At the Agali Community Health Centre in Attappady, Palakkad district, Kerala, Kavitha tends to her four-year-old child lying listlessly on the cot, critically ill. The doctor says the child is severely malnourished. He also says there are eight such infants and children, all suffering from malnutrition, admitted to the centre. This area in Kerala has seen 19 infant deaths in just two months, and 52 deaths of children due to malnourishment over the last year. These are children of tribal communities which make up 42 per cent of Attappady’s population.
Wise men coming here from the governments of Delhi and Thiruvananthapuram have declared that the women do not know how to feed their children properly, they must be educated about nutrition, exclusive breast feeding and weaning. The deaths are due to ignorance, they say.
The child’s mother looks puzzled when this is put across to her. But we do not have much choice in what we eat, she says, we eat what we can afford to buy. The current diet of a tribal woman in this area is a sort of rice gruel in the morning and rice and tamarind water at night. A locally grown green vegetable may be added, when available, to the night meal. Pulses are a rarity. Kavitha herself looks highly malnourished.
Health department officials say that a woman (given the average height of tribal women in this area) should weigh at least 48 kg before she can bear a child. But most women here weigh just 35 to 38 kg. The third National Family Health Survey in 2005-2006 showed that at the all-India level, 46.6 per cent of tribal women and 41.1 per cent of Dalit women have a body mass index that is below normal. Of these, an alarming 21 per cent of tribal women and 18.5 per cent of Dalit women are moderate/ severely thin. If Attappady is an indication, there has been little improvement.
Before Kavitha was born, her family owned land and grew millets and, sometimes, pulses which helped maintain a certain level of nutrition. As many health officials say, it is not a lack of knowledge but loss of land, which is an important factor behind poor nutrition. In Attappady, as in other parts of India, dispossession of tribals from their land by various methods of land grab has occurred. There is a consequent forced dependence of tribals on a now weakened public distribution system. In Attappady, once the child deaths became known and the UDF government was held accountable, it was announced that a minimum of 35 kg of foodgrains would be given to each family. But two months later, even those who hold a BPL card like Kavitha get only 25 to 28 kg of foodgrains a month. Two years ago, they used to get pulses, oil, salt at subsidised rates. Not any more. The mantra to cut subsidies implemented by the UDF government in the food, health and anganwadi sectors hits marginalised communities in a hard and cruel way.
A woman bearing a child with such an elevated level of malnutrition is at high risk as is her baby. In Attappady, the majority of infants who died were pre-term babies or babies with a very low birth weight. Perhaps they could have been saved, in spite of this, had health facilities been available. But of the 1,200 pregnant women who registered in the area last year, only 25 had institutional deliveries. One of the reasons women do not go to health institutions is the drastic cut in the facilities in the last two years. There is a Comprehensive Health Insurance Scheme (CHIS) for tribals, which is supposed to cover medicine and other expenses incurred by health institutions on tribal patients. For more than a year, not a single paisa has been released to the hospitals under CHIS. This not only reflects official callousness but also raises questions about the dependence on insurance schemes, instead of strengthening public health services. After the deaths, the State government promised the urgent release of Rs 10 lakh to the Agali CHC. This has not yet materialised. The consequences were being felt by Kavitha’s little boy. The doctors present said they were using samples of nutrition feeds for her child which they had been given free but the supply was running out. The only alternative before them was to spend their own money to buy the feed, they said.
State of anganwadis
A public interest litigation plea filed recently in the Kerala High Court paints a shocking picture of the state of anganwadis in Attappady. The food supply for anganwadis was handed over to private contractors by the present government, resulting in rampant corruption. Rotten, inedible food was supplied to children in most of the 172 anganwadis in the area. A Central government team found that the nutrition programme for pregnant women and adolescent girls was not implemented in the last two years. The State had also cut the nutritional requirements by half, cutting out eggs and fruit supplies to the anganwadis. It was only in April, after the furore over the deaths, that the responsibility for supplies was once again given to government agencies.
But it was too late for the children. Even now the situation on the ground in spite of all the announcements has not changed. The doctors fear more deaths. If this can happen in Kerala, what of those States where governments equally committed to neo-liberal policies do not even have a proper monitoring system?
Tribal communities want their land back, they want livelihood not charity. In the last year, in this area the average number of days of work provided under MGNREGS was only 63 days. The concerned Central Minister Jairam Ramesh who visited Attappady after the deaths made a grand statement of allocating Rs 120 crore for the area. It might have been more useful if the Minister had ensured that work, which has come to a standstill, had been provided and workers paid what was owed to them. According to the report of the District Vigilance and Monitoring Council, till the first week of April, delayed wage payments for unskilled workers were as high as Rs 28 lakh. But even those who have been paid subsequently have been denied a minimum wage. The same utterly insensitive mindset that blames a mother’s ignorance as the prime reason for her baby’s death also holds that it is because workers have become lazy that the stipulated wage rate is not earned.
With low levels of nutrition, women who comprise a large section of the MGNREGS workers in this area find it difficult to complete the tasks set for them. In this case, the piece rates are linked to a norm which requires a worker to dig or lift mud of around 1200 kg a day. Can a woman who herself weighs less than 40 kg, eating once a day, be expected to complete this task?
While the situation in Attappady is particularly bad, the continuing emphasis on earth work in MGNREGS projects across the country, with high and difficult-to-complete productivity norms, makes it virtually impossible for a malnourished labour force to earn a piece rate linked minimum wage. Although the Ministry of Rural Development in its operational guidelines for 2013 has specifically mentioned that in fixing SORs (schedule of rates), levels of nutrition should also be taken into account, this has not been translated into practice. On the contrary, in some States, for example in Andhra Pradesh, the Minister’s home State, the SORs were actually raised following the raise in the wage rate. This is a method of neutralising the increased wage rate, depriving the worker of the benefit and saving the government the additional money it would have had to pay.
India along with the sub Saharan Africa region is the only country in the world where the number of very poor people has registered an increase in the last 30 years. According to a recent World Bank study ( The State of the Poor: Where are the Poor and where are the Poorest ), India now accounts for one-third of the world’s poorest people — that is those earning around 87 cents, less than Rs 50 a day. In 1981, one-fifth of the world’s poorest people lived in India; in 2010, the numbers increased to one-third, around 400 million. Clearly, the government has to make drastic changes and reversals in its present policies to address the issues of deprivation. It should draw the right lessons from the Attappady tragedy because the deaths could have been prevented had the policies been different.
(Brinda Karat is Polit Bureau member, Communist Party of India-Marxist)