Child malnutrition is not only about nutrient intake. No sanitation and no waste management make things worse.
1,000 Days of Hunger
An in-depth look into child malnutrition in rural Ghana from the perspective of caretakers and community leaders.
Child malnutrition is a silent tragedy eating up the future of more than one million children across Ghana. Not far from Accra, tens of thousands of children under 5 suffer the irreversible effects of malnutrition in their critical first 1,000 days of life –the time in a child’s life that will determine their health as adults, their ability to learn in school and to perform at a future job.
The most recent data show that over a quarter of children under 5 in Ghana suffer chronic malnutrition and over 60 percent suffer anemia. These children will never reach their full potential. This is not new and it’s not getting better: 40 percent of Ghanaian adults suffered from stunting as children.
The malnutrition crisis in Ghana remains an abstract statistic that has not permeated public opinion.
Despite the signs of a serious public health crisis, government statistics about child malnutrition and stunting in Ghana, and data by UNICEF, WHO, the World Food Program, and the Global Nutrition Report, do not provide a sufficiently compelling picture of the situation. Like other similar stories around the world, so far this crisis remains an abstract statistic that has not permeated public opinion –in Ghana or anywhere.
The irreversible impact of malnutrition on the Ghanaian children’s first 1,000 days is invisible –even though a recent report calculates that the Ghanaian economy loses over 2 billion dollars a year due to this problem, which amounts to 6.4 percent of the country’s GDP.
Child malnutrition in Ghana is driving up healthcare costs and creating chaos in the health system, hindering workforce productivity, and straining education. It is ruining the future of children. But child malnutrition in Ghana is a very complex problem that also disempowers women and destroys the social fabric of communities. It’s aggravated by corruption, as well as misogyny, ancestral superstitions, and government’s lack of accountability and transparency.
The irreversible impact of malnutrition on Ghanaian children is invisible.
This story is an original piece of investigative reporting to help make this invisible problem visible. We prepared for six months, and orchestrated a team of 17 professionals (including photographers, journalists, designers, international development experts, and 10 Newton Europe consultants) to conduct over 100 hours of interviews with every relevant stakeholder (over 50 interviews). As part of this effort, we illustrated it with portraits of the protagonists and pictures of their environment.
We did our fieldwork in three rural communities in the Central Province of Ghana, only one hour away from Accra: Bentum, Apprah and Nyanyano, representative of a situation affecting the region –but serving just as an example of a problem infesting the whole country. In these three communities, over 30 percent of children under 5 suffer from severe malnutrition. However, local experts estimate that different levels of malnutrition and stunting affect the great majority of children in the area –and their mothers.
“Whatever you do for food, is on you.”
Nana Agya Kwao, 76, the Chief of the farming community of Bentum, working on his farm. He has been the Chief of Bentum for 35 years, most of which he has spent battling claims for the lands that have been traditionally assigned to him in his role as a local leader, a kind of a king. He is proudest of his palace and throne. Two years ago he sold most of the farming land in the Bentum area to a developer. As a result, the majority of local villagers lost their livelihoods, and now struggle to feed their families. “I am very proud to be the Chief. It’s not easy. No one will take my land. I know my people in Bentum cannot farm anymore. But whatever you do for food, is on you.”
“The thunder killed my baby.”
Kate Afful, 40, at home with her mother, telling the story of how one of her daughters died at age two. Another one of her six children died at childbirth. She worked as a fishmonger for her husband up until his death, about 10 years ago. Ever since, she struggles to find work and take care of her remaining four children. Her children are malnourished and often get sick –they only eat ‘banku’, a fermented corn and cassava dough. “God took my two-year old daughter. She was not feeling well so I put her to bed. Later that evening there was a bad storm. The sky was loud and angry. I heard an explosion in the clouds. When I went to check on my baby, she was dead. I believe the thunder killed my baby.”
“A lot of children die in this village.”
Ama, in her 20s, with her two children at home in the fishing village of Nyanyano. Her husband is a fisherman, and she works selling fried food on the street. Her two children are both malnourished, and her oldest child has suffered from an eye infection for two years without medical treatment. “A lot of children die in this village. People talk about my children being sick and malnourished but I don’t care what they say. There is nothing I can do because I can’t afford to take my children to the hospital or to give them the food supplements the nurses recommend.”
“My kitchen is empty.”
Hannah Abekah, 23, at her home, surrounded by the yellow buckets of rainwater she collected the night before. Hannah never attended school, and started working at a very early age as a fishmonger. She is married to a fisherman, and they have two young children who suffer from malnutrition. Her husband is often away for weeks. “My kitchen is empty. I have no food. My children don’t even eat the little food I give them. I don’t know about malnutrition. I just pray my children become great people”.
Lack of potable water means infections, malaria and diarrhea, multiplying child mortality and worsening malnutrition.
“Women don’t support each other here.”
