为什么亿万印度儿童营养不良
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“与纪思道同行”旅途，带着一位大学生参加采访活动。我带着这次的幸运儿——斯坦福大学的奥斯汀·迈耶(Austin Meyer)——漫步穿过一座印度村庄，希望能解开世界上最大的悬念之一：为什么这里的亿万儿童身心发育迟缓？
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.
印度是一个朝气蓬勃的民主国家，已经向火星发射了一个轨道飞行器。然而，它的儿童比那些远比它更贫穷的非洲国家的儿童更有可能挨饿。
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.
这是民主制度的一大失败。印度处于全球营养不良的震中位置：政府数据显示（其它估计数据更高），39%的印度儿童因营养不良而发育迟缓。印度儿童发育不良的情况比布基纳法索、海地、孟加拉国和朝鲜的情况更糟糕。
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，印度北部一个有着2亿人口的大邦，营养不良的情况更是令人咋舌。根据政府自己的估算，该邦5岁以下的儿童多数发育不良。根据2015年全球营养报告的数据，那里的情况比除布隆迪之外的任何一个非洲国家都要差。
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.
发育迟缓最大的代价不是身高，而是智力。反复的研究已经发现，早年的营养不良会妨碍智力发展，而且无法恢复。发育不良儿童的大脑发育会不正常——脑部扫描会让你看到区别——这也许是为什么发育不良儿童平均辍学较早。
“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.”
“我们关注发育迟缓不是因为我们担心孩子们长得太矮，”比尔和梅林达·盖茨基金会(Bill and Melinda Gates Foundation)营养专家肖恩·贝克(Shawn Baker)说道，他陪同我参观这里的农村地区。“我们关注发育迟缓，因为它是认知发展的体现，因为孩子正处于死亡的风险。”
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.
“与纪思道同行”之旅是让公众关注不怎么有趣但最要紧问题的机会。当数以亿计的儿童毫无必要地面临营养不良困境且终生发展遭到妨碍时，这应该成为一个全球性的优先处理事项。
Now a couple of bold new theories are emerging to explain why India does so poorly in child nutrition.
现在一些大胆的新理论不断涌现来解释印度为什么在儿童营养方面做得如此之差。
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，印度女性的地位低导致产妇营养比以前认为的糟糕许多。印度家庭中女性往往最后吃饭。根据普林斯顿大学经济学家戴安娜·科菲，42%的印度女性在怀孕前体重过轻。然后在怀孕期间，印度妇女只能增加一半的推荐体重。
“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.
“印度普通女性结束妊娠时的体重低于撒哈拉以南非洲地区普通女性开始妊娠时的体重”，科菲在《美国国家科学院院刊》(Proceedings of National Academy of Sciences)上写道。
The upshot is that many children are malnourished in the uterus and never recover.
结果是许多儿童在子宫中就营养不良，而且再也无法恢复。
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.
第二个新的理论是卫生条件差，特别是露天排便。大约有一半的印度人露天排便而不使用厕所。其结果是孩子们会感染损害肠道养分吸收能力的寄生虫和慢性感染。根据联合国儿童基金会，每年有11.7万名印度儿童死于腹泻。
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.
这也许可以解释一种异常现象：印度穆斯林的婴儿死亡率比印度教徒要低，尽管穆斯林更为贫穷。一个原因可能是穆斯林村民更可能使用屋外厕所。
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.
这是一个生死攸关的问题。政府投资坦克和战斗机来保卫自己的人民，但他们人民的更大威胁来自于自己的粪便。
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.
尽管如此，很少有人认识到这种风险。在世界范围内，能够使用手机的人比能有机会上厕所的还要多。这是因为电话被视为拥有更大的重要性。在奥斯汀和我参观的村庄，村民通常都有手机，但很少有屋外厕所。使用它们的人则更少：援助组织建造厕所很容易，但让人们去使用却很难。
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).
我们遇到了一个名叫莎莉罕·巴诺(Sahliha Bano)的女人，她有一个 11 个月大名叫莫妮(Munni)的女儿，严重营养不良。这个家庭没有厕所（村里很少家庭有）。
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.
巴诺本人体现了与营养不良有关的其他因素。她是文盲，约 14 岁时结婚，而莫妮是她的第六个孩子。巴诺拒绝节育，因为她认为这违背神祗的意愿。
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.
这些都是复杂的问题，但如果阿富汗和孟加拉国能取得巨大的进步（以及一些印度的邦，如喀拉拉邦），那么印度这个国家也可以。印度前总理曼莫汉·辛格称儿童营养不良为“一个国家的耻辱”，但该国还是没有解决这个问题的政治意愿。
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，在一项为赢得反对吃受精鸡蛋的宗教团体支持的政治举措中，中央邦最近拒绝了在儿童哺育计划中提供鸡蛋的构想。其结果将是更多的孩子加入到数以亿计余生都受到毫无必要的负面影响的人群行列中——一个伟大的民族正在削弱自身。
