The face of hunger is female

Our latest report shows how women are bearing the brunt of the burden of feeding their families, frequently skipping meals or eating last just so husbands and children can eat. The psychological stress of stretching meager budgets also falls on the women, who have traditionally been in charge of family budgets.

This report says that many poor families now resort to eating rice with salt, soy sauce or coffee, or what has been called surrogate ulam, because they can no longer afford to buy vegetables, fish or meat to eat with their rice. Instant noodles diluted with plenty of water are also now considered a full meal by many poor families. The poor, therefore, subsist on a diet of carbohydrates and salt. The result is chronic malnutrition.

But because their diets are short on nutrients but packed with calories, poor people may not look thin and gaunt, some may even be plump. But that is no indication of good health. According to nutritionists, overweight people are at higher risk of acquiring illnesses related to high cholesterol levels such as hypertension. A diet with too much salt can then affect vital organs such as the heart and kidneys.

About 40 percent of all Filipinos — 5.14 million families or over 31.2 million people — live on P32 or less a day. The Food and Nutrition Research Institute (FNRI) has prepared a menu of what it calls the “national food threshold” that costs about P22 a day per person. This includes a cup of rice, a slice of fruit, a third to half a cup of green, leafy vegetables, and a glass of whole milk. The FNRI also recommends that mothers serve their children fish, poultry or meat three times a week. For many poor families, however, even these basics are difficult to meet. Some, as the report shows, now eat only twice daily. Others have resorted to giving up some of their children to the care of relatives.

THE LAST time Lina Macaurog visited her youngest child Fatima, the four-year-old was running a fever and had cried violently when her mother was preparing to go. “I had a hard time leaving,” recalls Lina. But she had to go home to Culiat in Quezon City, where she works and lives with her two older daughters.

Two years ago, Lina’s husband and Fatima went to live with relatives in Pasig because their family of five was already barely eating. The husband had lost his job, and Lina’s income could not feed them all. Today she is still the family’s sole breadwinner — and she remains hard-pressed stretching her average income of less than P100 a day selling trinkets at the talipapa to feed herself and her two other daughters.

Most days, Lina and her two children eat just rice and instant noodles. On bad days, it is rice with soy sauce. Yet whatever food she manages to put on the table, Lina makes sure her children have their fill first. “Ako kahit kape na lang (I can make do with just coffee),” she says.

In many parts of the world, this country included, women, especially mothers, are always the last to eat when the family faces starvation or food shortage. This was true in the late 1990s, when the Philippines reeled from the effects of the East Asian economic crisis. In a report published in 1998, the PCIJ chronicled the “female famine.”

Today, despite poverty alleviation measures that have been in place for the last two decades, millions more families have slipped under the poverty line, and even more mothers are going hungry as their husbands and children make do with less and less food on the table.

That women bear the brunt of poverty is hardly a new observation, just as hunger and poverty are themselves old issues in this country. But indications are that the situation has gone from bad to worse, with far too many families now subsiding on rice and so-called “surrogate ulam” such as salt, bagoong or soy sauce — and the mothers surviving on even less than that.

Mothers also bear the psychological stress of finding ways to stretch meager budgets and of scrounging around for food when husbands don’t have jobs. Filipino women have traditionally been the keepers of the family purse and it is they who have to devise coping mechanisms to deal with crises. Today those coping mechanisms include eating less or not eating at all and sending off children to live with relatives.

Observes Lina, who looks older than her 34 years: “‘Pag wala nang makain ang mga anak ang babae ang unang natuturete ang utak sa pag-iisip kung saan kukuha ng pagkain. Ang lalaki puwedeng magyosi lang ‘yan sa labas (When the children no longer have anything to eat, the mother is the first one to go crazy thinking where to find food. The man just smokes outside).”

Lina remembers that five years ago, her family could still afford two pieces of pan de sal for each of them each day. “There was also leftover rice to fry for breakfast,” she recalls. “Nowadays, even the tutong (rice burnt black) is eaten.” There are no longer any leftovers, she says. Thus, far too frequently, she has gone without eating just so her children and her husband could have a few more bites.

Ill health among women is already evident in studies done by the Food and Nutrition Institute (FNRI). Anemia, for example, continues to impair 43.9 percent of pregnant women and 42.2 percent of lactating women. Severe anemia among pregnant women is the leading cause of death during childbirth; low iron in lactating women, in turn, manifests in similarly ill health in the child.

Lina’s predicament and that of millions of other mothers can be traced to worsening poverty. In Southeast Asia, the Philippines has one of the highest poverty incidence rates, with a large segment of its population living below $1 a day: 15.5 percent, which is lower than in Laos (39 percent) and in Cambodia (34.1 percent) but higher than 13.1 percent in Vietnam and 7.5 percent in Indonesia.

The Philippine government defines the poor as those who fall below the per capita poverty threshold of P32 a day. That is 40 percent of the population, about the same figure 20 years ago. In absolute numbers, however, there is a significant increase, given the leaps and bounds in population growth: In 1985 there were 4.36 million families who were poor; by 2000 the estimate was 5.14 million families or over 31.2 million people.

