India’s Malnutrition Shame

It requires a far wider spectrum of interventions than mere clinical management.

Written by Rajib Dasgupta | Updated: September 17, 2015 6:03 am
Malnutrition, India Malnutrition, Nutrition report, Global Nutrition Report, Global Nutrition Report 2015, Nutrition Report 2015, International Food Policy Research Institute, A civil society collective appealed to policymakers in a press release on July 23 to “declare malnutrition as a medical emergency to save India’s children dying of hunger”.

The latest edition of the Global Nutrition Report 2015 by the International Food Policy Research Institute, released on Tuesday, brings back the concerns over malnutrition into sharp focus. In July, the government of India, after much avoidable controversy, released malnutrition (used synonymously as undernutrition) figures from the Rapid Survey on Children (RSoC) data that was collected in 2013-14. This dataset was keenly awaited as it provides a nationwide assessment after the third round of the National Family Health Survey (NFHS-3), which is nearly a decade old now. The RSoC data also assumes significance as the world adopts the Sustainable Development Goals. Goal 2.2 seeks to end all forms of malnutrition by 2030, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under five years of age.

The RSoC was conducted by the ministry of women and child development with  technical support from Unicef. It found 29.4 per cent of children (aged less than three years) to be underweight (low in weight for their age), while 15 per cent were wasted (low weight for their height) and 38.7 per cent were stunted (low in height for age). On the face of it, this compares well with the NFHS-3 data, in which the corresponding figures were 40.4 per cent (underweight), 22.9 per cent (wasted) and 44.9 per cent (stunted). But in absolute terms, the current levels of underweight and stunted children are abysmally high and former Prime Minister Manmohan Singh’s assertion
that malnutrition is a “national shame” is still valid.

A civil society collective appealed to policymakers in a press release on July 23 to “declare malnutrition as a medical emergency to save India’s children dying of hunger”. The Union minister for tribal affairs on August 4 said that his ministry “will collaborate with Ramdev and Balkrishna to identify and document medicinal herbs helpful in the treatment [emphasis added] of malnutrition”. But ready-to-use therapeutic food was introduced as a “treatment” to combat this medical emergency nearly two decades back.

The moot question is: can malnutrition be “treated”? Current mainstream global notions draw upon African experiences, where severe acute malnutrition (SAM) has been triggered by acute crises, such as drought, crop failure and civil wars. Classical SAM is a medical emergency, carries with it a high risk of mortality, and requires not just therapeutic feeding but other medical inputs. This global wisdom was bought off-the-shelf by national experts and Indian strategies and guidelines continue to be largely clinical, essentially seeking to treat malnutrition.

The predominant form of malnutrition in India is significantly different from classical SAM and standardised protocols for treatment are not as effective in the Indian context, where longer durations are required for achieving targeted weight gains. This is on account of the high levels of underlying stunting. Stunting signifies chronic undernutrition and has no scope for “cure” in a therapeutic mode. Its levels in India are higher than in Africa, and exceedingly so among chronically poor populations. Severe chronic malnutrition (SCM) in children is characterised by stunted growth and is a potentially less serious but continual form of malnutrition. SCM is generally an outcome of latent poverty, chronic food insecurity, poor feeding practices and protracted morbidities, but rarely a direct cause of mortality. In short, stunted children are hungry but not sick.

Chronic malnutrition requires a far wider spectrum of programmatic interventions beyond clinical management. Multi-sectoral actions are needed to combat multi-dimensional deprivations. Simultaneously, there is an urgent need for promoting practices to improve the quality of local diets, improving child-feeding practices, reducing exposure to illnesses, and paediatric care services. This would need a broad-based commitment of resources as well as the creation and nurturing of local capacities and leaderships.

Despite recent gains, malnutrition continues to be a national emergency; though not a medical one. The National Nutrition Mission (a multi-sectoral programme earmarked for 200 high-burden districts) has not taken off in any meaningful manner. The penchant for a magic bullet to treat and cure malnutrition draws attention away from the Indian epidemiological reality. Policymakers and opinion leaders are increasingly impatient with the tardy progress of the current set of interventions. The way forward requires a reorientation of Indian research to inform policy and practice and change the current tenor of policy discussions. The Make in India call should apply no less to research and practice.

