Guwahati, Monday, January 18, 2010
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EDITORIAL

Under-nutrition among Indian children
— Dr Alakananda Goswami
According to India’s third National Family Health Survey (NFHS-III) of 2005-06, 20 per cent of Indian children under five years are wasted due to acute under nutrition and 48 per cent are stunted due to chronic under nutrition. Seventy per cent of children between 6 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 under nutrition 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.

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 die from common children illnesses such as diarrhoea, pneumonia, and measles. More than a third of all deaths in children aged five years or younger can be attributed to under nutrition. Children who survive under nutrition 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 under nutrition impedes socio-economic development and poverty reduction. With persistently high levels of child under nutrition, 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.

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

One can learn important lessons from the experiences of these countries. Firstly, 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. Secondly, targeted nutrition interventions to prevent mild and moderate under nutrition and treat severe under nutrition as part of a continuum of care for children, particularly among the most vulnerable ones. Thirdly, reliance on community-based primary health care to ensure high coverage through community-based workers. Lastly, strong supervision, monitoring , evaluation, and knowledge management to provide the evidence base for timely and effective policy, programme and budgetary action.

Meanwhile, child malnutrition has reached epidemic proportions in most parts of Madhya Pradesh. Over 500 children under the age of six died in the State due to acute malnutrition from May 1, 2008 to June 30, 2009. More than 35 children died in Jhabua district in November 2009 alone. Agasia and Madarani villages falling in the Meghnagar block of the predominantly tribal district, registered highest number of deaths. Severe malnutrition among the Kol tribal group in Jawa block of Rewa district is also reported. Recently, a Hong Kong-based Asian Human Right Commission (AHRC) report mentions that approximately 80 per cent children are malnourished in Rewa district. The displacement of tribal groups from their traditional forest dwellings, where they had access to minor forest produce like berries and other fruits to feed their children, has made matters worse in a scenario where the Public Distribution System (PDS) shops in tribal areas often open only once a month.

Significantly, in India, food deprivation is the result more of distribution than the lack of food. Correcting this systematic inadequacy is the larger challenge, but improving the working of the Integrated Child Development Services (ICDS), especially in the tribal dominated areas is something the State governments can do if they had the political will and vision. The World Bank’s 2005 study on the working of the ICDS highlighted three important mismatches: the gap between design and implementation, the neglect of the poorest and the most vulnerable, and the poor quality of services. The National Family Health Survey-III showed that States that had well-designed health intervention schemes such as immunization programme and maternal care fared better. Making local administration accountable is a much-required first step to mainstream development issues into the political agenda.

India has the resources – financial and human-to address, once for all, the challenge of child under nutrition The prevention and treatment of child under nutrition 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 channeled 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 Plan are ambitious, more ambitious than the international commitments set forth in the Millennium Development Goals (MDGs). Now is the time to combine the existing resources with the political will to change the lives of millions of India’s under-nourished children.