Can People in Sri Lanka’s Estate Sector Break Away from Poor Health and Poverty?
While Sri Lanka’s overall health indicators are on track to achieve the 2015 Millennium Development Goals (MDGs), malnutrition continues to be a serious concern in the country. Certain population groups fare worse than others. Priyanka Jayawardena discusses the causes of under-nutrition in one of the least developed sectors of the country, the estate sector based on her recent study.
People in Sri Lanka’s estate sector are one of the most marginalized groups in the country. Because the majority of them descended from indentured labour brought from India in the early 1900s and they were not granted citizenship status, they lived for decades without state provision of social services. Large inequalities exist in their access to and the utilization of, health services. Estate workers are largely dependent on the estate’s management for their basic needs – housing, health, and education.
Families working on estates are among the country’s poorest in terms of nutrition. About 30% of children under the age of five are underweight, nearly 1 in 3 babies have low birth weight, and one-third of women of reproductive age are malnourished (see Figure 1). This is a serious issue as it leads to a possible ‘vicious cycle’. The intergenerational cycle of malnutrition (see Figure 2), as established in Jayawardena (2012), is deeply embedded in the estate sector. A recent study by the author identified what factors influenced estate sector child and maternal malnutrition – important empirical insights in addressing the intergenerational cycle of malnutrition in the estate sector.
Figure 2: Intergenerational Cycle of Malnutrition
Debilitating Poverty Prevails
In the estate sector, households’ socio-economic status is considerably lower than in the rural and urban sectors. Almost 61% of its households fall into the poorest category, while in the urban and rural sectors this was at 8% and 20% respectively (see Figure 3). Households’ poor socio-economic status affects the health and welfare of people in the estate sector adversely. For example, as revealed in Jayawardena, (2012), a child belonging to the “poorest” socio-economic quintile is three times more likely to be underweight than a child in the richest quintile.
A significant reason for child and maternal malnutrition in the estate sector was intake of the ‘wrong’ kind of foods, specifically those lacking in protein. Consumption of nutritious food was much lower among children and mothers in the estate sector. In terms of food consumption by children aged 1-3 years, the estate sector demonstrates the lowest levels of consumption of protein-rich food (meat, fish, poultry, eggs, and cereals) , when compared to urban and rural areas (see Figure 4). Similarly, mothers in the estate sector consumed fewer protein-rich foods when compared to their peers in the other two sectors. Consumption of other essential nutrients, such as fruits and vegetables that are rich in vitamin A, were much lower among the estate sector children than the country average.
Estate Sector Alcoholism
The study revealed that regular alcohol consumption in the estate sector significantly increased the prevalence of malnourished women. Alcohol consumption was extensively higher among estate sector people. According to DHS 2006/07 data, 40% of the estate sector families were regular users of alcohol; whereas in the other two sectors it affected around 17% of families (see Figure 5). Although the estate sector recorded the highest poverty levels (11.4% of people compared to 8.9% at national level), they spend Rs. 1,216 per month on alcohol, tobacco, etc., which is roughly double that of the average household-level spend on alcohol in the rest of the country (Rs. 665).
Educated Women Hold the Key
Evidence suggests that women are critical in ensuring good nutrition for the family and household food security. Women have the greatest potential to make decisions that positively affect children’s’ health, how household income is spent, the quantity and quality of food, and in health-seeking behaviour. In the estate sector, the level of women’s education is much lower than in urban and rural areas. The study’s findings reveal that the education and knowledge of women have a strong impact on their nutritional status, as well as on the nutrition of her children. Poor education makes it difficult for women to take full advantage of the awareness raising campaigns on family health and hygiene practices offered in their localities, either by the government health service or by the estate management.
Addressing a Critical Concern
The causes of malnutrition are clearly multi-faceted and so actions to reduce it require interventions at different stages of the life cycle. It also requires that nutrition considerations are incorporated in to all sectoral policies. Sustainable nutritional interventions should be aimed at enhancing food security at the household and community levels as well as at schools in the estate sector. Nutrition education programmes should be strengthened to inculcate better consumption habits – what foods to select; how to prepare and feed children; and the hygienic and nutritional value of food. Strong national programmes on nutrition counselling and programmes that promote positive health practices and curb negative ones like alcoholism programmes can be useful in improving awareness among women in the country’s estate sector, and break the cycle of poverty and poor health.
This article is based on recent IPS study done by the author on “Socio-economic Determinants of Child and Maternal Malnutrition in the Estate Sector of Sri Lanka”. The study uses the nationally representative DHS (Demographic and Health Survey) conducted in 2006/07. All the estimates of this paper are based on DHS 2006/07 unless otherwise mentioned. Anthropometric index weight-for-age (underweight) is considered according to the WHO Child Growth Standards adopted in 2006, as a measure of underweight children. Low birth weight is defined as a birth weight of less than 2,500g. Body Mass Index (BMI) classification is employed for identifying mother’s nutritional status.
 Household socio-economic condition was defined based on the dwelling characteristics, ownership for assets, sanitation facilities and other characteristics which were related to household socio-economic status
 Jayawardena, Priyanka, 2012, “Socio-Economic Determinants and Inequalities in Childhood Malnutrition in Sri Lanka”, Well-Being and Social Policy Journal, Vol. 8 Number 1, pp. 1-22
 Haddad, L., 1999, Women’s Status: Levels, Determinants, Consequences for Malnutrition, Interventions, and Policy, Asian Development Review, Vol. 17 Nos. 1,2, : pp. 96-131