Despite staggering economic growth, Bihar has one of the highest rates of child mortality in India.
Bihar has been in the news recently for recording an average growth rate of 11.3 per cent for the period between 2004 and 2009. Much has been written about the quality of governance and the improved state of roads. This is indeed commendable, and no mean achievement, for a State that had virtually become a “development outcast”. I was pleasantly surprised to note on a recent trip to Bihar the great improvement made in providing more schools and notably, a huge effort to tackle the complex issue of child labour.
The script for Bihar’s success story is incomplete, however. The State has the dubious distinction of having one of the highest rates of child mortality in India. Out of every 1,000 children born in Bihar, 85 will not live to see their fifth birthday (according to the third National Family Health Survey). The deaths of a third of these children are associated with malnutrition. In fact, the Citizen’s Alliance against Malnutrition states that over 58 per cent of children in Bihar are malnourished. And the State, despite spending crores of rupees on improving the state of the roads, has failed to utilise the funds allotted to it under the Integrated Child Development Services (ICDS) which is mandated with tackling under-nutrition among children under six years of age.
The anomaly between impressive economic growth and the appalling rates of child mortality and underweight children is not peculiar to Bihar. The country as a whole has recorded an impressive economic growth (real GDP per capita grew by 3.95 per cent per year between 1980 and 2005). Yet, the percentage of underweight children under 3 went down by just six per cent from 52 per cent in 1992-93 to 46 per cent in 2005-06. Evidence suggests that for every 3-4 per cent increase in per capita income, underweight rate should decline by one per cent. This has not been the case in India.
At the present rate of progress, India will reach the Millennium Development Goal 1 target on eradicating extreme hunger only by 2043.
As we move to greater economic growth rates, the challenge we face is to make this growth more inclusive, ensuring that all of us, especially the most disadvantaged and marginalised groups benefit from this economic growth. Children especially must see the benefits of this growth now if we are to sustain economic growth in the future.
The reality in 2010 is that almost 50 per cent of India’s children are malnourished. In the nation’s capital alone, 42.2 per cent of children under five are stunted and a shocking 26.1 per cent are underweight.
Malnutrition stunts physical, mental and cognitive growth and makes children more susceptible to respiratory and diarrhoeal illnesses. Malnourished children are more likely to die as a result of common and easily preventable childhood diseases than those who are adequately nourished. According to a UNICEF report, 1.95 million children below the age of five die annually in India mainly from preventable causes that are directly or indirectly attributable to malnutrition. The children who survive the ravages of malnutrition are more vulnerable to infection, do not reach their full height potential and experience impaired cognitive development. This means they do less well in school, earn less as adults and contribute less to the economy.
While we have impressive policies and schemes such as the ICDS, these have not made a significant impact. The ICDS needs to reach the poorest and most excluded groups who need it the most, both in rural and urban areas. This is not the case however. Only 28.4 pc of children under six are able to access services provided by an anganwadi centre. Just in Delhi alone, for example, only 8.4 per cent of children under six have accessed an anganwadi centre.
India spends less than five per cent of the annual budget on children. The 2009-10 Union Budget earmarked 4.15 per cent on children! This, in a country where 447 million people are aged 18 and below! Of the total budgetary allocation on children, a mere 11.1 per cent is for child health schemes.
It is the poorest children in the poorest communities who experience much more malnutrition than their better-off counterparts. And yet, existing national nutrition plans barely tackle the socio-economic causes of the problem.
There is an assumption that economic growth will solve the problem of malnutrition but, in fact, economic growth often fails to reduce poverty. The economic causes of malnutrition are set to deepen: food prices remain high and are expected to stay high, the economic downturn is pushing millions more into poverty and climate change is causing an increasing number of extreme climatic events that devastate livelihoods and lead to destitution.
We have good policies and schemes in place. The time has come to implement these and more importantly, monitor their implementation. A task group on nutrition was set up by the Prime Minister’s Office in October 2008 but it appears that it has not yet met. We know which districts are hardest hit, we need to reach those districts and build the capacities of local health and nutrition workers to deliver effective services. We need to ensure greater convergence between the ministries that have responsibility for tackling malnutrition so that we have integrated plans at the district and panchayat levels to reach the communities that need it the most.
In the third century BC, Patna was the greatest city in India; the seat of the Maurya dynasty with Emperor Ashoka at the helm. Ashoka was arguably one of our greatest and most forward thinking leaders, who believed in inclusive development. If Bihar pays attention to social development ensuring that its economic growth benefits its most excluded groups and minorities, it may yet again lead the way for other States.
(Shireen Vakil Miller is Director of Advocacy with Save the Children)