A recent World Bank report says the Philippines is reducing malnutrition much slower than most of its Asian neighbors. The Bank defines the malnutrition rate as the prevalence of underweight children under five years of age. It says the country is reducing malnutrition by 0.6 percent annually, lower than the figures posted by Cambodia (1.1 percent), Laos (0.9 percent), and even Burma (0.8 percent), which is an international pariah outside of Southeast Asia.

The latest National Nutrition Survey that will be released Dec. 15 also says that despite a decline in the prevalence of undernutrition between 1998 and 2003, malnutrition persists.

Malnutrition occurs when a person’s diet is lacking or in excess of one or more of the basic nutrients that include protein, carbohydrates, fats, vitamins and minerals. In a poor country such as the Philippines, the problem is largely of undernutrition, although obesity is being observed in certain age groups.

Malnutrition reduces the working capacity of adolescents and adults and makes them vulnerable to chronic illnesses such as hypertension and tuberculosis. But malnutrition affects young children the harshest, retarding their growth. Children who suffer from growth retardation are in turn more prone to infectious diseases such as diarrhea and pneumonia.

Experts say the plight of these children is largely invisible. According to the United Nations’ 2002 World Health Report, more than seven of every 10 children who die from causes related to malnutrition were only mildly or moderately malnourished, showing no outward sign of their vulnerability such as reed-thin limbs and bloated bellies. For the children who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Medical anthropologist Michael Tan has described these malnourished children “who are slowly being wasted away by hunger.”

Aside from rice and instant noodles, the new staples in the poor Filipino family’s table are the surrogate ulam that are often salty: soy sauce and bagoong, as well as plain salt.

Yet in the latest National Nutrition Survey, the FNRI says that there has been “general improvement” in the Filipinos’ nutrition and food intake in the last decade, and showed an increased intake of most of the basic food groups except fruits, higher contribution of animal foods to total food intake and protein intake, and increased intake of energy and most of the nutrients except iron and vitamin C.

Dr. Ma. Regina Pedro of the FNRI explains the seeming disparity between these data and what poor families are actually eating by saying, “What the survey is looking at is the mean intake. One income class is probably eating more. Class E are probably eating less, but this (survey) is mean.” She says they would next look at the relationship between incomes and food intakes, although she adds that surveys done in 1987 and 1993 showed consistently that the lower income eats less than the higher income

In a 2001 study, marketing guru Ned Roberto, who first coined the term “surrogate ulam,” found that in Metro Manila, over a third of Class E and over a tenth of Class D had begun resorting to eating various “new viands,” among which he included coffee, pork oil, brown sugar, and Pepsi. In Cebu the proportion was more than 66 percent of Class E and over a third of Class D, and in Davao, almost 75 percent of Class E and nearly a fourth of Class D. But those proportions may have since increased, considering that initial results of the latest Family Income and Expenditures Survey (FIES) show average household incomes in real terms as having fallen by 10 percent from 2000 to 2003.

With their wallets depleted, many families have turned to carbohydrate-heavy diets to keep their stomachs from churning. Short on nutrients but packed with calories, these have also helped them from looking thin and gaunt. Indeed, despite her self-deprivation, Lina is rather plump, as are her children. But that is no indication of good health. According to nutritionists, overweight people are at higher risk of acquiring illnesses related to high cholesterol levels such as hypertension.

FNRI’s Daily Food Guide for Children

4-6 years 7-9 years
Vegetables Green, leafy and yellow 1/3 cup, cooked 1/3 cup, cooked
Others 1/4 cup, cooked 1/2 cup, cooked
Fruits Vitamin C-rich 1/2-1 medium size or 1 slice of a big fruit 1 medium size or 1 slice of a big fruit
Others 1/2-1 medium size or 1 slice of a big fruit 1 medium size or 1 slice of a big fruit
Fats and Oils 6 teaspoons 6 teaspoons
Sugars 5 teaspoons 5 teaspoons
Water and Beverages 5-7 glasses 6-8 glasses
Rice and Alternatives Rice and Others 3-4 1/2 cups, cooked 4-5 cups, cooked
1 serving = 1 cup rice, cooked, or 4 pcs pandesal (about 17 g each), or 4 slices loaf bread (17 g each), or 1 cup macaroni or spaghetti, cooked or 1 pack instant noodles, or 1 small size root crop (180 g)
Meat and Alternatives Fish/Meat/Poultry/Dried Beans/Nuts 1 1/3 servings 2 1/3 servings
1 serving of fish = 2 pcs (55-60 g each), about 16 cm long fish
1 serving of meat/poultry = 30 g lean meat, cooked or 1 1/2 cups cooked dried beans, preferably take at least 3 times a week
Egg 1/2 piece 1/2 piece
Whole Milk 1 glass 1 glass
1 glass = 240 ml (1 glass whole milk) is equivalent to 4 Tbsp powdered whole milk or 1/2 cup evaporated milk diluted to 1 glass water

Experts from the FNRI meanwhile worry over the popularity of salty surrogate ulam and sodium-laden instant noodles. They say that although the body excretes salt through normal processes such as sweating, there is still a chance that it will retain more salt than it needs, which can then affect vital organs such as the heart and kidneys.

