People's Democracy

Malnutrition of Children – Should The Govt Not Feel Ashamed?

K Hemalata

PRIME Minister Manmohan Singh has lamented the high levels of malnutrition among the children in the country and called it a ‘national shame’. It is indeed strange that it took a report of a study by a corporate NGO to rouse the indignation of the prime minister about the unacceptably high child malnutrition in our country. Many earlier reports including those of government agencies have established the fact that, despite the rosy picture sought to be painted through the GDP figures, the real health of the country as reflected by the conditions of children, and of the women who give birth and nurture them, is depressing. What is really a matter of shame is that the government, boasting of the growth of dollar billionaires under the neoliberal policies has turned a blind eye to the health of children and women.

As per the National Family Health Survey (NFHS – 3) conducted in 2005 -06 by the ministry of health and family welfare, 46 per cent of the children in our country were underweight. Data from the UNICEF show that 47 per cent of the children under three in India are underweight; around one third of the world’s malnourished children live in India. NFHS -3 also found that the percentage of children aged 6 – 35 months suffering from anaemia has actually increased to 79 per cent from 74 per cent in NFHS – 2 (1998 – 99). Prevalence of anaemia increased from 52 per cent to 56 per cent among married women and from 50 per cent to 58 per cent among pregnant women during this period. NHFS – 3 also shows that 38.4 per cent of children below three years of age are stunted, i.e. too short for their age and 46 per cent are wasted, i.e. too thin for their age. Prevalence of malnutrition is significantly higher among children from poor families, particularly those belonging to SC, ST and Muslim households. Such is the condition of the children and women in our country, 64 years after independence; clearly children are not in the priority list of the rulers who dream of the country emerging as a global economic power under the neoliberal regime.

Was the prime minister not aware of these facts all these years? Has it suddenly dawned upon him that ‘ we cannot hope for a healthy future for our country with a large number of malnourished children? ’ Why were effective measures not taken to improve the conditions of our children?

One of the major interventions that the government made to address the high incidence of infant mortality, maternal mortality, child malnutrition, anaemia etc was the Integrated Child Development Services (ICDS) programme. The ICDS was started experimentally in 1975 and has established its efficacy, as revealed by several studies including by National Institute for Public Cooperation and Child Development (NIPCCD), National Council for Applied Economic Research (NCAER), UNICEF etc. But the government failed to take measures to realise its full potential by allocating adequate funds. It has been administering it on an ad hoc basis. India spends less than one per cent of its GDP on public health and much less on child welfare. In fact, the 2G spectrum scam alone accounts for more than 17 times the meagre allocations to ICDS.

The prime minister heads the National Council on India’s Nutrition Challenges, but no concrete measures were taken to address the serious challenge of malnutrition. On November 28, 2001, the Supreme Court directed the government to universalise ICDS and provide all the services of ICDS to all children below six years and all pregnant and lactating mothers. Virtually nothing was done by the government till 2004 when the Supreme Court ordered to increase the number of anganwadi centres to 14 lakhs for universalisation. Though not at its own initiative, the government ultimately sanctioned the needed anganwadi centres. But even today, more than ten years after the Supreme Court order for universalisation, more than 1,10,000 anganwadi centres sanctioned on paper remain non operational. In more than 73,000 ‘operational’ centres, anganwadi workers have not been appointed. Around one-third supervisors’ posts have not been filled up.

Even after the so called ‘universalisation’, as per government records,  less than half of the total of 16 crores children below six years in our country are covered by the ICDS. The spread of anganwadi centres is uneven. While new centres are being opened where already anganwadi centres exist leading to crowding, there are no anganwadi centres in many areas, particularly where SC/ ST population predominates.

The conditions of anganwadi centres continue to be pathetic. Most of the anganwadi centres do not have own buildings and many, even today, function from open spaces. Nearly half do not have toilet and drinking water facilities. On the pretext of community participation, food supply, preparation and distribution are being privatised resulting in irregular supplies of food which is often inadequate and of bad quality, unfit for consumption and disliked by the children. The type of community participation being practiced results in harmful intervention in the functioning of anganwadi centres by a host of people including NGOs, local political leaders, panchayat members, ‘Mothers’ committees’, self help groups etc leading not to improved service delivery but harassment of the anganwadi employees and deteriorating functioning of the centres.

