Dalits and nutrition: Where is the catch up?

The performance of nutrition indicators amongst Dalits is improving, it is nowhere near the catch-up pace

Does a new government and a strong Prime Minister claiming to hail from the backward caste augur Achche Din for Dalits too? We hope so! But political commitment—or lack of it—has multiple manifestations. In a deeply stratified society like India with entrenched elitism, people from the Scheduled Caste (referred to as Dalits in this piece) have been subject to inter-generational violence, discrimination and reprehensible practices like untouchability. This has meant that Dalits face discrimination in labour markets in hiring, disbursement of wages, choice of employment, terms of employment, and the conditions of work. This problem remains a serious one, even at the very top of the human capital hierarchy, belying the argument that educational development of Dalits would help them in overcoming labour market barriers. Dalits also experience discrimination in ownership of productive assets. They still live in segregated residential areas and do not freely participate in community life in their neighbourhoods.

Posed with this challenge, India’s constitutional authors, had to not only build affirmative action to close the glaring gap between the caste Hindus and Dalits, but also put stringent safeguards to prevent and penalise the practise and perpetuation of structural violence, Dalits had been subjected to. The Constitution of India contains multiple provisions for the protection and advancement of its Dalit and other excluded/discriminated citizens. These, framed under the rubric of affirmative action aim at economic, health, social, educational development of Dalits. Twinned with Acts, Programmes and Policies, there is an attempt to right the wrongs which have been inflicted via multiple marginalisations.

After sixty-five years of this constitutional commitment and periodic and progressive advancements in policies and provisions, it is fair to expect gaps to be bridged. 

In a study supported by Global Alliance for Improved Nutrition, we (the author and her collaborator, Dr Ranvir Singh), find that the catch up is still some way off. Why nutrition? One, because it is a systems’ indicator, a composite tip-of-the-iceberg indicator for many things working well: healthcare, food security, education, water sanitation and social protection, as Lancet pointed out in its special nutrition issue in June 2013. Also because what was the second fastest growing economy not-so-long ago (i.e. India), has been stuck with sea-bed level under-nutrition figures at 46 percent—almost double the burden of Sub Saharan Africa at 28%. 

Using a combination of National Family Health Survey 2 and National Family Health Survey 3 unit level re-analysis, Census, Central Bureau of Health Investigation and National Sample Survey data-sets the nutritional changes in Dalit children have been traced and the challenges to bridging the gap investigated. Additional affirmative actions via constitutional provisions, policies, programmes and judicial injunctions have been mapped to unveil the challenges. 

In a four part series the key findings of the study, the challenges and the way forward will be discussed. An attempt will be made to shine a light on the inclusive programming framework needed to short-circuit discrimination.

An exercise in National Family Health Survey 3, 2005-6, (NFHS 3) re-analysis suggests that 53.6 per cent of Dalit children are malnourished (moderate and severe acute malnutrition) compared to 39.2 per cent of children from the general category.  The all India average is 48.4 per cent. While the decrease in the severe acute malnourished is at 3 per cent, the moderately malnourished amongst the Dalit children has in fact increased by 3.4 per cent negating the overall improvement since NFHS 2 i.e. 1998-99. Per NFHS 2 while the total malnourished children amongst Dalits was at 53.5% it has worsened marginally to 53.6% by NFHS 3.

Forty-eight percent Dalit children are stunted compared to the average of 35.6 per cent for general category children and 43 per cent for all India average. The 13 per cent additional stunting prevalence amongst Dalit children and similar figures amongst Adivasi children worsens the all India average and screams for specific action! 

Only 13.89 per cent Dalit households have piped water supply as compared to 27.51 per cent  amongst the general category. There was a limitation in NFHS 3 that it did not provide data for Handpump into Residence/Plot/Yard and it seems the survey merged this category  with Public tap/Handpump. Hence the performance/trend vis-à-vis NFHS 2 is difficult to assess. In this case it would be more significant to say that 86 per cent of Dalit households were not getting piped water in their house per NFHS 3. This is a major concern considering most habitat level discrimination and practices of purity and pollution is played out via water (access, inaccess and restricted access to same). As a counter, increasingly confident and affirmative Dalit youths are also expressing their dignity via water access, reversing practices of purity and pollution.

One fifth of Dalit mothers of underweight children can decide on their own about how to spend money, which is 7 per cent less than the general category mothers with children who were underweight. Between NFHS 2 and NFHS 3, autonomy in terms of decision making for spending money and seeking health care has shifted heavily from solely male partner’s domain to “jointly with partner” which is good development. Despite more economic engagement of Dalit women than general category women (who get confined inside houses with a notion of pride and elitism), almost 60 per cent  of women were not allowed to have money for their own use, which means Brahminical patriarchy was also rearing its head amongst Dalit households.

It is clearly evident that at the time of birth majority of the children’s size were average or larger than average.  Socio-political adversities make the underweight/wasted/stunted during their initial years of life. State’s role needs to be questioned here, both, in service provisioning and political will. The World Health Organisation’s global growth monitoring anthropometric standards were set up via an elaborate six country exercise where India was also a country case study. This means Indian children’s anthropometric failures are much to do with public policy and social challenges than our genetic coding.

During NFHS 2 it became evident that across all the sections of society the family planning worker were not visiting the households. And the visits were not significantly different between households with normal children vis-à-vis households with under-weight children. However, this question was changed in NHFS 3 to visits by Auxiliary Nurse Midwife/Lady Health Volunteer and Anganwadi worker, so they cannot be compared with NFHS 2. But it is important to note that for underweight children, the Anganwadi workers are paying less number of visits to all categories of households including the Scheduled Caste households. Home visits figures are extremely low and that is concerning. Visits to the pregnant or child-bearing household (or lack of the same), is also where discrimination by front-line staff, can and does easily pan itself.

Common sense says that prevalence of under-weight children in poor households is higher. However the conflation of poverty (low standard of living) and under-weight children is considerably higher amongst Dalits at 49.1% which goes much higher to 56.8 per cent for Scheduled Tribes. For the general category it is much lesser at 25.8 per cent and the all India average is 37.5 per cent. Again, a statistic made considerably worse at all India level because of the adverse performance amongst the Dalits and Tribal poor households and under-nutrition prevalence, which clearly points to the necessity of state intervention.

In summary, a rigorous re-analysis unveils that while the performance of nutrition indicators amongst Dalits is improving, it is nowhere near the catch-up pace. In fact it is lower than the general category performance. And the under-performance of nutrition indicators amongst the marginalised population categories is a double whammy, on one hand it is pulling down the all India averages and on the other hand, till catch-up happens, the anthropometric inequalities and its consequent unfortunate impact on learning, earning and inequality will endure!

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