21 July 2022

Pregnant Sri Lankans Fear ‘One Meal Per Day’

Dimuthu Attanayake

COLOMBO, Sri Lanka—In Koralawella, a coastal village just south of Colombo, Anusha Fernando, her husband, and their 7-year-old child have been surviving on just a single curry and rice most days, which they spread out between lunch and dinner. Despite living in a fishing village, Fernando, who is eight months pregnant, has barely been able to afford seafood—or even eggs, meat, or milk powder—since the beginning of the year.

“I eat less now, and I get [gastritis], which makes me feel nauseous. I have lost 2 kilograms [4.4 pounds] since last month,” Fernando said in June in their modest home in a housing block provided by the government for low-income families, a few streets from the shore of the Indian Ocean, with its colorful fishing boats and clusters of small wooden shanties. Fernando’s husband has found less and less work since January as a casual laborer at one of the neighborhood’s many carpentry workshops, and sometimes they are forced to choose between food and other daily necessities.

Fernando is just one of many pregnant women unable to find the nutrients they need amid Sri Lanka’s spiraling economic crisis. In May, Sri Lankan Prime Minister Ranil Wickremesinghe, who announced his willingness to resign after mass protests over the weekend, said that the country could face a food crisis by this August. But food shortages and skyrocketing food prices are already here—and although they have affected most Sri Lankans, they have had the worst impact on vulnerable groups, especially pregnant women and children from low-income families, who are often forced to skip meals and survive on whatever food they can find.

A number of bad policy decisions over the past couple decades propelled Sri Lanka toward an unprecedented economic crisis. These policies, which included major tax cuts and cycles of borrowing for development projects, then coincided with the COVID-19 pandemic, which brought a major loss in tourism revenue and in foreign remittances as expatriate workers returned home. Last year, facing external debt totaling more than $50 billion, Sri Lanka was plunged into a foreign exchange crisis. The crisis was only worsened by recent government policies—including unofficially pegging the Sri Lankan rupee to the U.S. dollar and excessive money printing—and has brought shortages of essentials such as fuel and medicine.

On June 16, the country was brought to a standstill when the government announced that existing stocks of fuel would only last for five more days. Schools closed, and critical surgeries were postponed as Sri Lankans waited in fuel and cooking gas lines for half a day or more. After that, fuel shipments from abroad have been delayed, and the government has limited fuel to essential services and requested that other sectors work from home.

Sri Lankans have responded to this unbearable economic pressure by protesting President Gotabaya Rajapaksa’s government for months—culminating in Rajapaksa’s decision on Saturday to announce his intention to resign. That day, tens of thousands of Sri Lankans stormed and seized the presidential palace, refusing to leave until the president stepped down. Rajapaksa fled Sri Lanka on Wednesday, and although it is not entirely clear who is now in charge of the country, Wickremesinghe was appointed as acting president that day. Parliament Speaker Mahinda Yapa Abeywardena has said Sri Lanka will elect a new president on July 20.

The situation is only poised to get worse. A government decision last year to rapidly ban chemical fertilizer in an effort to promote organic agriculture brought heavy crop losses, further squeezing the already strained food supply. Buddhi Marambe, a senior professor in crop science at the University of Peradeniya, said the organic agriculture push led to a loss in 50 percent of the paddy yield and 65 to 70 percent of the maize yield—the main animal food crop—with the latter contributing to increasing prices of chicken and eggs.

“With a very high level of confidence, you can say that the [next agricultural] season is also going to be a failure,” Marambe said. “So the cumulative impact of having two failed seasons is going to have a bigger overall impact on food availability, accessibility, and affordability in Sri Lanka.” He added that a food crisis is already here, “especially among the urban communities.”

According to the United Nations, in June, nearly 5 million people in Sri Lanka needed food assistance. A survey conducted by UNICEF from March to April found that 70 percent of Sri Lankan households surveyed, including the few that had no change in income, reported a reduction in overall food consumption over the past two years, citing rising costs of food as the main reason for the change. By June, year-on-year food inflation was 80.1 percent. In early June, the U.N. appealed for $47.2 million in humanitarian assistance to Sri Lanka, targeting the 1.7 million people “worst-hit” by the economic crisis, while UNICEF appealed for assistance for 1.7 million children, including 56,000 children with severe acute malnutrition.

Devika Kodituwakku, the president of the Government Midwives’ Association, a Sri Lankan trade union, said that midwives have observed “worrying trends” of people without adequate nutrition across the country, which she said will become a “critical issue” in the future. In Sri Lanka, midwives play a crucial role in maternal and child health care, especially at the community level, where they walk from house to house, seeking out families with pregnant women and young children, connecting them to clinics, advising them on how to ensure a safe pregnancy, providing dietary advice, and measuring weight at regular intervals.

For nearly 50 years, the government provided a nutrient-rich cereal supplement called Thriposha for free to pregnant women, lactating women with infants under 6 months old, and underweight children between 6 months and 5 years old, under a nutrition program aimed at “eliminating malnutrition” in the country. The program also gave pregnant women necessary vitamins, including iron tablets. But in recent months, the government has not provided Thriposha or iron tablets, and while the tablets are sold in stores, Thriposha is not being manufactured at all. “I last received Thriposha in December or in January,” Fernando said in June. “This time I did not get the iron tablets either.”

According to the UNICEF survey, since February or earlier, 91 percent of eligible households have not received Thriposha for malnourished children, 66 percent have not received Thriposha for pregnant and lactating women, and 94 percent have not received the iron supplement for malnourished children.

“On numerous occasions, midwives have observed families unable to afford a meal eating a small portion of Thriposha instead,” Kodituwakku said. “Now these poor families have lost that small relief, too.”

Kodituwakku said that while government officials have cited issues in importing maize as a major reason for Thriposha being unavailable, the main constraint to restarting the program is the “lack of interest” shown by the authorities. The government could have sourced some locally produced maize or prioritized importing maize, Kodituwakku said, but mainly, it is a problem with Sri Lanka’s bureaucracy: The program recently went from being overseen by the Ministry of Health to the Ministry of Education, and, she said, “I am not sure whether the Ministry of Education has an interest in looking after the health of pregnant women.” Although the midwives association has raised this issue several times with the Ministry of Health, asking for the agency to take over the program again, she said, “nothing has been done.” A recent government audit report on the state-owned Thriposha company also showed a number of areas where it has been mismanaged, including delays in procurement and an absence of agreements with suppliers.

There don’t appear to be any solutions to these problems in the short term. Early last month, Wickremesinghe promised three meals a day under a food security plan. But protesters criticized him for his lack of action in easing the shortages of essential goods, and now that he has announced his intent to resign—though his appointment as acting president has put this into question—it is unclear what will become of this plan.

Meanwhile, the country’s midwives, pregnant people, and medical professionals are deeply worried. Adequate nutrition, after all, is integral to ensure a safe and healthy pregnancy and infancy, and already, Kodituwakku has noticed “a slight drop in weight of about 20 percent of the children aged below 5,” she said.

Renuka Jayatissa, the president of the Sri Lanka Medical Nutrition Association, also warned of the developmental dangers of malnutrition. “Eighty percent of the brain development of children takes place before they are 2 years old. If they do not receive the sufficient quantities of daily nutrients this will affect their cognitive development, impacting them in the future,” she said. “Once they become adults, their educational achievements, intellectual capacities, work capacities, and everything will be affected.”

Back in Koralawella, Fernando worries about how she will soon feed her baby. “It is already hard for the three of us to survive. Soon there will be four of us, and it is going to be worse,” she said. “The way the country is going, we will be able to eat only one meal per day.”

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