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NEWS ALERTS | The under-nutrition problem in Bundelkhand should receive equal attention of the policymakers, if not more
The under-nutrition problem in Bundelkhand should receive equal attention of the policymakers, if not more

The under-nutrition problem in Bundelkhand should receive equal attention of the policymakers, if not more

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published Published on Dec 26, 2021   modified Modified on Jan 20, 2022

Recent media reports point out that the Bundelkhand region of Uttar Pradesh is likely to get about Rs. 6,300 crore projects ahead of the upcoming Uttar Pradesh assembly polls, including a Rs. 400 crore worth plant for the propulsion system of anti-tank guided missiles in Jhansi. The foundation was laid for the first project in the Jhansi node (related to the Uttar Pradesh Defence Industrial Corridor) on November 18, 2021. The two Defence Industrial Corridors of Uttar Pradesh and Tamil Nadu are expected to attract a total investment of Rs. 20,000 crore by the year 2024-25. The Arjun Sahayak project on the Dhasan river, built at a cost of around Rs. 2,600 crore in Mahoba district, is anticipated to provide irrigation facilities to 1.5 lakh farmers in 168 villages of Banda, Hamirpur and Mahoba districts. The Uttar Pradesh State Government led by Chief Minister Yogi Adityanath has claimed recently that nearly 76 percent of the work on the 296-km Bundelkhand Expressway (whose foundation was laid on February 29, 2020), connecting Etawah, Auraiya, Jalaun, Hamirpur, Banda, Mahoba and Chitrakoot, has been completed. The Ken-Betwa river interlinking project is supposed to end the water crisis of Bundelkhand, said Prime Minister Narendra Modi on December 11, 2021 while inaugurating the Saryu canal project at Balrampur in Uttar Pradesh.  

While the Bundelkhand region of Central India received attention from social scientists, researchers and civil society organisations for its socio-economic backwardness, in recent times it has received attention for political reasons thanks to the Uttar Pradesh assembly polls to be held early next year.

The Bundelkhand region of Central India is spread across 7 districts of Uttar Pradesh and six districts of Madhya Pradesh. The districts of Chitrakoot, Banda, Jhansi, Jalaun, Hamirpur, Mahoba and Lalitpur, which are part of the Bundelkhand region lie in Uttar Pradesh. The districts of Madhya Pradesh that belong to the Bundelkhand region are Chhatarpur, Tikamgarh, Damoh, Sagar, Datia and Panna. Annual precipitation is often erratic with a deluge followed by a long spell without rainfall. Although more than 95 percent of the rainfall occurs between June and September (with maximum rain generally in July-August), the small amount of rainfall taking place during November-May is quite useful for farming in the region. Owing to the geology and topography, and the pattern of the rainfall received, Bundelkhand region is affected by both drought and flood. Impermeable rocky layer exists at fairly shallow depths in most parts of the region. Rainwater runoff is high. It means that rainwater has little time to penetrate the soil in this region. 

Agriculture is the mainstay of the majority of the rural people residing in Bundelkhand. Besides farming, they rely on secondary activities like animal husbandry and dairying, poultry, fisheries, bee-keeping and sericulture. Successive droughts (caused by climate change in recent years) and uncertain monsoons have affected the livelihoods of the people residing in this region. Water shortage (due to the lack of assured irrigation facilities) coupled with low farm productivity has not only affected the purchasing power of the people, but also the food and nutrition security of both children and adults. Out-migration from the Bundelkhand region to other places of India for livelihood security is quite common. 

Against the above-stated background, an attempt has been made (using the National Family Health Survey-NFHS data) to assess the status of child nutrition in various districts of Bundelkhand region vis-à-vis the overall child nutrition situation in Uttar Pradesh and Madhya Pradesh.

In the present analysis, 3 indicators have been considered -- proportion of children under 5 years who are stunted (height-for-age); proportion of children under 5 years who are wasted (weight-for-height); and proportion of  children under 5 years who are underweight (weight-for-age). It should be noted that as per the United Nations Children's Fund (UNICEF), under-nutrition includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin (wasted), and deficient in vitamins and minerals (micronutrient malnutrition).

Prevalence of stunting among children under five years

The recently released data of the NFHS shows that for the country as a whole, the percentage of children below 5 years who are stunted has reduced from 38.4 percent to 35.5 percent between 2015-16 and 2019-21 i.e., by -2.9 percentage points. While for Madhya Pradesh, the percentage of children below 5 years who are stunted has gone down from 42.0 percent to 35.7 percent between 2015-16 and 2020-21 (i.e., by -6.3 percentage points), for Uttar Pradesh the same has decreased from 46.3 percent to 39.7 percent between the two time points (i.e., by -6.6 percentage points). Please see chart-1.

