爲什麼億萬印度兒童營養不良
Lucknow, India — I’m on my annual win-a-trip journey, in which I take a university student with me on a reporting trip. I’m traipsing through Indian villages with the winner, Austin Meyer of Stanford University, to tackle one of the world’s great whodunits: Why are hundreds of millions of children here stunted physically and mentally?
印度勒克瑙——我踏上了今年的“與紀思道同行”旅途，帶着一位大學生參加採訪活動。我帶着這次的幸運兒——斯坦福大學的奧斯汀·邁耶(Austin Meyer)——漫步穿過一座印度村莊，希望能解開世界上最大的懸念之一：爲什麼這裏的億萬兒童身心發育遲緩？
India is a vigorous democracy that has sent an orbiter to Mars. Yet its children are more likely to starve than children in far poorer nations in Africa.
印度是一個朝氣蓬勃的民主國家，已經向火星發射了一個軌道飛行器。然而，它的兒童比那些遠比它更貧窮的非洲國家的兒童更有可能捱餓。
In a remarkable failure of democracy, India is the epicenter of global malnutrition: 39 percent of Indian children are stunted from poor nutrition, according to government figures (other estimates are higher). Stunting is worse in India than in Burkina Faso or Haiti, worse than in Bangladesh or North Korea.
這是民主制度的一大失敗。印度處於全球營養不良的震中位置：政府數據顯示（其它估計數據更高），39%的印度兒童因營養不良而發育遲緩。印度兒童發育不良的情況比布基納法索、海地、孟加拉國和朝鮮的情況更糟糕。
Here in Uttar Pradesh, a vast state of 200 million people in India’s north, the malnutrition is even more horrifying. By the government’s own reckoning, a slight majority of children under age 5 in this state are stunted — worse than in any country in Africa save Burundi, according to figures in the 2015 Global Nutrition Report.
在北方邦，印度北部一個有着2億人口的大邦，營養不良的情況更是令人咋舌。根據政府自己的估算，該邦5歲以下的兒童多數發育不良。根據2015年全球營養報告的數據，那裏的情況比除布隆迪之外的任何一個非洲國家都要差。
The greatest cost of stunting isn’t stature but brain power. Repeated studies have found that malnutrition early in life reduces intelligence in ways that can never be regained. The brains of stunted children don’t develop properly — you see the difference in brain scans — which is perhaps why stunted children on average drop out of school early.
發育遲緩最大的代價不是身高，而是智力。反覆的研究已經發現，早年的營養不良會妨礙智力發展，而且無法恢復。發育不良兒童的大腦發育會不正常——腦部掃描會讓你看到區別——這也許是爲什麼發育不良兒童平均輟學較早。
“We’re not focused on stunting because we fear kids will be too short,” said Shawn Baker, a nutrition expert at the Bill and Melinda Gates Foundation, who accompanied me on visits to rural areas here. “We’re focused on stunting because it’s a proxy for cognitive development, and because kids are at risk of dying.”
“我們關注發育遲緩不是因爲我們擔心孩子們長得太矮，”比爾和梅林達·蓋茨基金會(Bill and Melinda Gates Foundation)營養專家肖恩·貝克(Shawn Baker)說道，他陪同我參觀這裏的農村地區。“我們關注發育遲緩，因爲它是認知發展的體現，因爲孩子正處於死亡的風險。”
The win-a-trip journey is a chance to spotlight issues that aren’t sexy but matter most. And when hundreds of millions of children are unnecessarily malnourished, holding them back all their lives, that should be a global priority.
“與紀思道同行”之旅是讓公衆關注不怎麼有趣但最要緊問題的機會。當數以億計的兒童毫無必要地面臨營養不良困境且終生髮展遭到妨礙時，這應該成爲一個全球性的優先處理事項。
Now a couple of bold new theories are emerging to explain why India does so poorly in child nutrition.
現在一些大膽的新理論不斷涌現來解釋印度爲什麼在兒童營養方面做得如此之差。
The first is that the low status of women leads to maternal nutrition in India that is much worse than previously believed. Women often eat last in Indian households — and 42 percent of Indian women are underweight before pregnancy, according to Diane Coffey, a Princeton University economist. Then during pregnancy, Indian women gain only half the recommended weight.
