Counting Calories

On any given day of the week, Mong Pheara eats rice. Rice porridge and small dried fish are her only other staple foods. Occasionally, she manages to eat a mango or a papaya. The same is true of Ms. Pheara’s entire household, which includes 10 members of her nuclear and extended family.

In three months, when Ms. Pheara gives birth to her second child, the number of people living in her house, sharing a latrine and a bar of soap, will reach 11.

Because of the lack of sufficient living space, durable housing, access to water and sanitation, and security of land tenure that would prevent forced evictions, their settlement in Russei Keo district’s Kilometr 6 commune falls into the classification of urban poor.

Chidren have lunch at their home in Russei Keo district’s Spean Khpos village. (Siv Channa)
Chidren have lunch at their home in Russei Keo district’s Spean Khpos village. (Siv Channa)

For Ms. Pheara’s family, as well as for an estimated 33,600 urban poor families—according to data from NGO Sahmakum Teang Tnaut—prospects for the future are bleak.

As a member of the nation’s poorest quintile, Ms. Pheara’s daughter Socheata, a vivacious curly-haired toddler, is three times more likely to die during childhood than a child born to a family in Cambodia’s wealthiest quintile.

“I used to breastfeed Socheata, but now she is about 20 months old, and she gets milk, rice and porridge. That’s what all of us eat. It might not be healthy, but it’s what we can afford,” Ms. Pheara said.

This week, the household was one of about 500 randomly selected to participate in a survey by Unicef and the Czech NGO People in Need (PIN) which aims to find out just how the Cambodian urban poor live.

“During the past two decades, Phnom Penh has experienced a rapid growth, with its population doubling from 1998-2008 mostly due to in-country migration of rural Cambodians seeking employment in the capital. This rapid and unplanned urbanization has created pockets of poverty within Phnom Penh,” Unicef said.

The fast growth of the city has come with only small improvements in infrastructure. Shan Huang, health program manager at PIN, said that now health centers often serve several urban poor communities, when they used to serve one.

“Generally, there is a lack of information on these communities, especially in terms of health and nutrition, and there just isn’t enough information to base programs on,” Ms. Huang said.

“It’s about finding out to what extent issues exist, how does it impact the families and what can we do? The problem might be nutrition, but the solution might be an economic one,” she said.

Results of the survey will be evaluated in the next two months, but some problems have already been identified, such as the unexpectedly large number of people living in each household.

“We expected to have a child in about every third household, but we found a child in almost every household,” Ms. Huang said.

That was also the case for Ms. Pheara’s family, which was the last one to be surveyed on Monday. Besides the household survey, she also patiently answered questions about her daughter’s health and nutrition, as well as that of a niece and nephew who are living with her.

“It surprising how little food they have on some days, and I see that the very poor will always make sure that the children have enough to eat, that’s always their main concern,” said Chea Sreyneang, a supervisor for one of five teams.

First, the surveyors asked about Ms. Pheara about her daughter Socheata’s medical history, including questions on vaccinations, whether she has had episodes of diarrhea, how long she had been breastfed, and if she ate any fortified food or received additional vitamins.

Then, they zeroed in on which types of food Socheata had eaten the day before. The surveyors ticked “yes” for only two out of 17 food groups: Food made from grains, such as porridge and rice, and Vitamin A-rich fruits such as mangoes and papayas.
“I am busy with my job at the garment factory, so I can not cook healthy meals. The food I can afford to buy at the stall is always the same. No vegetables, but rice, porridge, and dried fish,” Ms. Pheara said.

The lack of nutrient intake as well as Socheata’s weight and body measures showed that she was likely to be stunted.

“Stunting is irreversible once you have reached the age of two. If you don’t have enough nutrients between minus-nine months and two you can’t go back, you are already stunted,” Ms. Huang said, adding that malnutrition was found in almost all children of the urban poor communities.

While being a small adult doesn’t cause particular hurdles, stunting can correlate with slower brain development.

“It affects your IQ, so they grow up to be stunted physically as well as mentally. If your mental capacity is limited because you didn’t have proper nutrition, that becomes critical as an adult and limits your capacities,” she said.

Often, Ms. Pheara told surveyors, she cuts back on her own food to make sure that her daughter has enough to eat. But that creates a Catch-22 now that she is pregnant.

Six months into her second pregnancy, she is not only decreasing her own nutritional intake, but that of her fetus as well, Ms. Huang said.

“It’s an intergenerational issue and it will take one or two generations to get over with, which is why this is so important, because we are talking about the future of Cambodia for many generations to come,” she said.

PIN and Unicef found that the majority of children were moderately malnourished, and often on the borderline of being severely malnourished, but Ms. Huang pointed out that there is a silver lining.

“If they have moderate malnutrition, there are still things that can be done, and that’s really encouraging to do a program because you can still really help them. There’s a lot of potential,” she said.

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