India’s children need a better deal

For a country that aims to be a regional power, the data on child nutrition confirms that the situation is abysmal. Save for Bihar, six of the seven states with the highest incidence of stunting, for example, are ruled by the BJP or the BJP and its allies – Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh, Rajasthan, Gujarat and Bihar.

Written by V Ramani | Updated: July 17, 2017 2:05 am
children health, health survey, child health survey,indian children, children malnutrition, child health, National Family Health Survey, nfhs4, child under-nutrition The only state doing so regularly, Maharashtra, has uploaded aggregate child weight data on the internet – but only up to December 2016. (Express File Photo)

After an agonising wait of over ten years, the results of the National Family Health Survey (NFHS-4) are finally before us. The fact the data on the nutrition status of India’s children is disquieting is reflected in a recent letter from the NITI Aayog CEO to all Chief Secretaries of states with high under-5 years stunting rates in specific districts. The letter stresses the need for concerted action and setting annual targets in respect of critical maternal and child health and nutrition outcomes.

Unfortunately, there is no mention of the policy framework and systemic changes needed to break the vicious cycle of child under-nutrition.

First, therefore, we need to recognise that the seeds of child malnutrition are sown in the womb. Given the moribund state of health systems in many states, especially in northern India, little attention is paid to the condition of the pregnant woman. NFHS-4 data reveals that the big three problem states – Uttar Pradesh, Bihar and Madhya Pradesh – had very low full ante-natal care (ANC) coverage of mothers.

Incidentally, save for Bihar, six of the seven states with the highest incidence of stunting are ruled by the BJP or the BJP and its allies – Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh, Rajasthan, Gujarat and Bihar.

However, even in states like Maharashtra and Gujarat, where full ANC coverage was over 60 per cent, the position on the ground is that ANC visits are perfunctory in nature and there is no monitoring of physical parameters of pregnant mothers, especially those with low weight, poor weight gain during pregnancy, high blood pressure and a history of obstetric complications. Not surprisingly, most states in India still record distressingly high rates of maternal mortality.

Underweight, unhealthy mothers deliver low birth-weight babies, perpetuating the inter-generational cycle of malnutrition. India’s children, therefore, start with a handicap that is exacerbated by economic and social factors as well as a lack of focused attention from the huge paraphernalia of Public Health and Integrated Child Development Services (ICDS) staff.

Second, social sector administrators stubbornly refuse to use real-time data in policy formulation and implementation. Although the ICDS system mandates a monthly recording of weights of every under-5 year-old child, this requirement is observed more in its breach. Almost no state places data on aggregate ICDS project-wise monthly child weights in the public domain.

The only state doing so regularly, Maharashtra, has uploaded aggregate child weight data on the internet – but only up to December 2016. Without real-time data on child weights, it is not possible to identify the specific pockets of child malnutrition where focused interventions are necessary. More critically, this lack of data absolves the ICDS machinery of accountability for results. It is only when there is media and public furore about “malnutrition deaths” that governments swing into apparent action.

Nutrition and health administrators in Delhi are strangely reluctant to adopt the criterion of height measurement of under-5 children, recommended by the WHO as far back as 2008. Without height measurement, stunting in under-5 children, representing chronic malnutrition, cannot be measured. Stunting leads to impaired physical as well as cognitive development in children, with consequences for their future health and productivity. Wasting in under-5 children, one of the contributors to infant and child mortality, cannot be easily assessed in the absence of height statistics.

There is also policy confusion on what needs to be done to improve child nutrition indicators. This stems from what we may term a “food-centric” approach to an issue like child malnutrition that has wider economic and social ramifications. The ICDS machinery considers their job done if supplementary nutrition, in the form of take-home rations for mothers and under-3 children and cooked meals for pre-primary children attending anganwadis, is provided.

But growth monitoring of children, counselling of mothers on sound infant-feeding practices, home visits to under-3 children and early childhood education services for pre-primary children receive very little attention from anganwadis workers as compared to food distribution.

The 2012 reports of the Commissioners appointed by the Supreme Court have highlighted how administrations in Uttar Pradesh, Maharashtra and Karnataka have twisted Supreme Court orders to favour private parties. But governments will apparently never learn. Even today the central government favours commercial, pre-packaged, fortified food to under-5 children, notwithstanding the unsavoury history of poor quality supplies, widespread corruption and beneficiary apathy.

A recent study by LANSA, an international research partnership involving multi-nation research organisations and voluntary institutions, has detailed the massive siphoning of public finances in the supply of take-home rations and cooked meals in Uttar Pradesh, with no local authority oversight, little community participation and an unresponsive ICDS machinery.