“The guideline is to eat a variety of foods,” says Pedro. Except for breastmilk, no single food can provide all the nutrients a person needs. Pedro thinks that “if money is spent wisely,” even families with low income can fix their budgets in a way that proper food remains a priority.

The FNRI has prepared a menu for children that it says would fit a budget of what it calls the “national food threshold,” which Pedro says is the “least cost to meet your nutritional requirements.” At present, this threshold is estimated at P8,037 per year or P22 per day for each person. The food guide includes about four cups of rice or its alternatives such as bread and macaroni, a slice of fruit, a third to half a cup of green, leafy vegetables, and a glass of whole milk. At least three times a week, the FNRI says mothers should serve children meat or poultry (30 grams) or other protein-rich sources such as fish (about 55 grams) and cooked dried beans (1.5 cups).

Families like those of 38-year-old Divina de la Cruz in Pandacan, however, are already having difficulty coming up with P100 for the family’s entire expenses each day. If she were to feed her five children according to the FNRI menu, Divina would have to have at least P110 for her daily food budget alone, and that would be just for the kids. De la Cruz already counts herself lucky if husband Carlos makes P150 hawking shampoo on the streets. For the de la Cruzes and other poor families, basic necessities such as adequate food have themselves become luxuries, their choices reduced to whether to use three cups of water to cook the instant noodles or six cups to feed more.

As it is, the de la Cruzes can afford to eat only twice a day now, although this excludes their shared breakfast of a peso’s worth of coffee. The situation has driven one of the sons, 12-year-old Cesar, to scavenge for enough junk he can sell for about P10, which he then uses to buy instant pancit canton for his siblings and parents.

If the Manila social welfare office had its way, Cesar would not be working. The social workers had already tried sending the boy to Boys’ Town in Marikina, but Cesar ran away and went back home. Divina says she cannot keep him off the streets. “And that’s because I have nothing to give them,” she says.

The Macaurogs are not faring any better. Lina’s two daughters who are still with her — Jamella, 16, and Janina, 13 — say that in the past, they would wake up at six a.m. to help with the household chores. Now they deliberately sleep in late, getting up just in time for an early lunch, the better to save on meal expenses. And since they have no money for food to keep them going while they are in school, which begins at 12 noon and ends at seven in the evening, they drink a lot of water. They have to see to it that it is not cold, though, since they both have ulcer.

Yet even if they had a little bit more money, families like those of the Macaurogs and de la Cruzes may still not be able to follow the FNRI guidelines. After all, the food being sold in nearby sari-sari stores is often canned or instant and short on nutrients. If families want fresh produce, they would have to fork over more pesos for a ride to the markets, which are usually some distance away from impoverished communities.

Cooking from scratch is also often not an option, since low-income mothers either keep long hours at work or are run ragged caring for their children, doing chores, and looking for someone to loan them some money to buy the food itself.

Acknowledging the popularity of quick-cooking or prepared food especially among the poor, concerned government nutritionists have also been wracking their brains to develop nutritious and fortified instant food. Some of the results of their work have already been shared with small manufacturers who are now producing goods like iodine-rich drinking water, rice crispy bars, and canton noodles with squash.

The government has a three-pronged strategy of supplementation, nutrition education, and food fortification to curb the incidence of micronutrient malnutrition, particularly deficiencies in vitamin A, iron and iodine. The health department says food fortification is the most cost-effective and sustainable strategy to address micronutrient malnutrition. This is why the government has the “Sangkap Pinoy Seal” program, which grants a seal of certification to processed-food manufacturers who fortify their products with nutrients.

There have also been laws such as one mandating the fortification of all salt with iodine, and another stipulating the fortification of rice from the National Food Authority with iron, sugar and edible oil with vitamin A, and wheat flour with vitamin A and iron.

But it has come to a point where families can no longer even buy these fortified food. Some feeding stations across Metro Manila, for example, have reported a rise in the number of daily “clients.” Meant only as a temporary means of staving off hunger, the plain rice porridge offered by these stations have become the breakfast, lunch, and dinner of many impoverished folk who come day after day. Just recently, newspapers and television also ran stories about people who have resorted to eating food scrounged from garbage heaps.

As Divina de la Cruz says, “Kanya-kanyang diskarte na lang para makakain. At kapag walang makain matulog na lang. (To each his own way of finding ways to get fed. But if there’s really no food, well you can just go straight to sleep.)” The asthmatic mother has one more sacrifice to make: in just a few months, Desiree, the youngest child, will go and live with her grandmother in San Jose, Nueva Ecija.

De la Cruz sounds calm talking about what she believes has to be done, even if it means sending her seven-year-old away. She has been counseled that it is for the best, especially for her, “para naman raw makaginhawa ako dito nang kaunti (so that my troubles here will be eased a bit).” But then Desiree is still with her, and her resolve may not be as strong once her little girl goes to the province.

In Culiat, Lina’s cheeks are streaked with tears as she recounts her last visit to her youngest daughter. “I want to take her home so we can all be together again,” she says. But she knows that may not happen anytime soon. So long as she and her husband are unable to earn enough to feed their entire family, they will have to live apart.