Dahod, Gujarat; Mokhada, Maharashtra: In the last 15-16 years, Jhaluriben Baria has had eight children, two of whom died within five days of their birth. Her youngest child Heera Gopabhai Baria, a boy, is seven months old.
The infant is ensconced in a plastic sack strung across two sticks at the entrance of their house in Panchyasan village in Devgadh Baria block of Dahod district, Gujarat. Playing alongside is his sister, Premilaben Baria. At four years of age, Premila’s height is that of a two-year-old, her legs are short and slightly bent, her stomach protrudes and she struggles to walk.
Two years ago, Premila, severely undernourished, was finally admitted to the nearby Godhra government hospital, as she was too weak to even sit up. Her father Gopabhai Baria had refused to admit her to a hospital and relented only after Pradeepa, representing Anandi, a non-profit, pressurized him. “I had to agree to his condition that if anything happened to Premila, it would be my responsibility,” recalls Pradeepa, who uses only one name.
Though Premila is much better now, her parents are following the same routine with Heera, who is visibly undernourished, still fed only his mother’s milk.
Heera’s case is compelling as it is not in isolation. Nearly two million children in India don’t celebrate their sixth birthday. Among those who do, 61 million are severely undernourished and, hence, too small for their age; of them around 20 million die.
The Mokhada block in Thane district in Maharashtra is on the frontiers of the Deccan plateau. Here, water is scarce, the land is dry and the wells are almost empty. At a distance of almost every one kilometre, there is a cluster of three-four houses. Among the Adivasis or tribals that reside in this block, undernutrition among children is a common occurrence: So much so that these people have come to believe that this is how it should be.
In Pendkechiwadi village of Mokhada, Lalita Hanumant Baraf poses happily with her three children—two boys and a girl. Her younger boy is eating dry rice flakes from a steel bowl and though both boys are thin with protruding bellies, Lalita insists they are healthy and not undernourished. Her four-year-old boy weighs 12kg while the two-year-old weighs 7kg. As per the World Health Organization’s child growth standards, the two boys’ healthy weight should be 16kg and 12kg, respectively.
“Sometimes you might think that some symptoms are part of normal life. When the child is too weak, when the child is too sick, when the child is not gaining weight; mothers, fathers and the community need to know that that is not normal,” said Victor Aguayo, chief, child nutrition and development at the United Nations Children’s Fund (Unicef), India.
“But when in your community 50%, 60%, 70% of the children are underweight, stunted, wasted and anaemic, you might consider that normal because actually that is a norm,” he added.
For a country that is home to around one-fifth of the world’s children under five years of age, India accounts for 42% of the world’s burden of undernourished children according to Unicef, and has the highest levels of undernourishment in children below five years of age. The third National Family Health Survey (NFHS-3) 2005-06 shows that of the 20% under-fives in the country, 43% are underweight, 48% are stunted (chronically malnourished) and 20% are wasted (acutely undernourished).
More recent data shows that the situation has deteriorated. According to the 2009-2010 data of the women and child development ministry’s Integrated Child Development Scheme (ICDS), as on 31 December, only 54.16% children in the country are normal, the rest being either moderately or severely malnourished. Under nutrition in India is almost twice as high as that in sub-Saharan Africa.
The highest levels of undernutrition, according to NFHS-3 are found in Madhya Pradesh (60%), Bihar and Jharkhand (50%), Uttar Pradesh, Chhattisgarh, Orissa and Meghalaya (40%). Interestingly, Gujarat, one of the richest states in the country, had an undernutrition rate of 40%—suggesting that economic growth is no defence against undernutrition.
The death count due to undernutrition could be worse, since many deaths are attributed to symptomatic causes of undernourishment. “Under nutrition is an important factor contributing to the death of young children. If a child is malnourished, the mortality risk associated with respiratory infections, diarrhoea, malaria, measles, and other infectious diseases is increased,” states the NFHS-3.
More worrying, the levels of undernutrition have remained unchanged despite the acceleration of the Indian economy to over $1 trillion in size. Between the NFHS-2 (1998-99) and NFHS-3, surveys that were conducted with a gap of seven years, the undernutrition rate among children aged between 0 and 35 months was 43% and 40%. Over the same period India’s gross domestic product growth jumped from 6.7% to 9.5%.
Pushing growth alone won’t tackle this malaise, says Aguayo. “It is about how the economic gains trickle down and translate into policies that will address the major drivers of nutrition. Also, how women benefit from economic growth—are they empowered and are they able to make household and budget decisions?”