Growing up below the poverty line, street children’s health suffers the consequences

The way the Philippines as a country is faring in terms of maintaining children’s nutrition—particularly the children in more vulnerable economic situations—needs to be reviewed.

The last few months of the year are always the busiest. Traffic starts getting heavier as the holiday season nears, year-end reports start piling up at work, and everything somehow gets even more expensive. Amid the hustle and bustle that the latter half of the “Ber Months” bring, it is easy to get caught up in the here and now. Perhaps that’s why the National Children’s Month is celebrated every November—to remind the Filipino consciousness to look beyond the commotion of today and give attention to the ones that will herald our tomorrow. 

The theme of this year’s National Children’s Month is “Healthy, Nourished, Sheltered: Ensuring the Right to Life for All,” with its focus on healthcare and nutrition. This was chosen in light of the recent COVID-19 pandemic, as well as the current price inflations for basic goods such as food. For the Department of Interior and Local Government, the “importance of accessible and quality healthcare for children, despite any health and economic crises,” must remain a priority for our country. In light of this, the way the Philippines as a country is faring in terms of maintaining children’s nutrition—particularly the children in more vulnerable economic situations—needs to be reviewed.

Born at a disadvantage

Protecting the rights of children means protecting the rights of all children. While those from upper to middle income families are likely to grow up with all their nutritional and healthcare needs met, a reported 10.9% of Filipino families in 2023 live below the poverty threshold. This translates to 2.99 million families without enough income to meet their basic food and non-food needs. Furthermore, there is a significantly higher incidence of poverty in rural areas, with only 1.1% of families in the National Capital Region falling below the poverty threshold, but a whopping 24.2% families falling below the poverty threshold in Region IX. 

The developmental implications for a child coming from a family experiencing poverty can be devastating. Early childhood or the first six years of a child’s life in particular is believed to be the most crucial period in terms of physical, intellectual, and emotional development. In 2023, a staggering 7.8 million Filipinos between the ages of five and 24 were out-of-school youth, with more than half a million of them falling within the age five to nine demographic, according to the Philippine Statistics Authority.

These out-of-school-youth are more colloquially referred to as “street kids” or “batang kalye.” While not being able to get a formal education can limit their opportunities for intellectual and social development, the other realities of their lives living below the poverty threshold can have long-term health consequences that are even more alarming.

Wealth is health

The World Health Organization (WHO) and UNICEF evaluate child food poverty based on the diversity of their diet.  The minimum requirements require that children consume at least five of the eight defined food groups daily. If children are consuming any less than three of these food groups, they are experiencing severe child food poverty. The Philippines is among the 20 nations listed as having the most cases of severe child food poverty in the world.

According to UNICEF’s global databases in 2023, 18% of children living in the Philippines experience severe child food poverty. This number has risen in the last decade, since UNICEF’s records show only 12% of Filipino children experienced severe child food poverty in 2012. For children living in severe child food poverty, it is estimated that less than 10% can afford fruits and vegetables, and less than 5% are fed meat, poultry, or fish.

This lack of access stems from nutrient-rich foods becoming luxury products in the global market/economy.  “Nutritious foods cost much more per calorie than staple foods, especially in lower-income countries, and food inflation is pushing these foods further out of reach for parents, families, and their young children,” writes UNICEF in their 2023 report on Child Food Poverty.

This is evident in even the Philippine market, where the average price for a kilogram of rice in September 2024 was PHP 63.94 but the average price for a kilogram of pork that same month was more than five times that amount at PHP 333.74. Families living below the poverty line are more likely to reach for staple foods such as grains, roots, tubers, and plantains that they can purchase for less and in bulk than they are to spend on the other types of food groups that are more necessary for growing children.

To make matters worse, the fact that the 2022 National Demographic and Health Survey noted that while 71.8% of children between the ages of 12 and 23 months were fully vaccinated based on DOH guidelines, 11.2% of that demographic had received no vaccinations at all. This is reasonably alarming. The DOH-recommended basic vaccines protect against diseases such as polio, tetanus, pertussis, diphtheria, and measles, which can be especially dangerous for young children. Children coming from families experiencing poverty predictably made up the majority of the unvaccinated group. 

Making ends meet

The table below shows the eight main food groups listed by the WHO, as well as what products found in a Filipino palengke would fit under each category. The prices were taken from the PSA’s September 2024 Price Situationer for selected agricultural commodities. 

