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Resource centre on India's rural distress
 
 

India's Unique Enigma of High Growth and Stunted Children -Awanish Kumar
-TheWire.in

Diane Coffey and Dean Spears’ Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste is a path breaking addition to the literature on child malnutrition and development policy in India.

The history of global health has been marked with a dramatic turnaround starting from around the mid to late 19th century. This period witnessed an unprecedented decline in death rate and a steady increase in the life expectancy of populations across Western Europe and North America. Conventional wisdom for a long time held that the improvement in public health indicators came through because of rising incomes and consequently, rising nutritional levels. However, a number of scholars now agree that the real reason for the rapid advance in the conditions of human life in this period was made possible by the ‘sanitation movement’ that provided – particularly in the growing urban centres of industrialising Europe – sewers and clean drinking water to the population. The state played a very important role in the provisioning of these ‘public goods’ as the markets typically failed to deliver, say for instance universal vaccination or urban sewage systems, owing to what is known as market failures in neoclassical economics. Gradually, the long, arduous and killing phase of infectious diseases got over by the middle of the 20th century along with the new ‘therapeutic revolution’. Thus, improvements in basic health, nutrition and well being indicators are possible and have been achieved despite low economic growth, for instance in Kerala.

The Indian enigma

The South Asian region registers the highest rates of child malnutrition in the world despite the fact that the per capita income and GDP growth rate of this region is better than many other poor countries, including sub-Saharan Africa. Some scholars in the mid-1990s termed this peculiar problem as the ‘Asian Enigma’. For instance, India’s sustained level of growth since the 1980s and unprecedented economic growth rates in the last decade do not seem to have impacted the high levels of child malnutrition in the country. However, the same period saw Bangladesh and Nepal catch up with and leave India far behind in key indicators, such as life expectancy and child survival. Several scholars have identified two key factors responsible for child malnutrition in South Asia, specifically India –

    First, the status of women and their participation in the decisions related to their bodies, economic resources, and social and public services, which have been instrumental in transforming the landscape of Bangladesh, at least as far as child nutrition is concerned,

    Secondly, sanitation which includes provision of safe and clean drinking water and, in the case of India, the practice of open defecation.

The National Family Health Survey (NFHS)-4 (2015-16) suggests that about 52% of all Indian households defecate in the open. The share for rural India was much higher at 63%. The proportion of women between the age group 20-24 years who were married before they attained the age of 18 years was about 27%. The share of women between the age group of 15-49 years who were anaemic decreased from 55.3% to 53% between NFHS-3 (2005-06) and NFHS-4 (2015-16), a decline of less than two percentage points over a decade. The reduction in key child malnutrition indicators over a decade spanning from NFHS-3, pertaining to 2005-06 and NFHS-4 (2015-16) has also been very slow.

Take for instance, the reduction in the proportion of children under five years who were stunted (low height for age):

    The figure came down from 48% in the year 2005-06 to about 38% in 2015-16.

    The share of children who were wasted (low weight for height), in fact, increased from 19.8% to 21% in the given time period.

    The same is true for the proportion of children who were severely wasted which rose from 6.4% to 7.5% between NFHS-3 and NFHS-4.

    The decline in the share of children under five years who were underweight has been very slow, from 42.5% to 35.7%.

Diane Coffey and Dean Spears’ recent book, Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste, is a path breaking and brilliant addition to the literature on child malnutrition and development policy in India. In their long journey of following cases of child malnutrition and mortality, they zeroed down on a simple, commonly known but rarely acknowledged fact in policy and academic circles, and that was the link between open defecation and the spread of harmful germs that lead to higher levels of child malnutrition. The government of India and other multilateral international agencies even today swear by the myth that it is poverty which is at the root of open defecation. Coffey and Spears do not reject that poverty is a part of the problem, but they insist that social inequalities play a bigger role in explaining why a majority of rural Indian families continued to defecate in the open.

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