While in Damoh (-2.9 percentage points), Datia (-12.1 percentage points), and Tikamgarh (-22.2 percentage points) districts the percentage of children below 5 years who are stunted has decreased between NFHS-4 and NFHS-5, in Chhatarpur (+2.4 percentage points), Panna (+2.8 percentage points), and Sagar (+1.7 percentage points) districts the percentage of children below 5 years who are stunted has increased between the two time points.

In Chitrakoot (-3.4 percentage points), Jalaun (-0.5 percentage points), and Mahoba (-2.3 percentage points) districts the percentage of children below 5 years who are stunted has gone down between NFHS-4 and NFHS-5, whereas in Banda (+4.3 percentage points), Hamirpur (+9.5 percentage points), Jhansi (+4.8 percentage points), and Lalitpur (+5.9 percentage points) districts the percentage of children below 5 years who are stunted has climbed up between the two time points.

So, in seven out of 13 districts that fall in Bundelkhand, the proportion of children under 5 years who are stunted has increased between 2015-16 and 2020-21.

The prevalence of stunting among children under five years in 2020-21 is higher in Chhatarpur (45.1 percent), Damoh (40.3 percent), Datia (36.8 percent), Panna (45.1 percent) and Sagar (42.7 percent) in comparison to Madhya Pradesh (35.7 percent). The prevalence of stunting among children below five years in 2020-21 is higher in Banda (51.0 percent), Chitrakoot (47.5 percent), Hamirpur (48.0 percent), Jalaun (45.1 percent), Jhansi (40.9 percent), Lalitpur (46.6 percent), and Mahoba (42.3 percent) as compared to Uttar Pradesh (39.7 percent).

Note: Please click here to access the data of the above chart in a spreadsheet format

Source: Madhya Pradesh --

District Factsheet: Chhatarpur, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
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District Factsheet: Damoh, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Datia, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Panna, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Sagar, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access

***
District Factsheet: Tikamgarh, Madhya Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
Madhya Pradesh Factsheet, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 

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Uttar Pradesh -- 

District Factsheet: Banda, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Chitrakoot, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Hamirpur, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Jalaun, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Jhansi, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 
***
District Factsheet: Lalitpur, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access  
***

District Factsheet: Mahoba, Uttar Pradesh, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access 

***
Uttar Pradesh Factsheet, NFHS-5, 2020-21, Ministry of Health and Family Welfare, please click here to access  

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India Factsheet, NFHS-5, 2019-21, Ministry of Health and Family Welfare, please click here to access  

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According to the United Nations Children's Fund (UNICEF), stunting, or low height for age, is responsible for irreversible physical and mental damage to children. A child who is stunted is too short for their age, does not fully develop and stunting reflects chronic under-nutrition during the most critical periods of growth and development in early life. Stunting prevalence is defined as the percentage of children, aged 0 to 59 months, whose height for age is below minus two standard deviations (moderate and severe stunting) and minus three standard deviations (severe stunting) from the median of the World Health Organisation-WHO Child Growth Standards. Stunting is associated with an underdeveloped brain, with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood, reduced earnings and increased risks of nutrition-related chronic diseases, such as diabetes, hypertension, and obesity in future. Experts have noted that stunting starts from pre-conception when an adolescent girl who later becomes mother is undernourished and anaemic and it worsens when infants’ diets are poor, and when sanitation and hygiene are inadequate. It is irreversible by the age of two. Stunting adversely affects school attendance and performance. This, in turn, can reduce later adult income-generation. Under-nutrition reduces economic advancement due to losses in productivity, poorer cognition and poorer educational outcomes. The immediate and underlying factors causing stunting include infant and child care practices, hygiene and limited food security among the poorest households. It is closely connected to reproductive and maternal nutrition and is often determined in the womb by a mother's social status and level of education. Traditional beliefs related to food intake and quality of care of an adolescent girl and of a woman during pregnancy and breastfeeding are also factors. While exclusive breastfeeding practices have improved in the past 10 years, complementary feeding practices have worsened. It should be noted that poverty is not a clear cause of stunting as there are stunted children even among the richest households.  

Prevalence of wasting among children under five years

For India, the percentage of children below 5 years who are wasted has gone down from 21.0 percent to 19.3 percent between 2015-16 and 2019-21 i.e., by -1.7 percentage points. For Madhya Pradesh, the percentage of children below 5 years who are wasted has declined from 25.8 percent to 19.0 percent between 2015-16 and 2020-21 (i.e., by -6.8 percentage points), whereas for Uttar Pradesh the same has gone down from 17.9 percent to 17.3 percent between the two time points (i.e., by -0.6 percentage points). Please consult chart-2.

