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Resource centre on India's rural distress
 
 

How hungry is India? -Archana Mishra
-Tehelka

The country has egg on its face but not in its diet, as the Global Hunger Index reveals acute malnutrition

Swachh Bharat Mission, if implemented in a holistic fashion, holds the key to curbing not only the problem of diarrhoeal deaths for which India holds the world record, but also malnutrition. However, the World Toilet Summit, which was held in the national capital this year as part of the Mission, was unable to see the link: how diseases caused by poor sanitation are inextricably linked to chronic malnutrition among the country’s children.

The apathy displayed by successive governments towards the issue of malnourishment was laid bare in the 2014 Global Hunger Index Report, which ranks India at the 55th position. According to the index, 17 percent of India’s population is undernourished, 30.7 percent children under five years of age are underweight and 5.6 percent dies before completing five years of age. The numbers show a decrease from the last decade but their accuracy is in doubt.

The ministry of women and child development and UNICEF had conducted a Rapid Survey on Children (RSOC) in 2013-14. However, the results of the survey have not been released by the government on the grounds that it is still under review. This national survey covering all 29 states in India was used along with National Family Health Survey-3 (NFHS-3), a decade-old survey, to come up with the Global Hunger Index findings.

Significantly, the global nutrition report itself questions the RSOC figures. It says, “Most of the data are from different reports, and this often meant that the years when data were collected varied. The temporal diversity in the data made it difficult to compare nutrition data at the district and state levels or even different types of indicators for each district.” Perhaps this gives an explanation why the government looks unlikely to release the report anytime soon.

Comparing the NFHS-3 data with the RSOC report, the average annual rate of reduction in stunted growth is 2.6 percent, below India’s target rate of 3.7 percent. According to NFHS-3, which gives the data of 2005-06, 47.9 percent kids had stunted growth due to malnourishment. Going by the rsoc, this number had decreased by 9.1 percent by 2013. Even wasting (the process by which a debilitating disease causes muscle- and fat tissue to atrophy) under five years of age has reduced by five percent.

Since India has such a large population and high prevalence of stunted growth, this decrease even affects the Global Hunger Index.

Poor Sanitation
 
According to health experts, open defecation and unhygienic environment are making children more vulnerable to stunting of growth, wasting and being underweight. Nutritionists call this phenomenon ‘environmental anthropathy’. The chief of child development and nutrition at Unicef, Saba Mebrahtu, tells Tehelka, “The microvilli present in the intestine, if infected with faecal matter, cause chronic infection in the stomach. Due to this, the nutrient absorption capacity of the intestine decreases. Therefore, despite intake of nutrient-rich food, children suffer from malnutrition. The nutrients are consumed in fighting infection rather than physical development.”

According to studies, open defecation leads to 54 percent of international variation in child height (stunting). In contrast, variation in GDP has a contribution of only 29 percent. According to the Demographic Health Surveys (DHS), Indian children are very short compared to international standards. This lack of height is exactly what is predicted as a result of widespread open defecation in the country.

The link between open defecation and child height is stronger in countries with high population density such as India, as germs released into the environment due to poor sanitation affect a large number of growing children. Open defecation causes negative ‘spillover’ because germs from one person’s faeces, released into the environment, can make other people sick. Even if everybody in the family uses a toilet, children are exposed to germs by other people’s behaviour.

The immune system of children is further affected by the poor quality of supplementary food provided in Integrated Child Development Services (ICDS) centres and anganwadi schools.

The who recommends the introduction of solid or semi-solid food for infants around the age of six months because by that time, breast milk by itself is no longer sufficient to maintain a child’s optimal growth. However, almost half of breastfed babies are not given solid or semisolid food even at eight months.

Appallingly, almost 80 percent breastfed children around six to 23 months of age are not getting diverse meals which include apt intake of vitamins and proteins. As per the nfhs-3, only 22.1 percent children are getting grains, fruits, vegetables, meat, fish, poultry or eggs in apt quantity. Meanwhile, the remaining depend only on grains. Almost 90 percent kids are given bread, roti, rice, noodles, biscuits and idli while only 54 percent kids are getting food and vegetables rich in Vitamin A. Moreover, only 18.5 percent kids are getting cheese, yogurt and other milk products. Even the supplement food packages lack essential fat and oil products.

According to MS Swaminathan, who is known for his role in India’s green revolution, we have been attending only to the need of adequate calories. “Malnourishment has three dimensions — calorie deprivation, protein hunger and hidden hunger caused by the deficiency of micronutrients such as vitamin A, vitamin B 12, iron, iodine, zinc, etc. The other aspects of hunger are not receiving integrated attention. This explains why we have a high degree of malnutrition,” he says.

Compounding the problem is the lack of access to clean and potable water. Pranob Sen, commissioner, Indian Statistical Commission, says, “After six months, children are exposed to potential contamination due to unavailability of thoroughly sterilised water. So, by the time the child is two years old, his body becomes undernourished because of infections. Notably, this is one reason India has the highest number of diarrhoeal deaths.”

“The ICDS centres are merely focussing on remedial feeding system. They are catering to 17-18 percent of the malnourished kids. Women, along with the infants, do not visit these centres because of lack of information and awareness. We are only trying to control the damage due to malnourishment,” says Sen.

Saba says that 50 percent of stunted growth is related to maternal health. “In cases of stunted growth, wasting and being underweight, maternal and infant nutrition have equivalent share. Infection and poor dietary intake affect both mother and child equally. Almost 70 percent women are anaemic in India. Owing to iron deficiency at the time of pregnancy, infants are born underweight. So the damage is already done to the baby inside the womb,” she says. Further consequences are reflected in maternal- and infant mortality rates.

Food Security
 
It cannot be denied that food security has a larger role to play in such a scenario when millions are undernourished today. “The availability of food and its price do have an impact. Food access, however, is not a problem in the country today, except in a few places where food availability is largely dependent upon the local production,” says Sen.

Reiterating Sen’s view, Swaminathan says, “India is not food secure in the sense that there is still widespread hunger. We are, however, food secure in terms of production and availability of food. We produce nearly 260 million tonnes of food grains, over 260 million tonnes of vegetables and fruits and over 130 million tonnes of milk. This should be sufficient for a healthy diet for our present population, if there is equitable distribution.” According to Swaminathan, the National Food Security Act 2013 needs to be strengthened by adding pulses and bio-fortified crop in the public distribution system. Notably, the Act has been implemented in 11 states so far and the government has no data related to it.

“The PDS has certainly helped in making food grains available at an affordable cost to the public. It, however, does not cover issues such as the special nutritional requirements of pregnant mothers and that of children during the first 1,000 days of their life. We need to make PDS more holistic, making it a vehicle for ensuring nutritional security,” he says.

Interventions are urgently required to provide access to clean and potable water, better sanitation facilities and improvement in the quality of supplementary food to both rural- and urban poor. If implemented properly, Swachh Bharat Mission can contribute to bringing these figures down. Ending open defecation has to be policy priority. ‘Beti bachao, beti padhao’ campaign of the government has an important role to play in terms of creating awareness about women’s health and bringing down maternal- and infant mortality rates.

But the herculean task lies in providing sufficient nutritional food to children. Ironically, a recent decision taken by Madhya Pradesh Chief Minister Shivraj Singh Chauhan to remove eggs from the menu in anganwadis has politicised the issue of malnourishment.