Just under half of our children will grow up stunted because of malnutrition and hunger. How can we change this?
A year of scams and scandals is over. Can we expect 2011 to be different? If one had a wish list for 2011, topping mine would be a wish that the government make tackling child malnutrition in India one of its topmost priorities.
Everyone knows the glaring contrasts in India — between some of the richest men in the world and some of the poorest who also inhabit this country, between a high economic growth rate and increasing disparity and inequality, between unchecked consumption in our cities and the absence of basic survival needs of people in the villages and our forested areas.
What stands out as the worst statement about the state of India today is the fact that 46 per cent of our children are stunted because they simply do not get enough to eat. How can we accept this and at the same time boast about having moved up from the company of the poorest countries in the world into a middle-income country?
I began 2011 by looking again at the data on child malnutrition in India and it was like a cold shower. Sobering. Shocking.
India has more malnourished children than neighbouring Bangladesh which, until a decade back, was considered something of a basket case. Even African countries like the Congo, Lesotho, Tanzania and Rwanda are better placed than us.
Why be so concerned about this one issue? Because the very fact that almost one out of every two children in this country goes to bed on an empty stomach is shocking in itself. Malnutrition is the principal cause of child deaths. Half of all child deaths in India could be prevented if this one issue was tackled. Children die because malnutrition lowers a child's resistance to infection. As a result, they become vulnerable even when they have eminently treatable conditions like diarrhoea and respiratory infections.
What is worrying is not just the high percentage of children who are malnourished, but the fact that the rate is going down so slowly as to be virtually negligible. Between 1998-99 and 2005-06, the rate only came down by one per cent. At this rate, the challenge of cutting down on the prevalence of malnutrition in children by half by 2015, a part of the Millennium Development Goals, will be impossible.
So why is this happening in a country where there is an enviable economic growth rate? Development economist A.K. Shiva Kumar points out in a recent article that the belief that malnutrition automatically comes down if the per capita income improves is not necessarily true. He points out, for instance, that 28 out of 37 sub-Saharan African countries have a lower per capita income than India's and yet also have lower rates of malnutrition. Within India, Manipur has a per capita income of only Rs. 8,114 (1997-98), yet its child malnutrition rate is 28 per cent. By way of contrast, Gujarat has a per capita income of Rs. 16,251 and its child malnutrition rate is 45 per cent.
Dr. Shiva Kumar's contrasting data on two Indian states, Sikkim and Madhya Pradesh also brings out another important angle to malnutrition, that of gender.
Sikkim has 13 per cent children born with low birth weight; MP has 24 per cent. Sikkim has 11 per cent ever-married women with a BMI (Body Mass Index) of less that 18.5 (considered very low); MP has 38 per cent. The 0-6 years male female ratio in Sikkim is 986; in MP it is 929. The age of marriage for women in Sikkim is 22; in MP it is 19. Female literacy in Sikkim is 62 per cent; it is 50 per cent in MP. In Sikkim, 89 per cent of girls in the age group 6-17 years are in school; in MP it is 71 per cent.
In other words, women in Sikkim marry later, are more educated and are in better health. As a result, there are fewer children born with a low birth weight. The link between women's status — both in terms of access to education and health — and under-nutrition in children is obvious. Women who are themselves malnourished, anaemic (56 per cent of women in India suffer from some form of anaemia), and become pregnant when young, give birth to low birth weight babies who never catch up.
Interestingly, the National Family Health Survey – 3 (2005-06) that gave the latest data of anaemia in women also shows that while 56 per cent women were found anaemic, only 24 per cent men had the same problem. Clearly, there is a gender dimension even to anaemia. Also, 47 per cent of girls in the age group 15-19 years are anaemic. Furthermore, 59 per cent of all pregnant women in India are anaemic.
These might seem like a set of numbers. But translate that the next time you read about children dying in a village, or even in a slum in your city. Last month, people in Mumbai woke up to the rude reality that living in a fast-moving metropolitan city in India does not mean that poor children have better chances of survival. The story of 15-month-old Sahil Salim from the Shivaji Nagar slum in Govandi, who weighed just 9 kg and died from “fever and cold”, was a stark illustration of how hunger haunts the poor in city and village. Indeed, although the rate of malnutrition in children in urban areas is better than in rural areas, it is still unacceptable — 32 per cent or one in three children.
This is not the India we like to think about. Yet the numbers tell us that this is the India in which half of our women are anaemic, where just under half of our children have diminished chances of survival.
What do we do to change this? The government has to make this a priority and look again at programmes like the Integrated Child Development Scheme (ICDS) that was designed to deal with this issue.
But we need more than that. The media has run campaigns to save the tiger. That is a valiant campaign. I would suggest that India's children are also endangered. That they too need an active campaign by media, schools, colleges, politicians, corporates, anyone who cares, to see that we break this circle of poverty and hunger.
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