COMMENTATOR (COMM): Previously on Life...

DR MAISHTA GUPTA: Health is not a commodity that you can go and buy over the counter or - it's not something somebody can give you.

DR MUSTAFA KHALIL: There is a specific health problem here - as anaemia, as growth and development problem, as many things.

DAVID LEGGE : The maternal mortality rates of Third World countries is one of the grossest obscenities of the present regime under which we live.

COMM: It's early morning in the valley of Kathmandu, capital city of Nepal. Dev Kumari is one of many migrant women who has learnt to live with disappointment. Seven years ago she left her village in the district of Dolka and came west to Kathmandu in search of a better life. But life in the city has proved harsh. Living from hand to mouth means a daily struggle; selling enough roasted corn to pay the rent and feed her family. With her eldest daughter, Sarita, she spends over 12 hours everyday on the busy streets of the city - but that's only one part of her reality: her children and grandchildren are locked into an invisible cycle that is crippling Nepal's development. Protein Energy Malnutrition, or PEM, not only causes stunting, slow development, disease and death amongst young children today, it also has a disastrous knock on effect on each successive generation - a cycle that is proving hard to break. After 50 years of foreign aid and nearly three billion dollars of development money, Protein Energy Malnutrition, an interaction between poor diet and infection, still accounts for over half of Nepal's children being stunted; an irreversible condition after the age of two. It's also implicated in nearly 70% of children's deaths in Nepal through related illnesses, and has strong links with poor mental development - but if eradicating Protein Energy Malnutrition were simply a case of providing more nutritious food, would it still be such a harsh reality today?

Amidst the seasonal flow of tourists and trekkers who come in search of the serenity and beauty of the Himalayas, a call for the resignation of the Prime Minister on charges of corruption. It's been ten years since the Kingdom of Nepal became a democracy, a transition that has not been a smooth one: nine successive governments, coalitions and many disappointments. Development has been slow and the distribution of services to the rural areas even slower. As a result migration to the city has made Kathmandu one of the fastest expanding metropolises in Asia over the past 25 years, bringing with it problems of poor planning, pollution, water shortage and overcrowding. For the 300,000 migrants in the city, life without community support or extended family means adapting quickly to a new environment, an environment where everything, including food, has to be paid for with hard earned cash. Out of the one and a half million inhabitants of Kathmandu, recent arrivals are the most vulnerable to PEM. Patan Hospital: by the time most mothers bring their children here they are in critical condition.

Dr NEELAM ADHIKARI, Chief Paediatrician, Patan Hospital: This child is admitted with pneumonia and diarrhoea but his basic problem is really malnutrition. He is nine months old but his weight is only 5.2 kilos which is 62% of a normal average child. When it is about 60% or less that is severe malnutrition, so this is really bordering to severe malnutrition. You will see that there is very little fat on this baby. The buttocks are - show very less fat. Ribcage - all fat is not there. Abdomen is big as compared to the body because the muscle tone in the abdominal wall will be less in malnourished children and the intestines tend to protrude out. So abdomen is really big compared to um other children. You know, Protein Energy Malnutrition is what it does to the child is that, first is the child fails to grow, he stops growing - a growing child stops to grow. Second is then he would not have enough activity. He stops to be active and then, of course, infections will come in and the child gets sicker. You know, the solutions are not so much medical. Because medically we have the know-how. This is really, on a large scale, a socio-economic problem which relates to literacy of women, education, people having job opportunities, population control, hygiene, availability of food, which parents can afford. So the whole situation is really socio-economic.

COMM: These are problems with which 42 year-old Dev Kumari is only too familiar but about which she can do nothing.

DEV KUMARI (TRANSLATION): My parents were well off but what would my parents do for a daughter? Nothing! And in my husband's house there was always suffering, very little land and not enough food. I thought: if we leave things would be better.

COMM: Dev Kumari rents a small room near the bus station. Her two older daughters, Kopila and Sarita, and their babies live together with DK's three younger children, Chanda, Dipendra and Bidur. Menuka, her daughter-in -law, is eight months pregnant and also lives with them. That's ten of them crammed into one small room. Kopila was fifteen when she eloped with a married man and she was soon pregnant. Sarita's husband who lives with his first wife no longer takes care of her or the baby and Menuka who was recently married lives with her in-laws while her husband lives in the village. Sometimes Dev Kumari cannot even remember how many people live in the room.

