition has further refined this dairy-free RUTF to be both effective and less costly than the original formula. And cost is important. The price of a six-week course of treatment is about $41, with most RUTF bought and distributed by UNICEF. For now, these life-saving packets are available to roughly a quarter of the children who need them.
Another RUTF factory in Malawi is in the southern city of Blantyre. Project Peanut Butter distributes its foil packets to rural health clinics, where mothers bring in their children to be evaluated and treated. Some of the clinics double as research sites, with scientists such as Kenneth Maleta looking at how malnutrition is related to a disordered microbiome – that community of microorganisms that live on and in you, particularly in your gut – which is itself related to disease and parasites. We haven’t stopped learning about the science of malnutrition.
I want to tell you more about what I saw in Malawi, which is also known as ‘the warm heart of Africa’ for its friendliness and grace. I want to tell you about the children at those rural health clinics. How some screamed in outrage as their mothers laid them down to be measured and weighed. How others looked at me so calmly.
I want to tell you about the many success stories in ending childhood malnutrition. Countries as diverse as China, Brazil and Vietnam have dramatically reduced childhood stunting. The Indian state of Maharashtra went from 39 per cent of its children under two stunted to 24 per cent in six years, using a holistic approach that educated mothers about breastfeeding and childcare, provided vitamin and mineral supplements, promoted vegetable gardens, and improved access to clean water and sanitation. In other countries, similar success stories have included cash transfers that go directly to the women in a household, free school breakfast and lunch programmes, more rural health services, more RUTF for the children who need this food-medicine, and more nutritious, inexpensive, fortified food in the marketplace.
I want to tell you about the UN Food Systems Summit that met in September 2021. Their experts believe that, by investing an additional $33 billion a year in food systems for the next 10 years, we could end the majority of all hunger in the world not related to war and conflict. ‘Ten years and we’re done,’ said Carin Smaller, a director of the International Institute of Sustainable Development.
US politicians decided not to renew a child tax credit that could have reduced child poverty in half
We know what to do. And we have the money to do it. An additional $33 billion a year? Every year, Americans alone spend more than $90 billion on their pets and pet products. I am not saying we shouldn’t love our pets. I’m saying we have the money to do this. The UN Food Systems Summit urged corporations, in particular, to invest in ending hunger. In turn, these corporations would benefit by attracting investors and employees interested in social responsibility.
I want to tell you more. I want to talk about child hunger in my own country, the United States, where one in six households with children are food insecure. They don’t always know when their next meal will be. They don’t always get three meals a day. Their families often don’t have access to healthy food but must rely on cheaper, less nutritious ‘fast food’ which is related to obesity and adult disease. The number of these hungry children can go up and down based on who has been voted into power. Recently, for example, US politicians decided not to renew a child tax credit that could have reduced child poverty in half. In other words, in wealthy countries, child hunger is most clearly a choice.
I want to tell you more, but I have to stop. Sometimes, to be honest, I want to scream. These are our children. Why aren’t we feeding our children? The good news is – we can. Moreover, ending childhood malnutrition isn’t only about food or money or empowering women or better healthcare. It’s about a belief in the dignity and potential of every human being. It’s a set of values that accepts our responsibility for each other. The goals of the humanitarian, the economist, the artist, the scientist, the farmer, the politician and the environmentalist are aligned. A healthy Earth, healthy communities, healthy children. We are all part of this.
This is the world we want to live in. This is who we want to be.