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Infant mortality rates have fallen dramatically worldwide over the past 25 years. But, even as health officials celebrate that achievement, they also warn that those who survive malnutrition frequently face lifelong problems.
In the Americas, the situation is most dire in Guatemala, where roughly 50 percent of the children are so malnourished they're stunted, physically and developmentally, for life.
Now, for the first time in decades, that country's leaders have a coordinated program to bring those numbers down.
Hari Sreenivasan has our report, which was produced in collaboration with the Pulitzer Center on Crisis Reporting.
Each day around mid-afternoon, Maria Chamile begins a chore she knows may harm her children.
With no meat and few vegetables, she starts cooking dinner with the ingredients available to her. Usually, that's just beans. It's a staple meal here in the predominantly Mayan Highlands of Guatemala — one containing so few of the vitamins and minerals children need to grow properly that roughly eight in 10 of them are stunted in some communities.
Chamile saw it with her first four children. But she is hopeful things will be different with her 1-year-old daughter, Lydia. And international observers agree the outlook for many families seems brighter today than it has in a very long time — that there's reason for optimism.
To find out why, I traveled to Guatemala with journalist Roger Thurow. He's been covering chronic malnutrition and its impacts for more than a decade for The Wall Street Journal and more recently the Pulitzer Center on Crisis Reporting. We met up with Chamile at her home near the town of Chichicastenango.
How many kids? Six kids? Five kids?
Is he one of the boys?
He's the first…
Among the first topics of conversation:
How old are these guys?
So, this guy is 11, 6, 13.
The startling height difference between us.
Until recently, the assumption was that Mayans were simply shorter than other ethnic groups.
So, when people in the Mayan highlands look around and they see everyone around them of the same height, some of them might think it's genetic.
The thinking is beginning to change, some that genetics may have some role to it, particularly as they get into adulthood.
But, basically, they're finding that, "Wait a minute, there are certain standards and expectations of a child's growth during the first years of life, kind of no matter where the child is in the world." What they find here when they chart it, it's really — it's really interesting, that starting already several months into the child's life, you can start seeing the deviations begin.
Chamile has been warned of the dangers. It's why, every four weeks, she brings her baby Lydia to be weighed at this center operated by humanitarian group Save the Children.
The main focus here is on children within the first 1,000 days. This period between pregnancy and the child's second birthday is a make-or-break one for brain development and physical growth. When the proper nutrients are missing, development slows, making it very difficult, if not impossible, for the kids to make up the losses, even if they're well-fed later in life.
Studies show that not only does malnutrition cause growth disruption; it can also lead to vastly lower I.Q. scores and increase the likelihood for heart disease, diabetes, kidney damage and anemia into adulthood.
On this day, the health workers discover that baby Lydia is not on track for height or weight. She's much too small. So the Chamiles are escorted to another counseling session on good nutrition, where they learn about the importance of things like adding meat, fish and vegetables to their daily diets.
For a lucky few, there is even a small amount of Save the Children funding to help families obtain chickens for their eggs and goats for their milk. Others receive limited amounts of food straight from the government. But, so far, Maria Chamile and her family haven't received any of that.
So at the end of the day, they pick up an extra ration of rice, beans and oil from the United States Agency for International Development, before beginning the uphill climb home.
Carlos Cardenas, director of Save the Children in Guatemala, says it is going to take much larger structural change here to reach all of the families who need help.
CARLOS CARDENAS, Director, Save the Children, Guatemala: Guatemala has the largest GDP in Central America, still has the worst indicators in chronic malnutrition. So how do you explain that?
So it's not necessarily just economics. It's not just necessarily poverty. It's a combination of a number of other things that add up to make this a very, very complex scenario.
Among the biggest complexities: the agricultural paradox. The Guatemalan countryside is overflowing with fresh vegetables. But very little of those vegetables make it into local homes.
We're standing in this incredibly lush valley. There's lettuce at our feet. There's string beans, there's cabbage. All of this food here, how can Guatemalan kids be malnourished?