As mentioned earlier, a child has to consume food from at least five of these eight main food groups daily to reach the minimum requirements of the WHO dietary diversity score. Any fewer than that indicates that the child is experiencing child food poverty to some degree. For families living below the poverty threshold, the five most affordable food groups are eggs (PHP 9.00 per piece / PHP 108.00 per dozen), milk (PHP 51.31 per Liter), rice (PHP 63.94 per kilogram), ampalaya (PHP 88.88 per kilogram), and tomato (PHP 90.70 per kilogram). And there is of course breastmilk for infants, which is not something that needs to be bought. 

Assuming each member of the family eats one to 1.5 kilograms of food a day, the average five-person family would need to spend a minimum of PHP 402.73 a day just for base ingredients from five of the eight main food groups. This does not yet include other food-related costs such as cooking oil, cooking gas, water, salt, etc. and assumes that none of the meals have fresh food such as meat, poultry, or fish. Even with this terribly minimal and optimistic estimate, a 30-day month of adhering to the WHO’s minimum dietary diversity requirements would cost PHP 12,081.90 for just the base ingredients. Bearing in mind the average poverty threshold in the Philippines is PHP 13,873 per month, it’s no wonder that our country ranks so high on the child food poverty scale.

The real cost

Street children are often seen running around midday, making the city their playground, so it’s sometimes easy to forget that their reality is not as carefree as they make it appear. Their lack of access to the full spectrum of nutrient-rich food during their developing years has strong repercussions down the road for their health.

Stunting is the most prevalent form of malnutrition for Filipino children, based on the Expanded National Nutrition Survey in 2021. One in every five infants and young children up to 2 years old in the Philippines suffer from stunted growth, with the prevalence rising to 26.6% of children between the ages of three and five years old. Additionally, 12% of infants and young children up to 2 years are underweight, 7.2% are too thin for their height, and 3.6% are overweight.

The same report makes it a point to note that children from rural areas experience malnutrition at a higher rate than children from urban areas. The income status of the family can also greatly influence a child’s tendency toward malnutrition, with stunting observed among 42.2% of children up to 2 years old belonging to the surveyed families in poverty. Optimal nutrition during the first two years of a child’s life is particularly important because it “lowers morbidity and mortality [risks], reduces the risk of chronic disease, and fosters better development overall,” WHO states, so having nearly half of all street children in that age bracket suffer from stunted growth is decidedly a cause for concern.

Grains of hope

Despite how bleak the circumstances may seem at the moment, there are a few signs that times are changing for the better. For one, the country’s poverty rates have actually been going down. In the past two years, 11 out of the 18 regions in the Philippines recorded what the PSA describes to be “statistically significant decreases in poverty incidence among families.” Additionally, while inflation is still very much an issue and difficult to keep up with at present, the PSA notes that the average income per family is increasing at a faster rate than the average expenditures per family. With more families coming into economic stability, it is likely that less children will have to experience food poverty in the coming years. It is important to remember, however, that while poverty rates may go down, as long as poverty exists the problems relating to it will persist.

In line with this, the Philippine government has been making moves toward alleviating the threat of child food poverty and improving children’s health overall. The Department of Health (DOH) hosts free screening and immunization programs for newborns, although a 2021 publication from the Philippine Institute for Development Studies notes that this program has existed for almost 40 years and has never reached its target of providing full immunization to at least 95% of newborns. Additionally, the DOH has an Infant and Young Child Feeding (IYCF) program. While it is difficult to find information on how many people have benefitted from this program and whether or not its goals have been met, the IYCF program aims to aid mothers in providing nutritionally adequate complementary feeding to children until the age of six months. This is not nearly long enough to ensure a child’s nutritional health, but it’s a start. 

When a child ages out of the IYCF program, they are then eligible for the Department of Social Welfare and Development supplementary feeding program that provides “nutritious snacks and hot meals” to children between the ages of two and five. According to the Philippine News Agency, an estimated 1.9 Million children have benefitted from this feeding program in 2023 alone. For school-aged children, the Department of Education is trying to keep the support going by adding a School-Based Feeding Program to their proposal for the Philippine Development Plan in 2023.

Beyond government agencies, there are also many nongovernment organizations working toward ending child food poverty in the Philippines. Reach Out and Feed Philippines provides meal formulas and supplements specifically designed for malnourished children. ChildHope Philippines, on the other hand, launched a mobile soup kitchen during the height of the pandemic, with the goal of providing hot meals to street children. They also have a mobile health clinic, aptly named “KliniKalye,” to “give street children access to decent healthcare.” 

Signs of progress are few and far between, but they are present nonetheless. The more aware we are of the health crisis children in poverty face, the more resources get put into making that progress meaningful. The children of today are very literally our hope for tomorrow, and protecting their most basic right to health and nutrition is the least we can do.