This contrasts with the situation in neighbouring Chhattisgarh, where decentralisation of power to communities and panchayats has ensured far better delivery of ICDS services to mothers and children.

To improve child mortality and malnutrition indicators, the NITI Aayog should:

  • Ask state governments to prepare a concrete plan of action, covering both processes and outcomes. Chief Ministers should make the reduction of child malnutrition a top priority and gear up the ICDS and public health machinery to deliver results.
  • Develop, at the central level, a rigorous monitoring system, combining the regular flow of real-time data with periodic independent third-party surveys, to assess the ground situation.

The 2016 UNICEF State of the World’s Children Report shows India to be 48th highest out of 193 countries in under-5 child mortality (out of 193 countries). India also fares poorly in under-5 stunting, wasting and underweight indicators in comparison with other emerging economies and even with neighbours like Sri Lanka, Nepal and Bangladesh.

For a country that aspires to be an economic powerhouse and is already one of the largest markets in the world, investing in the health and productivity of its future generation is an imperative which can no longer be ignored.

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  1. D
    Dc
    Jul 18, 2017 at 8:59 am
    Why doesn't brahmins baniya Starts feeding their children gaumootra as they say it is a cure for everything. all the milk should be given to these poor malnuourished children.
    Reply
    1. A
      AlsoIndian
      Jul 17, 2017 at 6:28 pm
      Who cares? The priority for this country is already set by the PM and his party and it is "COW", "RAM MANDIR", "LOVE JIHAD", "ANTI ROMEO SQUADS"............ Under the current rule, the nation will never progress but would rather slip onto the path of destruction. A ruling party with the divisive politics will never lead this country anywhere.
      Reply
      1. U
        undefined
        Jul 18, 2017 at 5:09 am
        What "divisive"? India was divided in 1947 by Congress!
        Reply
      2. B
        Bert Brech
        Jul 17, 2017 at 5:04 pm
        The BJP is to blame. They have ruled for 8 of 70 years since Independence. The "Gandhi" family that ruled nearly all the rest of the time has no responsibility.
        Reply
        1. A
          AlsoIndian
          Jul 17, 2017 at 6:29 pm
          It is not about what they have achieved, but the path they are leading. And that path is clear to all Indians. Divide and rule!
          Reply
          1. D
            Dc
            Jul 18, 2017 at 9:02 am
            Time for u to work for these kids .guve up drinking milk.start drinking gaumootra and feed it to ur childern? milk should be given to these poor childern
            Reply
            1. D
              Dc
              Jul 18, 2017 at 9:02 am
              Time for u to work for these kids .give up drinking milk.start drinking gaumootra and feed it to ur childern,milk should be given to these poor childern
          2. A
            Akhilesh Manyu
            Jul 17, 2017 at 4:51 pm
            It is good to know that just in 120 days BJP is responsible for stunted growth of children in Uttar Pradesh. "Incidentally, save for Bihar, six of the seven states with the highest incidence of stunting are ruled by the BJP or the BJP and its allies". I do not want my comment to be deleted but if the writer is reading this he must know what I wish to write here.
            Reply
            1. L
              Lovely
              Jul 17, 2017 at 12:43 pm
              Only solution to this problem is ADOPT SMALL FAMILY NORMS. Nothing else wil work.
              Reply
              1. V
                valsaraj karayil
                Jul 17, 2017 at 10:47 am
                One side India booming in all aspects and the other side need to improve a lot in the matters like famine, malnutrition, etc,etc...
                Reply
                1. P
                  paarth
                  Jul 17, 2017 at 10:01 am
                  This article was fine until it headlined BJP ruled states, as if implying there is any causality. Let the author note that Bihar is not BJP ruled. And UP and Mehalaya only recently elected BJP to the state legislature. So any implied causality or correspondance is misleading and only takes away from what was an otherwise well written article. We should stop making this about politics and more about the fact that it is a pressing problem that needs attention.
                  Reply
                  1. B
                    Biswadeep Das
                    Jul 17, 2017 at 1:46 pm
                    So it also mentioned the word "Allies".
                    Reply
                    1. A
                      AlsoIndian
                      Jul 17, 2017 at 6:31 pm
                      We were expecting that with all its promises, BJP will act wisely. Unfortunately it didn't. A CM for UP who is an active terrorist and leads a terrorist organization will only deliver terror.
                      Reply
                    2. R
                      Ramesh Chhabra
                      Jul 17, 2017 at 7:17 am
                      Food security bill?
                      Reply
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