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Updated: December 10, 2009 01:01 IST

Child undernutrition in India is a human rights issue

Karin Hulshof
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A MATTER OF NATIONAL SHAME: According to India's Third National Family Health Survey of 2005-06, 70 per cent of children between six months and 59 months are anaemic. PHOTO: RITU RAJ KONWAR
A MATTER OF NATIONAL SHAME: According to India's Third National Family Health Survey of 2005-06, 70 per cent of children between six months and 59 months are anaemic. PHOTO: RITU RAJ KONWAR

Despite a booming economy, nutrition deprivation among India’s children remains widespread.

“All human beings are born free and equal in dignity and rights.” So begins the Universal Declaration of Human Rights established 60 years ago and celebrated today around the globe. This year’s theme is non-discrimination. When it comes to nutrition, all of India’s children are not equal. According to India’s third National Family Health Survey (NFHS-3) of 2005-06, 20 per cent of Indian children under five-years-old are wasted due to acute undernutrition and 48 per cent are stunted due to chronic undernutrition. Seventy per cent of children between six months and 59 months are anaemic. Despite a booming economy, nutrition deprivation among India’s children remains widespread.

In absolute numbers, an average 25 million children are wasted and 61 million are stunted. The state of child undernutrition in India is — first and foremost — a major threat to the survival, growth, and development and of great importance for India as a global player. Prime Minister Manmohan Singh has referred to undernutrition as ‘a matter of national shame.’

Children who are undernourished have substantially lower chances of survival than children who are well-nourished. Undernourished children are much more likely to suffer from serious infections and to die from common childhood illnesses such as diarrhoea, pneumonia, and measles. More than a third of all deaths in children aged five years or younger can be attributable to undernutrition. Children who survive undernutrition do not perform as well in school as their well-nourished peers and as adults they are less productive.

Good nutrition early in life is a key input for human capital formation, a fundamental factor for sustainable and equitable economic growth. Widespread undernutrition impedes socio-economic development and poverty reduction. With persistently high levels of child undernutrition, vital opportunities to save millions of lives are being lost, and many more children are not growing to their full potential.

There is a critical window of opportunity to intervene when mothers are pregnant and during children’s first two years of life. After that age, the window closes and the opportunity for the child is lost forever. We know what works — ten proven, high-impact interventions can dramatically reduce undernutrition in young children if delivered nationally:

- Timely initiation of breastfeeding within one hour of birth

- Exclusive breastfeeding during the first six months of life

- Timely introduction of complementary foods at six months

- Age-appropriate foods for children six months to two years

- Hygienic complementary feeding practices

- Immunisation and bi-annual Vitamin A supplementation with deworming

- Appropriate feeding for children during and after illness

- Therapeutic feeding for children with severe acute malnutrition

- Adequate nutrition and support for adolescent girls to prevent anemia

- Adequate nutrition and support for pregnant and breastfeeding mothers

These 10 essential interventions could halve the proportion of undernourished children over the next 10 years.

A number of emerging economies have encountered nutrition challenges similar to those currently facing India. For example, China reduced child undernutrition by more than half (from 25 per cent to 8 per cent) between 1990 and 2002; Brazil reduced child undernutrition by 60 per cent (from 18 per cent to 7 per cent) from 1975 to 1989; Thailand reduced child undernutrition by half (from 50 per cent to 25 per cent) in less than a decade (1982-1986); and Viet Nam reduced child undernutrition by 40 per cent (from 45 per cent to 27 per cent) between 1990 and 2006.

Four lessons can be learned from these countries’ experiences: 1) Leadership at the highest level to ensure that priority is given to child nutrition outcomes across sectors and states, with large investments in nutrition interventions and successful poverty alleviation strategies. 2) Targeted nutrition interventions to prevent mild and moderate undernutrition and treat severe undernutrition as part of a continuum of care for children, particularly among the most vulnerable children: the youngest, the poorest, and the socially-excluded; 3) Reliance on community-based primary health care to ensure high coverage through community-based frontline workers; 4) Strong supervision, monitoring, evaluation, and knowledge management to provide the evidence base for timely and effective policy, programme and budgetary action.

The universal delivery of this package of ten evidence-based, high impact essential nutrition interventions will lead to an unprecedented reduction in child undernutrition. India has the resources — financial and human — to address, once and for all, the challenge of child undernutrition. The prevention and treatment of child undernutrition in the first two years of life needs to be a national development priority.

India’s leadership is recognised globally and its economy is growing at an enviable rate. That strength and leadership can be channelled to ensure survival of India’s most precious asset — its children — to thrive and survive. The nutrition targets set forth by the government in its Eleventh Five-Year Plan are ambitious, more ambitious than the international commitments set forth in the Millennium Development Goals. In the government’s own words, “it is better to aim high, than to fail low.”

Now is the time to combine the existing technical knowledge with the political will to change the lives of millions to guarantee the human rights, dignity and rights of all of India’s children. Now is the time to combine the existing technical knowledge with the political will to change the lives of millions to guarantee the human rights and dignity of all of India’s children.

This is a ‘make or break’ time to emerge as global leader in the fight against undernutrition… 61 million children are waiting. — Courtesy: U.N. Information Centre for India and Bhutan.

(Dr. Karin Hulshof is UNICEF India Representative.)

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