Nepal, July 5 -- Sarmila was 19. She already had three daughters and was four months pregnant with a fourth child.

She was thin, in ragged clothes and worn-out slippers, but with thick dark hair, comely in a way hard work slowly tries to erase. Her youngest child, 13 months old had been identified as underweight earlier that morning during the monthly mothers' group meeting at the health post.

When the nurse asked what the baby had been eating, she smiled softly. Rice and dal, she said. Sometimes nettle soup. Why hadn't she fed the child better? She said she was always tired. Her husband had been working in India for four months, and there was no one to help at home. She had eloped at 14.

When tea and millet bread were passed around in...