Despite a fast-growing economy and the largest anti-malnutrition programme, India has the world’s worst level of child malnutrition. The government plans to pump in Rs 1,23,580 crore over the next five years to tackle the problem. Jyotsna Singh travels to highly malnourished districts in Madhya Pradesh and Rajasthan, while Kundan Pandey quizzes experts across the globe to unravel the enigma
Two-and-a-half-year-old Rabina weighs 6.5 kg. A healthy child of her age should weigh at least 8 kg. But Rabina could not escape the curse of being born in Shivpuri district of Madhya Pradesh—ill-famed as one of the highly malnourished districts of the country for the past 30 years.
Rabina was not always so. At birth, she was healthy and weighed just right—a little more than 2.5 kg. But something went wrong and she did not grow at a healthy pace. At nine months, the anganwadi worker of her tribal-dominated village Udvaya declared her severely acute malnourished, a condition that could stunt her physical growth and cognitive development forever. She referred Rabina to the Nutrition Rehabilitation Centre (NRC), some 20 km away. Doctors there put her through intense nutrition supplement for a fortnight and managed to bring her out of the malnourished state. But back home, in the absence of a regular healthy diet, her condition worsened again. She is now categorised as chronically malnourished in the anganwadi worker’s register.
Shivpuri has 11,392 severely acute malnourished children, show the district administration’s records of 2012. But very few—2,629 in 2012—get admitted to NRCs. Of those admitted, less than a quarter are nursed back to health. Shivpuri’s Sahariya tribals, once known for their lion-like physical strength and often made to fight wild animals in the king’s courtyard for entertainment, are now fighting a losing battle against malnutrition. “I do not remember any child from my generation or previous generations being so thin or unable to perform daily chores due to lack of energy,” says Ram Avatar, resident of Udvaya, as he wonders what ails the children of his community.
|MEASUREMENT EFFORTS WORLDWIDE
1970s: Countries do not have measures for malnutrition. Towards the late 1970s, the National Centre for Health Statistics (NCHS) of the US develops a standard for monitoring child growth. WHO adopts this and recommends it to other countries for measuring malnutrition among children
1980s: The NCHS measure runs into controversy. Experts complain that breastfed infants grow taller than the standard set by NCHS
1990s: WHO’s Department of Nutrition sets up a working group to assess the growth pattern of breastfed infants. Its report published in 1994 highlights a number of problems with the NCHS standard. WHO begins work for a new measure. Experts propose that the standard should suggest “how children should grow” instead of “how children are growing”
2000s: WHO begins survey in six countries, including developed, developing and under-developing economies. In 2006 it publishes its new growth reference. All countries adopt the model the same year
More than 100 districts in the country share the fate of Shivpuri, making India home to the largest number of malnourished children. In the absence of latest government figures, estimates by the National Family Health Survey (NFHS) in 2006 show that 48 per cent, or 61 million, under-five children in the country are stunted (they have low height for their age); 43 per cent, or 53 million, are underweight; and nearly 20 per cent, or 25 million, are wasted (low weight for height).
Of the 25 million wasted children, eight million are severely wasted or suffer from severe acute malnutrition like Rabina. India is home to one-third such children. Sixty per cent of them live in six states: Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Maharashtra and Tamil Nadu.
Such high prevalence of child malnutrition in India defies logic. After all, the country’s economy has doubled since 1991, when the government started counting the malnourished children. The world’s largest programme to tackle child malnutrition, the Integrated Child Development Services (ICDS), has been in force in the country since 1975, much before any country, other than the US, introduced measures to tackle the problem.
All the states with a high burden of malnutrition have the public distribution system in place to ensure that the poor, even in inaccessible areas, get food grains at subsidised rates. Yet, reports regularly appear both within and outside the country, highlighting child deaths due to malnutrition.
According to the Registrar General of India, in 2010, under-five mortality in India was 59 per 1,000 live births, one of the highest in the world. In 2012, British non-profit Save the Children reported that 1.83 million Indian children die every year before they turn five and pinned malnutrition as the key reason for the deaths.
“The child may eventually die of a disease, but that disease was lethal because the child was unable to fight back due to malnutrition,” Victor Aguayo, chief of Child Nutrition and Development at Unicef-India, told the media in New Delhi recently.
All surveys indicate that India is slipping into a vicious cycle of malnutrition. Scientists say the initial 1,000 days of an individual’s lifespan, from the day of conception till he or she turns two, is crucial for physical and cognitive development. But more than half the women of childbearing age are anaemic and 33 per cent are undernourished, according to NFHS 2006. A malnourished mother is more likely to give birth to malnourished children.
The HUNGaMA (Hunger and Malnutrition) Survey across 112 rural districts in 2011 by non-profit Naandi Foundation shows the impact of the world’s oldest anti-malnutrition programme. Eighty per cent of the mothers have not heard the word malnutrition in their local language, says the report.
It seems India is all set to miss one of its key Millennium Development Goals: halving malnutrition by 2015. This is the reason past few months have witnessed a flurry of high-profile public statements and programme decisions to fight malnutrition. In September, Parliament passed the National Food Security Act, which aims at fighting malnutrition by tackling food insecurity. The following month, the Centre declared that NFHS will resume after a gap of seven years. It will begin in February 2014. In 2012, the 12th Five-Year Plan restructured the ICDS scheme immediately after Prime Minister Manmohan Singh termed malnutrition as a “national shame”. The scheme will provide supplementary nutrition, pre-school education, health and immunisation to children under the age of six in 200 high-burden districts by the end of the year by setting up more anganwadi centres. So far, ICDS was catering to the needs of children in the age group of three to six, leaving out the crucial under-three children. By the next year, when the scheme will be expanded to cover the entire country, its scope can be compared with the polio eradication campaign. The Centre has allocated a whopping Rs 1,23,580 crore for the scheme. This is almost thrice the budget allocated to ICDS in the previous Plan period. The government hopes this will help bring down malnutrition among under-three children by 10 per cent and among girls and women by 20 per cent.
But are these measures sufficient to tackle the menace? In popular perception, poverty is synonymous with malnutrition. Reports show a major chunk of malnourished children belong to poor families and traditionally poor states. But rates of malnutrition are also significant among middle- and high-income families.
As the stage is set for onslaught of malnutrition, it is time to critically look at the not-so-obvious reasons for its high prevalence in the country.