Khandwa (Madhya Pradesh): Cradling a frail son on her hip and with a plastic bag stuffed with clothes in one hand, Tara Jadam walked into the rehabilitation centre inside the district hospital here to spend the next two weeks.
On a hot afternoon, she has walked several miles to catch a bus from her village 45 minutes away. She walked some more after she reached this town, arriving with a group of women who, like her, have sick babies in their arms. Feeling dizzy, she flops on the ground at the entrance, tries to breastfeed her child. The baby refuses to suckle.
With running fever and diarrhoea, he has rejected food the past whole week.
The Nutrition Rehabilitation Centre is one of the 200 free clinics that cater specifically to sick children, as Madhya Pradesh grapples with a new malnutrition news. An ongoing study by Hyderabad-based National Institute of Nutrition (NIN) suggests that there are far too many underweight children than these centres can handle. About half of 145,000 children surveyed in 29 out of 50 districts are malnourished, preliminary figures provided by a state official indicate.
Also listen to Prakash Michael, founder of Spandan, speaks about malnutrition and food security.(Download)
And the measuring scale confirmed Jadam’s fear: At 3.2kg and 52.5cm on the measuring tape, her seven-month-old is thinner and shorter than a healthy baby.
India’s record of tackling malnourishment in the last several decades has been described as “disappointingly low” by Prime Minister Manmohan Singh. Addressing the first National Council on India’s Nutrition Challenges in November, he said high rates of undernutrition will hurt the country’s progress in the long term. Malnutrition, combined with ailments such as diarrhoea, measles, pneumonia and malaria, has been India’s big infant killer. About 46% of children under three years of age are underweight, according to the 2005 National Family Health Survey (NFHS) report.
Also read | The previous parts of this series
On the ground, states such as Madhya Pradesh, which reports one of the country’s highest infant death rate, are battling to curb its effects. Madhya Pradesh is offering cash—Rs65 a day as wage compensation—to attract women like Jadam, a daily wage labourer, to sign up their infirm children for the two-week rehab programme. Soon after they arrive, the sick are fed a boiled concoction of coconut oil, milk and rice powder to gain weight.
At least 122,422 babies less than 12 months old have died in the state between April 2006 and January 2010, the state assembly was informed last year. Some 12% of the 6.5 million children suffer from Severe Acute Malnutrition, and whose chances of survival are slimmer if they fall sick, a government official said.
Combating hunger: (from right) Sukhiya Korku and her four-year-old son at the Nutrition Rehabilitation Centre in Khandwa children at an anganwadi in Patalda village. The government provides free meals in anganwadis, but these efforts have not been enough to prevent malnutrition.
News of malnutrition deaths continue even as India pushes to introduce a food security Bill in Parliament soon, a result of a decade-long Right to Food campaign built by a computer-savvy network of 2,500 advocacy groups. It has been pressing for entitlement rights and increase in food subsidy, even as grains continue to rot in government warehouses.
To combat hunger, India distributes free meals in anganwadis (government-run day-care centres) and schools across the country under the Centre’s Integrated Child Development Services, but these schemes have hardly been able to prevent under-nutrition. Free lunches can also be subjected to queer cultural whims as much as political hysteria, as the programme escapes quality regulation.
Last year, supply of boiled eggs was blocked in state anganwadis when the Jain communityobjected on religious grounds. In 2009, the Indian government banned United Nations Children’s Fund from importing an energy-enhancing peanut paste called Plumpy’nut, a ready-to-use therapeutic food (RUTF), accusing the international agency of running test trials without permission. Accepted as a standard treatment for malnourishment worldwide, Indian researchers, too, back the use of RUTF, indigenous or foreign. The government doesn’t have an alternative plan, derailing prevention programmes as it blocks official visits to?nations to learn more about RUTF’s efficacy.
Meanwhile, the state is now crafting an even more ambitious child project—the Atal Bal Aarogya Evam Poshan Mission. Launched in December and named after former prime minister Atal Bihari Vajpayee, it’s going to be a coordinated strategy to track malnutrition.
Researchers and advocacy groups, however, say low nutrition levels among the population can be linked to low priority to women’s well-being. Policies continue to heavily tilt towards the child of the future, bypassing an entire generation of women, whose overall health has a direct bearing on the child’s growth in the first place, they say. Apart from societal quirks such as excessive focus on the male child, policies look at women from their womb—as future or expecting mothers. Past efforts have made little dent in improving her overall status.
