The widening nutrition gap

Difference in the nutritional status of Kerala’s general rural populace and that of Attappady could be as high as 50 per cent

By M Suchitra
Published: Saturday 13 July 2013

Kerala’s Attappady tribal block definitely suffers from under-nutrition but it it’s not as acute as in the tribal areas in states like Odisha, Madhya Pradesh or Andhra Pradesh. 

“But the gap in nutritional level between other rural areas in Kerala and Attappady is high compared to the rural-tribal nutritional gap in other states,” says A Laxmiah, public health nutrition specialist with Hyderabad-based National Institute of Nutrition, who led an experts’ team that conducted a nutrition survey in Attappady’s adivasi settlements. “If this difference is 25 per cent in Madhya Pradesh or Odisha, it could be 45-50 per cent in Kerala,” he says.

This is a clear indication that Kerala has failed to care for its marginalised communities while marking achievements in the health sector. The state has already achieved the UN Millennium Development Goals (MDG) for maternal mortality rate (MMR), infant mortality rate (IMR) and under-five mortality rate (U5MR) while many other states, especially north Indian states, are far behind the targets to be achieved by 2015.

As per the statistics with the sample registration system (SRS) of the Office of Registrar General of India 2011, MMR (number of women dying of delivery-related complications per 100, 000 live births, is 212 for India. But for Kerala it is 87. Similarly, IMR (number of deaths of infants in the first year per 1,000 live births) is 50 for India; Kerala has achieved an index of 12. U5MR (number of children (0-4 years) who die before reaching their fifth birthday per 1,000 live births) is also relatively low for Kerala. The state leads in all these three indices. Peri-natal mortality in Kerala, which includes stillbirths and very early infant deaths (in the first week of life), as happened in Attappady, is 11 deaths per 1,000 pregnancies that last seven months or more.

“It has always been highlighted that Kerala has achieved the distribution of economic services based on equality and social justice through its internationally-acclaimed development and health model. But that’s not true,” points out P B Ajaya Kumar, executive director of RIGHTS, a non-government organisation working among the marginalised communities in Kerala. “Attappady is just the tip of the iceberg,” he adds.

Adivasis constitute just 1.4 per cent of the state’s 33 million people. The Planning Commission of India, in its Kerala Development Report 2005 has noted that “… rural poverty among adivasis in Kerala persists and comes to more than two-and-half times that of the rural population of Kerala in general. Adivasis constitute only around one per cent of the state’s population, nearly one-fourth of them still live below the official poverty line; the actual incidence of poverty among them could be even higher, this high incidence of poverty among adivasis points to the various dimensions of social inequalities prevalent in the state ….”

“The condition of dalits and fisherfolk is dismal, too,” says Ajaya Kumar. Dalits constitute 10 per cent of the population and fisherfolk number 189,300. He points out that just like the adivasis, they are living in congested colonies and lack of safe drinking water and sanitation. Prevalence of malnutrition and water borne diseases are high among them, he says. But, as he points out, exact figures for MMR and IMR are not available in the  case of the marginalised.

Kerala otherwise leads in human development Millennium
  Development Goals
(2015) (MDGs)
Kerala India
MMR* 109 81 212
IMR* 28 12 50
U5MR* 42 14 64
*MMR: maternal mortality rate (number of women dying of delivery-related complications per 100,000 live births)
*IMR: infant mortality rate (number of deaths of infants in the first year per 1,000 live births)
*U5MR: Under 5 mortality rate (number of children (0-4 years) who die before reaching their fifth birthday per 1,000 live births)

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