首先，印度女性的地位低導致產婦營養比以前認爲的糟糕許多。印度家庭中女性往往最後吃飯。根據普林斯頓大學經濟學家戴安娜·科菲，42%的印度女性在懷孕前體重過輕。然後在懷孕期間，印度婦女只能增加一半的推薦體重。
“The average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy,” Coffey writes in the Proceedings of the National Academy of Sciences.
“印度普通女性結束妊娠時的體重低於撒哈拉以南非洲地區普通女性開始妊娠時的體重”，科菲在《美國國家科學院院刊》(Proceedings of National Academy of Sciences)上寫道。
The upshot is that many children are malnourished in the uterus and never recover.
結果是許多兒童在子宮中就營養不良，而且再也無法恢復。
The second new theory is poor sanitation, particularly open defecation. About half of Indians defecate outside without using toilets. The result is that children pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrients — and 117,000 Indian children die each year from diarrhea, according to Unicef.
第二個新的理論是衛生條件差，特別是露天排便。大約有一半的印度人露天排便而不使用廁所。其結果是孩子們會感染損害腸道養分吸收能力的寄生蟲和慢性感染。根據聯合國兒童基金會，每年有11.7萬名印度兒童死於腹瀉。
That may explain an anomaly: Infant mortality is lower for Indian Muslims than for Hindus, even though Muslims are poorer. One reason may be that Muslim villagers are more likely to use outhouses.
這也許可以解釋一種異常現象：印度穆斯林的嬰兒死亡率比印度教徒要低，儘管穆斯林更爲貧窮。一個原因可能是穆斯林村民更可能使用屋外廁所。
This is a life-or-death matter. Governments invest in tanks and fighter aircraft to defend their people, when the greater threat to their citizens comes from their own poop.
這是一個生死攸關的問題。政府投資坦克和戰鬥機來保衛自己的人民，但他們人民的更大威脅來自於自己的糞便。
Still, few recognize the risk. Worldwide, far more people have access to mobile phones than to toilets. That’s because phones are seen as the higher priority. In the villages that Austin and I visited, villagers routinely had mobile phones, but very few had outhouses. Even fewer used them: It’s easy for aid groups to build latrines, harder to get people to use them.
儘管如此，很少有人認識到這種風險。在世界範圍內，能夠使用手機的人比能有機會上廁所的還要多。這是因爲電話被視爲擁有更大的重要性。在奧斯汀和我參觀的村莊，村民通常都有手機，但很少有屋外廁所。使用它們的人則更少：援助組織建造廁所很容易，但讓人們去使用卻很難。
One woman we met, Sahliha Bano, is a villager with an 11-month-old girl named Munni, who is acutely malnourished. The family doesn’t have a toilet (few in the village do).
我們遇到了一個名叫莎莉罕·巴諾(Sahliha Bano)的女人，她有一個 11 個月大名叫莫妮(Munni)的女兒，嚴重營養不良。這個家庭沒有廁所（村裏很少家庭有）。
Bano herself reflected other factors sometimes associated with malnutrition. She is illiterate and was married at about 14, and Munni is her sixth child. Bano rejects birth control because she believes it is against God’s wishes.
巴諾本人體現了與營養不良有關的其他因素。她是文盲，約 14 歲時結婚，而莫妮是她的第六個孩子。巴諾拒絕節育，因爲她認爲這違背神祗的意願。
These are complex issues, but if Afghanistan and Bangladesh can make great progress (along with Indian states like Kerala), so can all of India. Manmohan Singh, India’s former prime minister, called child malnutrition “a national shame” — but there’s still no political will to address it.
這些都是複雜的問題，但如果阿富汗和孟加拉國能取得巨大的進步（以及一些印度的邦，如喀拉拉邦），那麼印度這個國家也可以。印度前總理曼莫漢·辛格稱兒童營養不良爲“一個國家的恥辱”，但該國還是沒有解決這個問題的政治意願。
Instead, in a political move to win support from religious groups that object to eating fertilized eggs, the state of Madhya Pradesh recently rejected the idea of serving eggs in child-feeding programs. The result will be more children added to the hundreds of millions held back unnecessarily for the rest of their lives — as a great nation weakens itself.
相反，在一項爲贏得反對吃受精雞蛋的宗教團體支持的政治舉措中，中央邦最近拒絕了在兒童哺育計劃中提供雞蛋的構想。其結果將是更多的孩子加入到數以億計餘生都受到毫無必要的負面影響的人羣行列中——一個偉大的民族正在削弱自身。