It's one of the remarkable paradoxes of this country, one of the sad paradoxes, that there is so much nutritious food that is growing here that you can see, that you can walk through.
Where does all this stuff that's growing around us go?
People will come by in trucks. They will — the farmers will harvest it. They will load it onto the trucks, and then it's off to export markets in the United States, in Europe, elsewhere in Central America. And very little of it stays here.
Maria Pilar is the mother of 5-month-old Blanca. She carries Blanca on her back as she weeds fields of peas by hand.
When we asked Pilar if she would keep some of this fresh food for herself or to better nourish her baby through her breast milk, she said no, she prefers corn and beans.
The deep roots of the problem have led many to believe that the answer is not in the countryside at all, but rather with the government in the capital. In 2012, President Otto Perez Molina launched an effort to reduce childhood chronic malnutrition by 10 percent in the next few years.
Among Perez Molina's chief aims for the Zero Hunger campaign was more spending on health services, particularly surrounding the first 1,000 days, and a greater emphasis on education.
So we're here in the middle of Guatemala City. Compared to the highlands, how are they tackling malnutrition here?
You know, I think a big part is just a growing awareness. Two years ago, if we were standing in this square in the center of Guatemala City, and we asked people that were walking by about it, they would really have no concept about what malnutrition is, the impact of it in the country.
But now it's a fairly accepted notion that it's a really crucial issue that the country has to deal with. And when you're here and you look around the hubbub of the city and the cars going around and the billboards and the skyscrapers and kind of the activity of life here, it's, like, "My goodness, is that a different world? Is it the same — is it actually the same country?"
So, there's like two Guatemalas.
Exactly. But what has happened, I think, with the Zero Hunger program and this awareness of the malnutrition, this — this frontal attack on malnutrition and hunger, it's bringing these two worlds together.
There are some here who say poverty is the overarching problem, that widespread malnutrition won't be solved until a list of cultural and economic concerns are addressed first.
But Luis Enrique Monterroso disagrees. He's Guatemala's minister of food security and nutrition.
LUIS ENRIQUE MONTERROSO, Minister of Food Security and Nutrition, Guatemala (through interpreter): Guatemala focused many years on poverty, thinking that, if there was work on that area, it would reduce malnutrition. And it didn't work. What we are doing here is logical interventions that are proven to reduce malnutrition. In that way, we can reduce poverty in the long run.
One of the most successful portions of the campaign was when hundreds of government officials and business leaders each spent a night in the homes of the rural poor. It's an experience these captains of industry still discuss when they meet on the 18th floor of Alvaro Castillo's company headquarters in downtown Guatemala City.
They say they have a vested interest in the topic. Each day, the problem costs Guatemala $8.4 million in lost productivity, increased hospitalization and academic setbacks.
ALVARO CASTILLO M., Director, Alliance for Nutrition (through interpreter): We reached the agreement that a country could not be competitive if its human capital was malnourished since childhood. How could we let this happen in our country? We have to do something.
So, you are going to keep the pressure on whoever becomes president?
ALVARO CASTILLO M. (through interpreter):
It doesn't matter if it's Zero Hunger as a name, but everybody has to be committed to giving the problem of malnutrition the attention it deserves.
But even if they succeed, the change won't come fast enough for Maria Chamile and baby Lydia. Just back from the Save the Children center, Chamile's head is full of information on what she should be feeding her daughter and what she wants to be feeding her — fresh vegetables, goat milk, maybe some chicken.
But the fact is, she can't. So Lydia will eat beans and local herbs tonight, just like everyone else in the family. And her mother will keep hoping for more.
Online, you can track child mortality rates around the world, learn more about Guatemala's efforts to reduce malnutrition, and view Hari's postcards from the field. That's all on our Health page.
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Hari Sreenivasan joined the PBS NewsHour in 2009. He is the Anchor of PBS NewsHour Weekend and a Senior Correspondent for the nightly program.
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
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