Mumbai: As a national debate rages over the Indian poverty line, in the heart of Bandra, one of Mumbai’s richest suburbs, in a shanty with barely enough standing space for two adults, three-year-old Priya Doiphode , clad in a red T-shirt, lies listless on a string bed.
Priya is one of the 78,856 children in Mumbai?who?are?malnourished, according to government data—a statistic that makes Mumbai the most malnourished of India’s six biggest cities.
Priya weighs less than 10kg, perilously close to being severely underweight. According to classifications used by the World Health Organization that India also uses, Priya is malnourished or, more specifically, undernourished.
In the illegal wood-brick-and-sackcloth settlement of Indira Nagar, known as Pipeline to locals, a well-nourished child is as hard to find as a toilet. Like many Mumbai slums, Pipeline is a breeding ground for infectious diseases, which strike children more than adults.
Houses in Pipeline are built on wooden planks placed on a giant pipeline ferrying water to the city. Close by, an open gutter flows. Many children are born at home, and the squalor strikes them hard, says resident and railway coach attendant Dilip Shantaram Satpal (33), whose nephew Ritesh (8) has not grown in height over the past three years.
Bandra is where the brightest and richest of Mumbaikars stay, where many of India’s largest companies have their head offices. The heaving, bustling suburb represents to Mumbai what Mumbai represents to India and India to the world: a striking contrast between rising economic prosperity and stagnating rates of malnutrition.
About one-third of Mumbai’s children are undernourished. Not only is this the third highest proportion of such children in Maharashtra, it is more than the neighbouring tribal lands of Thane and Nashik, infamous for grinding poverty and malnutrition deaths. The proportion is most in the state at Nandurbar (42%), followed by Gadchiroli (37%); Amravati ties with Mumbai (29%.)
The bad news is that malnourishment in Mumbai could actually be worse than the figures show.
Official statistics likely underestimate malnutrition, based as they are on data provided by the Integrated Child Development Services (ICDS), a government child-care programme that reaches only a quarter of children in the city’s slums.
Despite three decades of growth averaging 6%, India still has the highest number of malnourished children in the world. Nearly half the world’s underweight children are Indians.
“With rapid economic growth and little progress in banishing under-nutrition, India is an economic powerhouse and a nutritional weakling,” wrote Lawrence Haddad, director, Institute of Development Studies (IDS), UK, in a 2009 paper on under-nutrition in India.
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India’s neglect of public health since independence is a major reason why health and nutrition indicators lag behind the decline of poverty. With public health expenditure at 1% of gross domestic product, India ranks a lowly 171.
If India leads a “Dr Jekyll and Mr Hyde” existence, as Haddad puts it, Mumbai presents the most vivid reflection of such two-faced development.
The brighter side: Priya with her father Santosh and her mother in the background. Photo: Hemant Mishra/Mint
Per capita health expenditure in Mumbai is Rs210 per year, less than the national average of Rs245. While there is a universal health scheme for rural areas, there is none for urban slums.
A proposed National Urban Health Mission is still to see the light of day. The 150-odd health outposts in Mumbai serve little purpose other than as immunization centres. Family visits are rare.
Increasingly recognized as a leading national malnutrition hub, Mumbai is the only metropolitan city to figure in a list of 158 high-burden districts affected by malnutrition nationally, according to the Women and Child Development ministry.
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The problem with achievement
But this is not a story about grinding poverty.
The city of gold, as Mumbai is often called, offers employment to locals and migrants, who accepted a hard life in return for a decent income. Many are part of India’s continuously growing informal sector, offer a variety of services—as taxi drivers, cooks, domestic servants and housekeeping staff—and have, statistically at least, clambered into the growing middle class.
In slums such as Pipeline, the average daily wages are more than Rs200, which means the daily per capita income of a family of five is Rs40 or Rs80, depending on whether there are one or two wage-earners. At Rs80, the average income is 100% higher than the official urban poverty line of Rs32. That slots them just below the lower middle class, which consumes $2 (Rs98) to $4 (Rs196) per person per day, according to a 2010 Asian Development Bank report.
Yet, most cannot think of owning a house and are forced to live in congested slums without sanitation. Slums account for 78% of the city’s population, according to the latest census figures.
Studies show how women and children bear the brunt of this darker side of urbanization. Children under five in the slums of Mumbai, compared with children in non-slum areas, are 40% more likely to be underweight and 14% more likely to be stunted, according to National Family Health Survey data.
The parents in Pipeline may be lower-middle class, but they work long hours to stay there. They are ignorant of the right feeding practices and endure unsafe water and limited sanitation, which spread infectious diseases and exacerbate the effects of under-nutrition.
Priya’s father, Santosh Ramdas Doiphode, is an electrician and her mother a maid. Together, they earn more than Rs8,000 a month. Like most people in Pipeline, they are not officially poor and do not have ration cards to buy subsidized food. They can afford food, but not healthcare.
Like many other malnourished children in the city, Priya frequently suffers from diarrhoea. “Jab mitti khati hain, bimar parti hain (she falls ill whenever she eats mud),” says Doiphode.
Doiphode says his daughter has “sukha“, or dryness. He relies on a “vaidya“ (traditional medicine practitioner), who advised a garland of garlic.
Recourse to quacks is a testament to inadequate healthcare in a city famous for its super-specialty?hospitals.
There is an overburdened public hospital in Bandra, with long, snaking queues. For common ailments, locals frequent quacks and “bees-wallah doctors” (doctors who charge a fee of Rs20).
Parveen Sheikh, the mother of Faizaan, another malnourished child of Pipeline, prefers to consult such “bees-wallah doctors” in neighbouring Naupada when her daughter falls ill.
Some of the “bees-wallah doctors” in Naupada have been trained in alternative medical practices such as Unani. Others are “self-trained”!
Doiphode says his daughter likes to have tea and bread pakoda from a nearby stall but has little appetite for home-cooked food, a story repeated in several other families.
The high prevalence of infectious diseases and child malnutrition is part of a vicious circle. Undernourished children have lower immunity, making them susceptible to infectious diseases. Children who are ill suffer from low appetite and have limited ability to absorb nutrients, raising the risk of under-nutrition.
The burden of infectious diseases per person in India is extraordinarily high and 15 times the burden in the UK, contributing to one-third of the disease burden in India, according to a research paper by Indian epidemiologist T. Jacob John and others published in a 2011 Lancet special series on health in India.
John, a former professor at Christian Medical College, Vellore, said India’s failure to stem the prevalence of such preventable diseases is because of inadequate public health facilities, which include safe drinking water, sanitation, vector control and waste disposal.
(This special report on malnutrition is the result of a fellowship jointly awarded by “Save The Children” and Mint. To know more about Save the Children: www.savethechildren.in)
Next: Why the world’s largest child-services scheme cannot stop Mumbai’s malnutrition deaths.