Imagine that India has managed to fulfil its cherished dream: a permanent seat at the United Nations Security Council (UNSC). The country’s robust growth and growing international clout finally enables it to join the big boys club—that of the “permanent five” at UNSC. That, however, would be only an aspect of a more complicated reality. Another UN body—the UN Children’s Fund, or Unicef—would continue to point to an unhappy truth: The large-scale prevalence of anaemia in women in the age group 15-49. More than half of them are anaemic.
An anaemic mother is quite likely to deliver a baby who is underweight, and stillbirth is one of the deadliest consequences of anaemia during pregnancy. India’s maternal mortality ratio (MMR) is 10 times higher than that of China. According to another UN report, India’s MMR is worse than that of Pakistan. “Per 100,000 live births, 320 mothers die in Pakistan as against India’s 450”.
Not many nations in the world can boast of practising as many programmes and schemes for women’s welfare as India can do. The Union government, 28 states, and seven Centrally administered territories have multiple agencies working on women’s health and nutritional issues. Yet a whopping 55.3% Indian women suffer from anaemia of some kind or the other.
That means, nothing has worked—government programmes, economic growth, non-governmental organization activism, and Unicef and World Health Organization initiatives. If nothing has worked so far, and we continue with the programmes we already have, where is India headed to before it actually joins the elite club at the UN?
Or, we have got things badly wrong, and treating dengue for malaria or vice versa. Most stakeholders identify one common factor behind the majority of Indian women being anaemic—poverty-driven unavailability of nutritious food. Granted, poverty can certainly be a factor. But to what extent? What if India eliminated poverty completely? Will India still have addressed the issue of anaemia hitting majority of Indian women?
The National Family Health Survey-3, 2005-06 (NFHS-3)—the bible of the public policy aficionados, which shows 55.3% Indian women as anaemic, has another set of data staring at the collective wisdom of health policy experts. NFHS-3 shows that 46.1% women belonging to the wealthiest quintile—top 20% households—are anaemic, too. Among moderately rich—or the second quintile— 52.2% women are anaemic.
Faced with this set of NFHS-3 data, what do we do? If the top two quintile—40% of India’s households—cannot escape anaemia, how are we going to solve this problem among the poor? To decode this puzzle—let’s examine as why rich women are anaemic, too.
Humans receive nutrition from three food sources—cereals, dairy products/fruits and meat/vegetables. Medical sciences propose the view that the cereal/veg-based diet brings down body’s iron absorbing capacity. Non-veg, on the other hand, enhances body’s ability to absorb iron and vitamins, protein minerals etc., greatly.
But NFHS-3 data shows that only 36.7% women in the richest quintile ate meat/chicken/fish at least once in a week. Overall, 35.1% women never ate meat/ chicken. The idea here is not to pitch non-veg against veg food. Assuming for the time being that veg-based food regime is as good as non-veg, or even better in terms of rich nutrition source, let us see what do the women in the wealthiest quintile eat.
The NFHS-3 data shows that, among the wealthiest quintile, at least once a week intake of milk/curd, fruits, dark-green leafy vegetables was at 74.8%, 71,8%, and 93.8%, respectively. While NFHS-3 has no data on a daily food intake on wealth index basis, the report gives some idea about the overall population. To NFHS-3, daily intake of milk/curd, fruits, and dark-green leafy vegetables is at 39.8%, 12.7%, and 64.2%, respectively.
The wealthiest, who can afford even the most expensive veg food, are not eating well. Is there a caste-regulated hierarchy even in food where certain food sources are stigmatized?
Gajar mooli samjha hai kya mujhe (you mistook me for carrot and radish!) goes the saying in the entire Gangetic belt. Sag, pat khila diya (served us leafy vegetables and wild grass) is another metaphor. Examples can run in several dozens where certain food sources are stigmatized. Ask a dietician about nutritional virtues of carrot, radish, and dark-green leafy vegetables to find out as why nearly half the rich women are anaemic. The NFHS-3 data validates this understanding.
The NFHS-3 data is no Alfred Hitchcock’s psychological thriller where every next scene is unpredictable. To the NFHS-3 data, 58.3% Dalit women are anaemic, which is lower than the last two quintiles—64.3% and 60.3% women, respectively, are anaemic. Dalits are marginally behind the second quintile-moderately rich Indians, where 52.2% women are anaemic. By all accounts, Dalits will be far behind the rest in incomes, but in terms of the curse of anaemia, Dalit women are better than the last two quintiles—40% of India’s population, simply because Dalits don’t observe any food taboos.
The big question—how come the people who foresaw that globalization is not a threat, but an opportunity, and unleashed massive wealth generation phenomenon in India could not decipher the basic grammar of the Indian society—that certain social classes, despite their wealth, don’t eat certain foods because of the caste-driven food morality, and bring shame to India.
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Chandra Bhan Prasad is a writer and one of India’s leading Dalit thinkers.