DEV KUMARI (TRANSLATION): All the problems exist because of poverty. There was never enough to eat and nothing to wear. That's why they eloped. My husband and son have gone back to the village. There are three, four, five - seven of us here. I am Dev Kumari. This one is Dipendra - she is Menuka; Sarita, Kopila, Dev Kumari, Chanda, Bidur - again I forgot his name! Yesterday I forgot him - today I forgot him. There are too many in the family it is just impossible to count. I didn't think I was going to have any more kids and these two were born. These two are extra - the ones I love are the four older kids. I didn't take care of these two, the older ones did, I just gave birth to them - their brothers and sisters took care of them. For feeding or clothing - even when they are sick, I do not spend any money on them.

COMM: Kopila's baby is 45 days old. She has been sick since she was born; the medicine she bought from the local pharmacy isn't working.

NEELAM (TRANSLATION): How much did she weigh when she was born?

KOPILA (TRANSLATION) : 2kgs and 300 grammes

NEELAM (TRANSLATION): You had a small baby.

KOPILA (TRANSLATION): I guess I was weak.

NEELAM (TRANSLATION): I think more than weakness, you were too young to have the baby. Do you understand? If you have a baby before you are 20 years of age the baby can be small - till then you are still a child and your body's not be ready for the baby - understand? It is like children having children. So do not have another baby until you complete 20 years of age.

COMM: Because of teenage pregnancy and lack of care during maternity, 25-30% of infants in Nepal are born with low birth weight. These children are prone to PEM and are more susceptible to disease and infection. The baby has severe malnutrition and has caught pneumonia. Dr. Adhikari decides to admit them. STEWART MCNAB, UNICEF, Nepal: Gender cuts across the whole malnutrition issue because malnutrition begins, usually, in the uterus of the woman when she's pregnant, the child doesn't grow properly, a low birth weight child is born. If that child is a girl child she may not receive enough food - she may not receive the same amounts of food as the other children in the family. Then if she goes to school, if she is lucky enough to go to school, she also has to work hard and therefore her - er, work hard on the, in the household, in the farm, collecting firewood; water. Her growth is stunted and this in itself then leads to a problem when she becomes a young bride - maybe getting married by the age of 15, 16 - not being ready to give birth to-to a child. But invariably that's what happens and that child will also fall into the cycle of malnutrition. So the cycle goes round and round and it's essential that we break this in early childhood.

COMM: But it's not only the recent arrivals in Kathmandu who are vulnerable. The district of Achham is an hour's flight and two days' drive from Kathmandu. Its remoteness and lack of roads has kept most development and distribution of services away. Like many of the remote districts of Nepal, change has been too slow in coming. Levels of infant mortality, PEM, health services, safe drinking water and gender status are some of the worst in the country. A few kilometres away from the market town of Saphe Bagar is the small village Jalpadevi. For just over a year Jalpadevi's village development committee has been working with UNICEF to try and make the problem of PEM more visible to the women: through a simple system of monthly weighing sessions and discussions, the children's weights are plotted on a chart. Since all the children in the village are small for their age, plotting their weights against an international standard helps the women to recognise the problem.

Gayatri works as a voluntary "community mobiliser". At twenty Gayatri is herself a mother and in a month is expecting her second child.

GAYATRI (TRANSLATION): This one is not healthy either - he too is malnourished. If he moves from here to here, he would be well nourished. He is better than last time. I wake up at four in the morning, then I light the fire. When there is light I go and fetch water, I mop the front yard and I start getting ready for cooking. I then go to fetch water again. When I finish cooking, I go tend the cows. I go and work on the fields and wash clothes, I carry the clothes with me - there is water on the way, so I wash clothes at time. After working for a while in the fields, around ten, I return home. I eat and then wash all the pots and pans. Nowadays, I go and teach the women after eating. I return around two and I go down again to tend the oxen. I go and do whatever is necessary on the fields - like now it is the season to cut the wheat and that is what I do - I fetch water, and come home. I come back around six. I cook once again and feed the children. I eat, clean and around nine - nine-thirty - ten I go to sleep.

Dr ROGER SHRIMPTON, Senior Nutritionist, Helen Keller International: Wherever women are in control of resources at family level, in general there is far less malnutrition. Wherever women are oppressed, wherever women are not treated as equals, then you tend to get more malnutrition. So the solutions lie in that direction - in the long run. Perhaps the most important for achieving that is ensuring that all women are properly educated: that primary education is complete for all women and secondary education. And some of the most important indicators that are there are participation, as I said, of women in political life - how, how often do you see that in Nepal? Not yet, I don't think.

