In March 2013, UNICEF published a report on the state of nutrition in North Korea based on research conducted between September 17th and October 17th 2012.
This summary is a little delayed, but serves as a vital starting point for assessing the consequences of North Korea’s agricultural performance this year. In particular, with the seasonal rains in July and August setting back harvests annually, it will be important to know where North Korea stands currently. Additional summary and analysis was published by Sino-NK in March.
The report exhibited a degree of optimism, placing great emphasis on the slight improvements that have occurred since October 2009 when UNICEF conducted a Multiple Indicator Cluster Survey.
According to the new 2013 report, 27.9% of children under the age of 5 exhibited signs of stunting due to chronic malnutrition – this figure shows a slight improvement since 2009 when 32.4% showed signs of stunting. A slight decline was also observed with acute cases of malnutrition; UNICEF estimated in 2009 that 5.2% of children under the age of 5 exhibited cases of acute malnutrition – now the numbers have slightly curbed to 4%.
However, cases of severe acute malnutrition appears to have increased in the last three years, going from 0.5% in 2009 to 0.6% in 2012.
Of course, these are estimates and actual figures may be slightly lower or higher than the presented numbers.
In fact, there are certain things to keep in mind when reading the 2013 report – the sample collection of the 2012 study is much smaller than the one conducted in 2009. In 2009, 7496 households were interviewed and interviews with mothers and caretakers for 2175 children were incorporated in the study. Nonetheless, the 2009 report noted that the estimates should be interpreted with some caution as sample size desired for each of the domains could not be acquired – in the 2012 study, 423 children from Pyongyang and 812 children in other provinces constituted the core sample, a much smaller number than the 2009 report. Given that only 3.3 million out of the country’s total population of 24.6 million live in Pyongyang, the study intuitively feels somewhat skewed.
Despite these problems, there are several vital points to keep in mind for the future.
The study believes that Community Management of Acute Malnutrition (CMAM), carried out since 2008, which provided nutritious food and treatment to children between the ages of 6 months and 6 years and pregnant women, influenced the drop in acute malnutrition – albeit the reduction of services since March 2012 due to lack of funding.
The study also revealed a correlation between acute malnutrition and low food diversity, emphasizing the importance of consumer goods other than simply grains.
The 2013 report’s breakdown of nutrition along provincial boundaries also confirmed the continuation of a strong Pyongyang-bias in consumption. Multi-micronutrient supplements (daily pill with 15 vitamins and iron) are supposed to be available to all women upon their pregnancy – however, the study revealed that only 26.9% of mothers used it for the recommended 6 months while an additional 26.4% took the important supplement for merely a month. Analyzing the consumption of these supplements between regions, the four northeastern provinces (North and South Hamgyong, Ryanggang, and Jagang) took less pills than Pyongyang.
Perhaps the most blatant sign of uneven distribution of resources can be seen in how Pyongyang’s chronic malnutrition rate of 19.6% (among children under the age of 5) and acute malnutrition rate of 2.3% are significantly lower than those in Ryanggang (chronic malnutrition at 39.6% and acute malnutrition at 6.1%), North Hamgyong (28.4% and 3.8%), South Hamgyong (32.9% and 4.3%), and Jagang (33.3% and 5.7%) provinces (the four northeastern provinces). Overall, the southern provinces were less malnourished than northern provinces along the Chinese border.
Medicine, water, sanitation and hygiene proved still to be a major problem in the country – something that will only be exacerbated with the inevitable floods in the summer.
All in all, 68,225 children are still acutely malnourished with 10,234 severely affected.
The report’s overall results seem to point at the importance of iron-rich food and multi-nutrient supplements. The nutrition of children is more important than is perhaps highlighted in the news – I wrote before about the potential long-term impact and cost of having a large traumatized and stunted youth population to argue that the United States must not categorize supplements and nutrient-rich baby food as “food aid,” so that these vital goods are not held up by a political or diplomatic conflict between the US and the DPRK.
As North Korea nears the summer rains and the months when it requires the most assistance for its people, the United States and the international community should make an effort to ensure the continued flow of nutritional supplements into the DPRK, no matter what the political environment.
On that note, the new report, despite its methodological problems, is a comprehensive and expansive study – it should guide the discussion that is inevitably going to happen with the next food crisis around the corner.