In Chhatarpur (-1.4 percentage points), Damoh (-4.8 percentage points), Datia (-9.8 percentage points), Panna (-0.8 percentage points), and Sagar (-1.7 percentage points) districts the percentage of children below 5 years who are wasted has decreased between NFHS-4 and NFHS-5, whereas in Tikamgarh district (+0.5 percentage points) the percentage of children below 5 years who are wasted has increased between the two time points.

Although in Chitrakoot (-8.5 percentage points), Hamirpur (-11.7 percentage points), Jalaun (-12.7 percentage points), Jhansi (-2.0 percentage points), and Lalitpur (-20.3 percentage points) districts the percentage of children below 5 years who are wasted has fallen between NFHS-4 and NFHS-5, in Banda (+7.7 percentage points) and Mahoba (+1.1 percentage points) the percentage of children below 5 years who are wasted has risen between the two time points.

Therefore, in three out of 13 districts that come under Bundelkhand region, the proportion of children under 5 years who are wasted has increased between 2015-16 and 2020-21.

The prevalence of wasting among children under five years in 2020-21 is higher in Panna (23.2 percent) and Tikamgarh (19.7 percent) in comparison to Madhya Pradesh (19.0 percent). The prevalence of wasting among children below five years in 2020-21 is higher in Banda (25.7 percent), Chitrakoot (24.8 percent), Hamirpur (20.6 percent), Jalaun (19.5 percent), Jhansi (25.2 percent), Lalitpur (18.7 percent), and Mahoba (25.0 percent) as compared to Uttar Pradesh (17.3 percent).

Note: Please click here to access the data of the above chart in a spreadsheet format

Source: Same as Chart-1
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According to the UNICEF, wasting refers to a situation when a child is too thin for his or her height. Wasting happens due to recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted faces an increased risk of death, but treatment is possible. Wasting is considered as a life-threatening condition attributable to poor nutrient intake and/or disease. Characterised by a rapid deterioration in nutritional status over a short period of time, children suffering from wasting have weakened immunity, increasing their risk of death due to greater frequency and severity of common infection, particularly when severe. Wasting is considered to be the most immediate, visible and life-threatening form of malnutrition. It results from the failure to prevent malnutrition among the most vulnerable children. Children with wasting are too thin and their immune systems are weak, leaving them vulnerable to developmental delays, disease and death. Some children affected by wasting also suffer from nutritional oedema, characterised by a swollen face, feet and limbs. Wasting and other forms of acute malnutrition occur due to maternal malnutrition, low birth weight, poor feeding and care practices, and infection exacerbated by food insecurity, limited access to safe drinking water, and poverty. Growing evidence suggests that wasting occurs very early in life and disproportionally affects children under 2 years of age. The number of children who suffer from wasting can increase dramatically as a result of conflict, epidemics and food insecurity, including that caused by climate change–induced droughts and flooding. Yet, wasting is not only a characteristic of crisis. In fact, two thirds of all children with wasting live in places that are not facing emergencies. While the number of children being treated for wasting and other forms of life-threatening malnutrition has increased in recent years, only one in three children with severe wasting are reached with the timely treatment and care they require to survive and thrive. Technically, it is defined as the number (also proportion) of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median weight-for-height of the reference population.

Percentage of children under 5 years who are underweight

For the country as whole, the percentage of children below 5 years who are underweight has decreased from 35.8 percent to 32.1 percent between 2015-16 and 2019-21 i.e., by -3.7 percentage points. Although for Madhya Pradesh the percentage of children below 5 years who are underweight has fallen from 42.8 percent to 33.0 percent between 2015-16 and 2020-21 (i.e., by -9.8 percentage points), for Uttar Pradesh the same has decreased from 39.5 percent to 32.1 percent between the two time points (i.e., by -7.4 percentage points). Please have a look at chart-3.

In Chhatarpur (-6.7 percentage points), Damoh (-5.7 percentage points), Datia (-17.5 percentage points), Panna (-1.6 percentage points), and Tikamgarh (-8.4 percentage points) districts the percentage of children below 5 years who are underweight has gone down between NFHS-4 and NFHS-5, whereas in Sagar district (+5.3 percentage points) the percentage of children below 5 years who are underweight has risen between the two time points.

Although in Chitrakoot (-10.7 percentage points), Hamirpur (-3.5 percentage points), Jalaun (-13.1 percentage points), Jhansi (-0.2 percentage points), Lalitpur (-14.0 percentage points), and Mahoba (-14.3 percentage points) districts the percentage of children below 5 years who are underweight has fallen between 2015-16 and 2020-21, in Banda district (+8.3 percentage points) the percentage of children below 5 years who are underweight has increased between the two time points. Banda is the only district in Bundelkhand region, which has experienced a rise in all three indicators of under-nutrition i.e., prevalence of stunting, wasting as well as underweight among children below 5 years of age.