GAYATRI (TRANSLATION): I was married when I was 16. I was studying in seventh grade then - I was very young. After marriage, when I reached 18, I had my daughter. Now my daughter is three I am pregnant again and I guess that is fine. Since I already have a daughter, I would like a son. I cannot decide on whether or not to have more kids without consulting my husband. If it were up to me I would stop after this one. I suffered because of early marriage - I did not get to study. Had I been to school I would have finished my school last year. It would have been useful to study. The state of malnutrition is not so bad here - we have five babies out of 40 with malnutrition. The rest have good nutrition - they have the problem because of lack of good care, cleanliness and the mothers are not educated more. They do not have the time to feed their children - there is too much work.

COMM: With the workload in the village there is little time for the women to worry about pregnancy and birth. Lack of education and empowerment compounds the problem. Not getting enough to eat during pregnancy and working right up to the day of delivery jeopardises the health of both the mother and the baby.

GAYATRI (TRANSLATION): One of the malnourished babies is Laxmi Luhar. Earlier she had caught measles - worse they always had a problem with food and clothing. She had problems at home. They get sick often - when she was born, she was born small.

COMM: A healthy six month old baby weighs six kilogrammes - Laxmi weighs six kilogrammes but she's two years old. After a life-threatening struggle with measles, she's been constantly plagued by diarrhoea and other illnesses. Padma comes from a low caste family and was 17 when her mother, who could not take care of her, gave her away to 58 year old Bir Bahadur. Padma is his second wife. After three girls with his first wife, he was anxious to have a boy - now they have one boy and more three girls.

BIR BAHADUR (TRANSLATION): When I brought her she was 17 - now, she is 28. Then, I was 58. After that I had a boy - that's the boy. Had I gone to India after that, there would not have been more children but I was at home - with a woman and a man around things are just like that. I have heard of family planning, I only had one son. I kept on hoping for another son and this is what happened. It is the will of God. Where can you get a son if you ask for one? He had to give us one - he gave. Once daughters blossom we don't know where they go, they do not take care of us. That's why you have to marry again.

COMM: In some districts like Achham, sons are the only ones who are considered as children. The birth of a daughter is a curse and she gets condemned along with the mother. Since sons are believed to pave the way to heaven, families keep trying for sons even after having a number of daughters.

GAYATRI (TRANSLATION): Rambha has six children. Among the twins, the son is healthy but the daughter is malnourished. When she was born she was smaller than the boy, really tiny. In terms of milk, I think she feeds them equally. Because of reasons of her birth weight, the girl has malnutrition.

RAMBHA (TRANSLATION): The little ones - they are not healthy, both are malnourished. They do not eat well. We do not have enough money to give them all things like biscuits and bread - that costs. If they want to eat, they have to eat dal and roti - if not there is nothing else. If they eat, they eat - I don't force them. She is very thin. Keeps on getting sick. What to do? Always has diarrhoea. Even dal and roti she sometimes eats and the other times she doesn't eat. When she eats she has only a few grains.

COMM: Rambha's husband has no idea how she's brought up the children. Like many men of the village he left for Bombay, lured by the city's promises.

RAMBHA (TRANSLATION): When my husband left for Bombay he was 16 - now he is 38. It really spoilt his habits. Bombay really spoils his habits. He drinks, he stays in Bombay. Doesn't know how to work now. If you leave at 16, what work will you know? He doesn't know how to work on the fields, hold a sickle or carry loads. At times he sends 500, 200 or 700 rupees - maybe once or twice a year. Every three or four years he comes back, stays here for a month and returns. Each time he comes back there would be a baby.

GAYATRI (TRANSLATION): Men who understand and are educated are a little useful - even if they work, they send money to the family. Here, they drink and scold their daughters and wives. I believe if men are ignorant, they are useless.

COMM: It's women like Gayatri who show there is a way out of the vicious cycle of PEM and poverty. Nutritionists say that if governments invest in social programmes to improve women's status PEM could be eradicated in 20 years but if governments just wait passively for economic growth, it will take a 100 years and thousands of Nepal's children will remain at risk of death and disability.

GAYATRI (TRANSLATION): In five years from today I wish that no parents make their children suffer from malnutrition; everyone pays attention to cleanliness, and that everyone has a toilet in their house. When there is a meeting and when the children are weighed that both the father and the mother bring the child. This is what I wish for. I hope the children get to study on time and get to eat and for them to stay far from malnutrition. I wish for both sons and daughters to get love and affection in equal amounts and for them to go to school - now daughters, especially those from lower castes, are not sent to school. There are a lot of children from the lower castes. After that, I wish that both sons and daughters are equal and there is no sexual discrimination.

END