Despite running a patchy national programme for anaemia prevention since the early 1970s, more than half the women in the age group of 15-49 remain anaemic. The first district-wide haemoglobin estimation among pregnant women and adolescent girls was carried out for the first time as late as 2002. The prevention of anaemia, which is responsible for a high number of maternal deaths in the country, has been broadened to now include teenage girls under the National Rural Health Mission.
“There’s an excessive focus on women as baby-producing machines,” Biraj Patnaik, adviser to the Supreme Court-led Right to Food commission, says. “There’s an inherent gender bias.”
Newer researches throw new facts on malnutrition among women. A 2010 paper by Sunny Jose and K. Navaneetham in the Economic and Political Weekly highlighted how the lack of basic infrastructure affects a woman’s nutritional needs. With no toilet, women eat less during the day to avoid going to the fields to defecate, as they exhaust their energy collecting wood and water.
At least one-third of women suffer from chronic energy deficiency in India, according to NFHS. The paper, which looked at both rural and urban households across states, found that these incidences can reduce between a quarter and a half, if women have access to toilets and clean fuel.
True, women are also living longer. But the problem lies elsewhere: Out of the 26 mothers admitted at the rehab centre in Khandwa, only three owned ration cards to access food subsidy.
Jadam, for example, doesn’t possess a ration card, or a job card, which promises 100 days of work under the Mahatma Gandhi National Rural Employment Guarantee Scheme. She cuts wheat and grows onions in other people’s farms, earning Rs100 a day. During the wheat season, chances of getting this money peters out, as she gets paid in grains she harvests, often less than Rs100 worth.
Jadam prepares two meals for the family every day, mostly chappatis and repeat of vegetables such as potatoes and brinjal that she buys from the weekly market. Her alcoholic husband doesn’t work, while she forages for twigs and branches to cook before heading out to work.
“I eat, but after serving everyone I sleep hungry most days,” says Jadam, who complains of headache spells. Her children eats food at the local anganwadi, and out of pity, the staff also pass her leftovers after the children have eaten and gone home, she says.
Sukhiya and Asharam Korku have admitted two of their five children at the clinic. They don’t have an employment guarantee card either. Both scrape together a living by tripling as masons, road builders and farm workers. Their four-year-old son Kamlesh, whose tiny frame has ribs sticking out, is suffering from tuberculosis. A traditional doctor tried to cure the boy’s loss of appetite by placing searing hot coals on his swollen abdomen, leaving patterned scorch marks on the skin.
Sukhiya belongs to the Korku tribe here in these parts, where poverty is so perennial and illness so common, that they have a pantheon of deities dedicated to diseases from blindness to small pox. Among them is the god of “shrivelled body”, which is nothing but a “god of malnutrition”, says Prakash Michael, founder of Spandan Samaj Seva Samiti, an NGO fighting for food security in this region.
According to Michael, malnutrition can be traced to the drawing boards of policymakers, who never get their poverty numbers right, impacting food distribution in the country. The Planning Commission fixed the number of people living below the poverty line in Madhya Pradesh at 4.2 million in 2002. Since then, the state has increased this number to 6.7 million, reducing grain supply per family, he says.
The National Sample Survey Organization shows that average calorie intake in rural homes has dropped from 2,153 a day in 1993 to 2,047 in 2003.
In his second speech on nutrition in seven months, Prime Minister Singh stressed the importance of planting a wider crop variety such as millets to tackle what he called the “hidden hunger” of essential vitamins. Malnutrition is not the consequence, but also the cause of poverty, he said in February this year.
But here, in the heart of India, as market forces convert this region into a soya bean bowl, traditional foods such as millets that once formed part of the local diet have long vanished. Today, soya bean, and its oil cakes are exported from here. “Soya is a good protein source,” according to Avula Laxmaiah, NIN’s deputy director. But it isn’t advisable for a malnourished population to eat more than one-fifth of the total food intake, he says.
The monsoon months between June and September are the hardest for most families, when the wheat harvest is over and the next one hasn’t come, a time when people borrow grain from neighbours, says Michael.
This is also the time when the rehab centres get crowded with infants, as their mothers squat on the hospital floor to breastfeed between servings of formula food.
“The irony is that malnutrition is coming in and nutrition is going out,” says Michael. “You can find your Ethiopia in Madhya Pradesh.”
This is the fourth part of a six-part series that examines key challenges faced by women throughout India and attempts to overcome them, drawing on experiences in Madhya Pradesh, which has among the worst indicators in the country as far as women are concerned.
Photos by Priyanka Parashar/Mint