In just two out of 13 districts that belong to Bundelkhand, the proportion of children under 5 years who are underweight has grown between 2015-16 and 2020-21.

The prevalence of underweight among children under five years in 2020-21 is higher in Chhatarpur (34.6 percent), Panna (39.2 percent), Sagar (35.8 percent), and Tikamgarh (34.9 percent) in comparison to Madhya Pradesh (33.0 percent). The prevalence of underweight among children below five years in 2020-21 is higher in Banda (49.8 percent), Chitrakoot (41.8 percent), Hamirpur (36.3 percent), Jalaun (36.1 percent), Jhansi (39.3 percent), Lalitpur (34.8 percent), and Mahoba (33.4 percent) as compared to Uttar Pradesh (32.1 percent).

 
Note: Please click here to access the data of the above chart in a spreadsheet format

Source: Same as Chart-1
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According to the United Nations, the prevalence of (moderately and severely) underweight children is the percentage of children aged 0-59 months whose weights for age are less than two standard deviations below the median weight for age of the international reference population. The international reference population, often referred to as the NCHS/WHO reference population, was formulated by the National Center for Health Statistics (NCHS) as a reference for the United States and later adopted by the World Health Organisation (WHO). Children with low weight-for-age are known as underweight. A child who is underweight may be stunted, wasted, or both. The mortality risk is increased in children who are even mildly underweight, and the risk is even greater in severely underweight children. 

Data on child mortality indicators

Although data is available for the three child mortality indicators i.e., Neonatal Mortality Rate (NNMR), Infant Mortality Rate (IMR) and Under-Five Mortality Rate (U5MR) at the national and state-levels (Madhya Pradesh and Uttar Pradesh), it is unavailable for various districts that are part of Bundelkhand region. As a result of this, we could not look at the trends of child mortality in the 13 districts of Bundelkhand region.

References

The DHS (Demographic and Health Surveys) Program, National, State and Union Territory, and District Fact Sheets 2019-21 National Family Health Survey NFHS-5 (English), USAID, please click here and here to access  

Stop stunting, UNICEF, please click here to access, please click here to access  

Malnutrition, UNICEF, April 2021, please click here to access 

Child Nutrition, October 2019, please click here to access

Progress for Children: A Report Card on Nutrition, Number 4, May 2006, please click here to access  

Millennium Development Goals Indicators, United Nations Statistics Division, please click here to access 

Malnutrition, World Health Organisation, 9 June, 2021, please click here to access  

Malnutrition in children: Stunting, wasting, overweight and underweight, World Health Organisation, please click here to access

Voices of the Invisible Citizens II: One year of COVID-19 -- Are we seeing shifts in internal migration patterns in India? prepared by Migrants Resilience Collaborative (a Jan Sahas initiative) in collaboration with EdelGive Foundation and Global Development Incubator, released on 25th June, 2021, please click here to access

Water Resources Management of Bundelkhand, Uttar Pradesh Planning Department, Government of Uttar Pradesh, please click here to access

Bundelkhand: Overview of 2018 Monsoon, SANDRP, 12 October, 2018, please click here to access  

Bundelkhand: Building on Partnership -Rakesh Singh, Pradan (NGO), NewsReach March–April 2015, please click here to access 

Assessment of Impact of Drought on Men, Women and Children: An Inter-Agency Initiative, Rapid Assessment Survey conducted in Banda, Chitrakoot, Siddharth Nagar, Sonbhadga & Mahoba districts of Uttar Pradesh during 2016, Prepared by CASA, ActionAid, UNICEF, please click here to access

Bundelkhand Drought Impact Assessment Survey 2015, Swaraj Abhiyan in association with Parmarth, Orai, please click here to access

Bundelkhand Historic Region, India, Britannica.com, please click here to access  

Study on Bundelkhand, Planning Commission, please click here to access  

In five years we have done more work on Saryu canal project than what was done in five decades: PM, 11 December, 2021, please click here to access

Defence Industrial Corridors, Ministry of Defence, Press Information Bureau, 3 December, 2021, please click here to access

Expressways, airports, AIIMS: Yogi government’s big infra race before polls -Maulshree Seth, The Indian Express, 27 November, 2021, please click here to read more 

PM Modi to launch Rs.6300 crore projects in Bundelkhand region of Uttar Pradesh -Haidar Naqvi, Hindustan Times, 18 November, 2021, please click here to access

Dried Wells, Broken Dams, Distressed Villagers Define UP's Multi-Crore 'Bundelkhand Package' -Dheeraj Mishra, TheWire.in, 27 October, 2021, please click here to access 

No one needs the Ken-Betwa Link Project -Himanshu Thakkar, The Indian Express, 8 April, 2021, please click here to read more 

 

Image Courtesy: UNDP India
 



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