Tackling Chronic Undernutrition in Sri Lanka’s Plantations

Story Highlights

• In Sri Lanka, undernutrition among mothers and children under five, especially those living on plantations, remains a chronic development issue.

• Poor dietary practices result from high-priced nutritious foods, inadequate dietary information and traditional beliefs.

• On plantations, nutrition awareness programs are inadequate and should be reshaped to include a comprehensive behavior change communication strategy.

Time stands still at the Tea Plantation Workers’ Museum & Archive in Gampola. Located in a row of traditional line rooms that are over a century old, the museum attempts to convey what life was like for Sri Lanka’s plantation—also known as estate sector—workers not so long ago.

The first room—approximately 100 square feet—recreates an entire home, complete with clay walls and pots and pans hanging above the basic fire hearth.

While the quality of housing for estate workers is  still a contentious issue, much has changed for this community over time.

Poverty on plantations fell from 30 to 10.9 percent between 2002 and 2013. Today, some families living in line rooms typically have access to cable TV and cell phones.

However, unlike declining poverty rates, malnutrition is still prevalent.

A new World Bank report brings the spotlight on these undernutrition and health issues that affect populations living on plantations in 12 districts spread across the Western, Central, Uva, Sabaragamuwa, and Southern provinces.

Key Findings

Poor nutrition in Sri Lanka’s estate sector drives up national malnutrition rates

In Sri Lanka, undernutrition among mothers and children under five remains a chronic development challenge.

Families living on plantation estates remain markedly disadvantaged, and districts with a high percentage of tea estates have the highest rate of stunting among children under five.

Sri Lanka’s Demographic and Health Survey 2007 finds that the rate of stunted children and underweight adult women in estates was respectively 2.9 and 3.4 times higher than in cities.

Similarly, low birth weight rates in the estate sector were 2.4 times higher.

Children and women’s malnutrition rates persist and call for urgent action

Although Sri Lanka surpassed most of the targets set out in the Millennium Development Goals, progress in improving nutrition has stalled, especially in the estate sector.

The stunting rate of 36 percent in Sri Lanka’s estate sector shows a ‘high’ public health significance while the wasting (16%) and underweight rates (36%) show a ‘very high’ public health significance. These rates require urgent action.

Undernutrition is a behavioral and cultural problem, not just an economic one

Mothers in the estate sector were either unsure how to introduce complementary foods (fish, meat and eggs) to their children’s diets or ignored the importance of introducing them at six-months of age.

The influence of traditional beliefs was strong.  For instance, eggs, which are affordable and available in the estates, were believed to generate “phlegm” in children.  Fresh milk was suspected of causing allergies and triggering symptoms like skin rashes and shortness of breath.

The scope and quality of key nutrition programs is inadequate

Nutrition awareness programs implemented by the Ministry of Health or other ministries do not always reach targeted populations, lack adequate supplies, and are not always properly monitored or coordinated.

The report also highlights the inadequacy of communication methods or channels that do not meet the specific needs of a largely illiterate and Tamil-speaking population.

Tackling undernutrition in Sri Lanka’s estate sector will require a multi-pronged approach

There is a pressing need to improve the effectiveness of existing programs for children and women and girls before and during their pregnancies, and improve performance monitoring and coordination between various ministries in charge of these programs.

The Ministry of Health and relevant stakeholders are encouraged to develop new and complementary models of nutrition service delivery to better target and reach  underserved populations.

The report also recommends using a comprehensive behaviour change communication strategy to reach mothers and childcare providers in the estate sector as well as policy makers to raise awareness about the long-term health and economic impacts of stunting during the first 1,000 days of life.