The writer is professor and chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi

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  1. I
    Inderneil Roy Chowdhury
    Oct 20, 2015 at 7:55 am
    1. G
      Sep 18, 2015 at 2:35 am
      Stunting (physical and, perhaps, mental) is one of the most disastrous consequences of malnutrition. Even more surprisingly, it has continued even though income levels have increased over the last 20 years. Some studies have also pointed to poor hygienic living conditions as being a significant contributor to poor health and stunting. All this points to a need for improved education about nutrition and better hygienic practices. In this light, the recent emphasis on cleanliness is of critical importance for the poor. So also are initiatives for school lunch programs. All of these initiatives continue to suffer because of the relentless politicization by our left wing politics (even Modi's swacch bharat campaign has seen strident political opposition). The people of the country have to take an ownership of these problems and not look to the govt for solutions. As long as we expect the govt to solve the problems of our neighborhoods we will never get anywhere.
      1. N
        Nilmani Singh
        Sep 17, 2015 at 9:50 am
        Need of hour to focus on nutrition specific & senstive interventations for reduction in malnutrition not in theory but in praticemunity mobilization with involvement of SHG can help in reduction of malnutrition.
        1. R
          Raghvendra Dubey
          Sep 17, 2015 at 6:08 am
          Malnutrition problem in India continue till 69 th Independence, Government had taken a lot of step to reduce but it still not fully effective . My suggestion is that government apply a new policies a new way using the modern technology , also taken the adhesive step like potion growth !
          1. R
            Ramesh Grover
            Sep 17, 2015 at 7:50 am
            One would like to know about gender distribution of malnutrition, stunting, and other related maladies, as one suspects that malnutrition is more likely to be affecting female potion rather than males, not merely for economic causes but other deep rooted social attributes leading to female foeticide, deprivation of wsome meals to female child, and our social mindset
            1. R
              Sep 19, 2015 at 4:08 pm
              Indians alone know the art of making 'Waste of the Best'. It is a festive season after Gokul Ashtmi and Ganeshotsav, followed by Mangalgauri, Navratri, Durga Pooja, Deepavali etc besides lot many local festivals of Gram Devta, Kuldevta and Nagardevtas. We can see the quantum of foodgrains, Ghee, milk, curd, coconuts, fruits and dryfruits are just wasted and burnt in the fire, in Prasads and feasts known as Mahaprasad on the final day. My dhobi is hand to mouth. His children do not get enough milk and Ghee is a luxury for them but he wastes about 10 grammes of pure ghee in lighting the lamp before the God. The road side tea vendors just flow the first cup of tea on the road as an offering to the 'Dharati Mata' but nourishing the flies and mosquitoes. If we save the wastage done in the name of the faith and belief, it can feed the millions. In fact nobody is concerned about the malnutrition and hungry people, the Netas and the Sarkar only want to debate and discuss the problem but nobody wants any solution. As such there is no dearth of food grains and resources in the country, some people like to keep a section of the society hungry so that they have an agenda to discuss. Ruling party worries and the opposition criticise them. However the end result is always a 'ZERO'.
              1. S
                Oct 18, 2015 at 8:42 am
                1. S
                  Oct 18, 2015 at 8:41 am
                  self deprecating ignoramus
                  1. S
                    Stephen Billings
                    Sep 18, 2015 at 5:56 pm
                    Sadly there are thousands of cattle that are roaming free across the country that could be used to feed the starving children and raise their nutrition levels. But because of religious beliefs we let them starve. I am sorry but there is no god that wants children to starve. Religious zealots mus go back to their originals texts and read them again to show eating beef is not against their beliefs! Eggs would be another way to enrich their diets but even those are banned in the name of religion!
                    1. T
                      Sep 17, 2015 at 3:40 pm
                      "SCM is generally an outcome of latent poverty, chronic food insecurity, poor feeding practices and protracted morbidities, but rarely a direct cause of mortality." Could you specify in simple terms what this means, i.e. are the price and unavailability of food a problem, or is it lack of awareness about a balanced diet? In either case, what needs to be done to improve the situation?
                      1. V
                        vinod kumar
                        Sep 18, 2015 at 7:23 pm
                        True,a shame it is.While experts may fight over SAM or SCM category,what NGO & well meaning people can do is to come up and sponsor PAN India Dhabas providing cheap and healthy food and clean drinking water to the needy. Strengthen mid day meal scheme in schools,and among kids and their mothers in construction workers. Why Ambani,Adani,TATA,Bajaj,Murti,premji,can not come forward as part of their social responsibility to sponsor such AAM ADMI DHABAS. Disaster management and relief is good but I humbly remind RSS that this is what true RASHTRA building is,a nation of healthy smiling young ones.
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