BIZARRE

ARGUMENT

A bizarre argument has been put forward by a representative of the NGO who conducted the study that malnutrition in India was not due to poverty or hunger but is about ‘eating and feeding practices’. Even at the officially defined poverty line, which is ridiculously low, 31 crores of our people are shown to be poor according to the Human Development Report of the Planning Commission. The overall per capita intake of calories and pulses has come down during the neoliberal regime.  India is placed at 67th position in the Global Hunger Index (GHI) out of the 84 countries ranked by it. GHI scores countries on the basis of the proportion of undernourished population, proportion of underweight children under five and the mortality rate of children under the age of five. As per the India specific survey in 2008 that covered 17 states with 95 per cent of the country’s population, no state in the country is exempt from hunger, including the states like Punjab which is considered to be rich. In 12 states, the situation was ‘alarming’ while in Madhya Pradesh it was ‘extremely alarming’. With the escalating prices of food articles including pulses, eggs, meat etc since then, families are not able to afford nutritious food. Children in these families are fed ‘almost all carbohydrates’ out of the desperate need to feed them something to somehow keep hunger at bay and not by choice. In such cases, what is immediately necessary is to bring people out of poverty by providing decent jobs; to provide them some immediate relief by strengthening the public distribution system that provides cheap food, not only rice and wheat but also pulses, edible oils, etc at cheap prices and ensuring regular supply of nutritious food in adequate quantities to all the children, pregnant and lactating mothers at the anganwadi centres. Information, education and communication programmes involving corporate houses and film stars may generate hype but would not yield results at the ground level.

STRENGTHEN

ICDS

The cat is out of the bag when the prime minister reveals the hidden agenda by saying ‘we can no longer rely solely on ICDS to fight malnutrition’. Since the advent of neoliberal policies, the government has been trying to privatise ICDS and somehow divest itself of its responsibility. In the name of community involvement, supply, preparation, distribution of supplementary nutrition and management of anganwadi centres are being handed over to panchayats, self help groups, mothers’ committees, NGOs (including the corporate NGO that conducted the present study) and even big corporate houses like Vedanta  as reported in the press. This has worsened the functioning of the anganwadi centres, not improved them in any way. In several states, nutrition centres, nursery centres etc are being opened on temporary basis by different government departments just in the vicinity of anganwadi centres catering to the same children and creating unhealthy competition for the same beneficiaries and resulting in wastage of public money.

The anganwadi workers and helpers, the most vital functionaries of ICDS at the grass root level, the ‘backbone of ICDS’, are treated most shabbily. While their workload is being increased by allotting all sorts of village level work of different government departments, often unrelated to ICDS, they are not even paid minimum wages. The government refuses them to provide any social security benefits like gratuity, pension etc on the plea that they are only ‘social workers’, even as it forces them to ‘retire’ on reaching 58 – 60 years after working for 30 – 35 years. Very often they are at the receiving end for the failure of the government administration in providing the benefits at the anganwadi centres.

Reacting to the findings of the report, the women and child development (WCD) minister said that the ministry plans to ‘restructure’ ICDS. Any restructuring of ICDS should be to strengthen it through adequate budgetary allocations but not for its privatisation. It is regrettable that while the revised plan outlay for ICDS in the 11th Five Year Plan was Rs 72, 877.52 crores, only around half this amount was allocated for the entire period. The WCD minister said that her ministry has asked for an allocation of Rs 2 lakh crores for ICDS for the next five years for improving its functioning and infrastructure facilities. Considering that the revenue foregone through tax concessions for the few corporates and the rich in the last three years alone was a whopping Rs 14,28,028 crores, this amount for the benefit of the 16 crores children and crores more pregnant and lactating women should not be denied by the finance ministry. Besides, financial allocations should also be made for the regularisation of anganwadi employees, providing them minimum wages and social security benefits including pension etc.

It will truly be a national shame if an important scheme like ICDS, which holistically addresses the serious problems of malnutrition, infant and maternal mortality etc plaguing our country, is restructured/abandoned by the government at the behest of corporates and NGOs. If the prime minister sincerely feels that such high incidence of malnourishment and stunting among our children is unacceptable and a ‘national shame,’ he should take immediate steps to ensure that adequate financial resources are allocated to ICDS in the ensuing budget.