Poor care: India accounts for 3 out of every 10 stunted children globally

By Moin Qazi*
"We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer ‘Tomorrow,’ his name is today." ― Gabriela Mistral
A recent alarming signal in the health profile of Indian children went largely unnoticed. India, whose growing prosperity has hardly made any significant dent into chronic malnutrition of children, slipped three places to 100 in the 2017 Global Hunger Index (GHI) of 119 countries in which it has consistently ranked low .India has historically fared poorly on child nutrition indicators and has been plagued by periodical waves of malnutrition-related deaths in tribal areas.
With 17% of the world’s population, India is home to a quarter of the world’s hungry. A population almost the size of Uttar Pradesh remains hungry every day. It is a tragic irony that while it has made impressive gains in foodgrains production this has not been p[parlayed into any significant improvement in elimination of hunger. The Food and Agriculture Organisation (FAO) of the United Nations, in its report titled, ‘The State of Food Security and Nutrition in the World, 2017’ depicted a grim picture — a staggering 190.7 million people or 14.5 per cent of the population is undernourished in India. .The dismal health of Indian women and children is primarily due to lack of food security. Food security exists when all people at all times have physical, economic and social access to safe, adequate and nutritious food that meets their dietary needs for a healthy and active life. Malnutrition affects women more than it affects men due to the specific nutrition needs of women during adolescence, pregnancy, and lactation;
India is the leading producer of milk with the largest buffalo population, the second largest producer of vegetables, fruits, and fish. Despite this, it has failed to vanquish hunger. Nearly one-third of adults in the country have a Body Mass Index (BMI) below normal just because they do not have enough food to eat.

• Of all Indian children under five,one in three (35.7%) is underweight(low weight for age),
• one in three (38.4%) is stunted (low height for age),
• one in five (21%) is wasted(low weight for height),
• only every second child exclusively breastfed for the first six months,
• 3,000 children die every day from poor diet-related illness,
• fewer than half of all Indian children start nursing within their first 24 hours, although breast-milk helps to protect infants against infection.

This is worse than many sub-Saharan countries. Overall, India accounts for more than three out of every 10 stunted children globally. This is largely owing to a lack of quality food, poor care and feeding practices and inadequate water, sanitation, and health services in the country. The chronic impact of stunting on lifelong learning and adult productivity, in addition to increased disease susceptibility, is well known. Going by NFHS-4 results, it appears that 40% of our future workforce will be unable to achieve their full physical and cognitive potential.
Many children are born to anemic and malnourished teenage mothers. Indeed, 33.6% of Indian women are chronically undernourished and 55% are anaemic. The loss of gross domestic product to anaemia was estimated at $22.64 billion (Rs 1.50 lakh crore) in 2016, more than three times the health budget of the country for 2017-18.
According to the “India: State-level Disease Burden Report and Technical Paper”, the disease burden due to malnutrition dropped in India substantially since 1990bt but was still responsible for 15 per cent of the total disease burden in 2016 and was 12 times higher than in China.
The well known development economist Jean Dreze argues that the most serious nutrition challenge in India is to reach out to children under three years of age: “It is well known that if a child is undernourished by age three, it is very difficult to repair the damage after that.” The costs of failing to do so—both in human and economic and terms—are huge. Pervasive long-term malnutrition erodes the foundations of the economy by destroying the potential of millions of infants. Children stunted on account of malnutrition are estimated to go on to earn an average of 20% less as adults. Many of them will turn out to be morons.
Much less investment is required to maintain adequate nourishment for children than is required to repair broken children. A package of basic measures—including programmes to encourage mothers to exclusively breastfeed their children for up to six months, fortifying basic foods with essential vitamins and minerals and increased cash transfers targeted at the poorest families—can turn the tide.
India already has two robust national programmes addressing malnutrition—the Integrated Child Development Service (ICDS) and the National Health Mission—but these do not yet reach enough people. The delivery system is also inadequate and plagued by inefficiency and corruption. Some analysts estimate that 40% of the subsidized food never reaches the intended recipients.
Most child deaths in India occur from treatable diseases like pneumonia, diarrhea, malaria and complications at birth. The child may eventually die of a disease, but that disease becomes lethal because the child is malnourished and unable to put up resistance to it .The staff of ICDS places part of the blame of malnutrition on parents being inattentive to the needs of their children, but crushing poverty forces most women to leave their young children at home and work in the fields during the agricultural seasons.
A significant cause of malnutrition is also the deliberate failure of malnourished people to choose nutritious food. One survey by the economists Duflo and Banerjee has found that, overall, the poor in developing countries had enough money to increase their food spending by as much as 30% but that this money was spent on alcohol, tobacco, and festivals instead.
The good news is that there are bright spots on the horizon. Progress is still slow and the political will patchy but there are signs that a sensible stewardship is emring.. India’s official think tank NITI Aayog has drafted a National Nutrition Strategy that aims to eradicate malnutrition from the country by 2030.With this end in view it has set the following targets:To reduce under nutrition in children (0-3 years) by 3% per annum until 2022.
To reduce the prevalence of anemia among young children, adolescent girls and women in the reproductive age group (15-49 years) by one-third of the NFHS 4 levels by 2022.
Some other recommendations are for programmes to promote breastfeeding for the first six months after birth, universal access to infant and young child care including ICDS and crèches, provisions to provide bi-annual critical nutrient supplements and programs aimed at de-worming children. In the area of maternal care, the strategy proposes that the government provide nutritional support—in particular, the adequate consumption of iodised salt—to mothers during pregnancy and lactation. There is also an urgent need of good quality universal free school meals for all primary children.
These policies can reap the desired dividends if the government sets hard coded timelines and maintains stringent monitoring. Good intentions have to be accompanied be accompanied by similar actions on the ground.
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*Author of “Village Diary of a Heretic Banker”