Rebecca is 17, and her two children are malnourished and fall ill frequently. Her children receive over-the-counter medical remedies from the local store instead of professional healthcare at the hospital. Like many women in the village, Rebecca doesn’t receive much support from the father of her children: “He doesn’t take care of us as he should. He says he doesn’t have money, but I know he is not honest”. Rebecca feels she has nowhere to turn: “Women don’t support each other here, it’s not something we do”.
Most households in the area spend less than USD $10 a week to feed an entire family.
“I am not happy.”
Rachel Edifile, 18, here with her two children, works as a fishmonger. She struggles to provide food for her children. Her youngest child is underweight and malnourished, and she relies on the help from her grandmother to pay for medical costs. Like many mothers in the area, she cannot send her older child to school. “I am not happy. I want take better care of my children, send them to school and buy good food.”
School feeding programs help lessen the burden for the few who can afford it.
Still the effects of early childhood malnutrition and chronic hunger are visible.
“Our effort is just a drop in the ocean.”
Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at the Kasoa Clinic, the most important center assisting malnourished children in the area. However, according to Beatrice’s estimate, only 20 percent of malnourished children are taken to this clinic –mostly extreme malnutrition cases. A few community nurses cover an area of more than 30,000 people. “Women with malnourished children have problems that they cannot openly discuss with friends or family. There is a stigma associated with having a malnourished child. So we mostly identify malnutrition cases by talking to neighbors. Besides, mothers of malnourished children are lonely and they don’t feel supported by their husbands. Our most important job is to provide a safe environment to counsel them about their children, so that they don’t feel embarrassed about bringing them here. But our effort is just a drop in the ocean.”
Health services lack the resources to tackle widespread malnutrition. The majority of malnourished children in Ghana never get treated.
“I struggle to earn a quarter of what I made before.”
Christy Ansah, 32, with her youngest daughter besides the farm where she used to work in Bentum, a community plagued by poverty and child malnutrition. Two years ago, the village Chief sold all the farming land in the community to a local company. “No one here can access their farms. I was able to feed my four children before, but there is no food anymore and no jobs in this village. I struggle to earn a quarter of what I made before.”
The discarded signs previously used to identify farm boundaries in Bentum.
“I have no freedom and no future.”
Dorothy, 17, with her youngest child at a grocery store in Nyanyano. Dorothy was orphaned at age 14 and is now mother to two malnourished children from separate fathers. Though she rarely sees either, Dorothy has been taken in by the family of her second child’s father. Fathers in the fishing village of Nyanyano do not accept pregnancy without marriage, and they abandon the mothers –many of which are discriminated against and perceived by the community as prostitutes. Dorothy is trapped in a sort of domestic slavery. She is unable to leave the household without permission and has no decision-making power over any aspect of her life. When she is outside, she fears physical abuse from men and verbal harassment from women. “I have no freedom and no future. I only get to meet people when I am sent on errands. My sister in law controls the food and money so I can only feed my children whenever she wants.”
This is a world of mothers -they struggle alone for their children. Mothers also suffer from malnutrition in a cycle going back generations. Most fathers are not involved in childcare.
“My baby went to sleep and didn’t wake up.”
Mary Essil, 27, at her home in the farming community of Bentum, holding the bottle of glucose that a nurse gave her at the clinic to combat the malnutrition symptoms of her newborn baby. She could not breastfeed her son, who was very small at birth. Following advice from the nearby clinic, she gave glucose to her baby until he died six weeks later, at just 2 months old. “My baby went to sleep and did not wake up”. Local tradition mandates that when a baby dies of malnutrition, the baby is taken away. Mary and her husband were not allowed to attend their son’s funeral.
“I have no power.”
Nana, the Chief of Nyanyano, at his palace. As a traditional leader, he is responsible for overseeing political and ethical issues revolving around the Nyanyano fishing community –a coastal area with multiple challenges, from child malnutrition to human trafficking. “Fishermen leave women pregnant and then they run away. Mothers are left to fend for themselves and support their children alone. My people are starving. Mothers are desperate –many sell their children to fishermen to get some cash and food. The government does nothing about it. So many people look to me for answers, but I am only one man. I wish I could help them, but I have no power.”
This project was produced by DAWNING in partnership with Newton Europe. It is an independent effort, self-funded, non-partisan and non-ideological, in the tradition of social science and journalism in the public interest.
Project Director: Raul Roman
Creative Director: Joey Rosa
Executive Editor: Nick Parisse
Fieldwork Logistics Manager: Bright Fiatsi
Research Assistants and Translators: Yaa Yevoaa Adu, Ida Asare, Oppong Niayantakyi
Assistant Editor: Rafe H Andrews
Interviews, Transcripts and Photography:
Stephen Coy, Daan De Voogd, Rosanne Furniss, Paul King, Richard Lum, Jonathan Pemberthy, Emily Roche, Alan Rogers, David Taylor, and Adam Walker, Joey Rosa, Nick Parisse, and Raul Roman