Each of the 88 families belonging to the Saharia tribe has lost at least one child to malnutrition in Bhairopura village in Madhya Pradesh’s Shivpuri district.
Dhaka Adivasi, 30, has three children and has lost six over the past decade. Two of 32-year-old Parvati’s five children died before the age of five. Anjana, 25, lost one baby last week, her third to die in as many years. Eighteen-year-old Malti’s first-born Lakshmi died a few days after she turned nine months old.
Most of the deaths happened between nine months and three years. All the children died of hunger—defined medically as severe acute malnutrition (SAM) which, directly or indirectly, causes for one in three under-5 deaths in India.
Countless mothers across India share the tragedy of Parvati and Anjana. Though the shockingly high number of children dying of malnutrition has put the spotlight on Sheopur and Shivpuri, hunger and malnutrition are chronic in many parts of India.
Poverty and social exclusion plays a big role, as does lack of information. Mothers feed their children the best they can, but their best is not enough. Most children are being exclusively breastfed till well past the age of 18 months, sometimes up to age 2.
Malnourished and anaemic, most women cannot nourish their babies, who waste away slowly and die while the mothers watch helplessly.
The cause of the children’s deaths, when certified, is listed as SAM, characterised by very low weight for height (below -3z scores of the median growth standards), visible severe wasting, or nutritional oedema (swelling from acute protein deficiency).
Over the past two months, 23 children have died of malnutrition in neighbouring Sheopur district, where the highly-publicised Nutritional Rehabilitation Centres (NRC) meant to save SAM children remain deserted.
Aganwadi workers and ANM (for auxiliary nurse midwife, or village health worker) bring visibly diseased children ages six months to 5 years to NRCs, where the children are admitted with their mothers for 14 days and given nutritional therapeutic care.
The mother is fed and trained in healthy nutrition practice and baby is discharged only after there is at least 15% weight gain over the admission day, which takes around two weeks. The children are followed up four times at an interval of 15 days over the next two months to ensure the weight gain continues and the child becomes healthy.
Reality, however, presents a different picture. Last week, the 20-bed NRC at Karhal had one occupant and another at Pohari had three women with children. In both places, the women had been admitted that day.
There was a spike in admissions in Karhal NRC over September following an outcry over malnutrition deaths, with SAM admissions going up to 302 in April-October 2016, compared to 239 in April 2015-March 2016, but the referrals dipped during the festive season of Dusshera and Diwali, when most aganwadi workers and ANMs were on leave.
“One woman was forcefully taken away by her husband today. Her baby was doing well, and had put on almost 300 gm over four days,” said Arti Pathak, feeding demonstrator, Karhal NRC. “Her husband said he’d bring her back, but we have three more children on their way.”
The newer and larger NRC ward at Pohari has sicker children and less enthusiastic workers. All three children weigh half of what they should: Dipika and Lalita are 15 months old and weigh 5kg and 5.05kg respectively, and 14-month-old Kamal Singh weighs 5 kg.
“These three just arrived, more should come over the week now that the anganwadi workers are coming back from leave,” says Suman Tomar, caretaker at the NRC.
The block medical officer has a different take on the low bed occupancy. “Mothers are given Rs 100 for travel, Rs 120 a day to compensate for lost earning, and Rs 220 for each follow-up, but they still leave. They don’t like it here, they like living in the jungle. They don’t care for their children like other people do,” explains Dr Pawan Korku, block medical officer, Pohari.
Sachin Kumar Jain, state advisor to Supreme Court Commission on Right to Food, however, points to other factors.
“More than half of the doctors’ posts are vacant, primary health system is not responding to the needs. It’s a chronic hunger situation and we need a commitment to ensure the availability and access to diverse local food in a sustained manner,” Jain says.
“There is urgent need to plan interventions to address the underlying and structural causes of malnutrition. The Madhya Pradesh government has not shown any willingness for making operational framework for community based management of malnutrition.”
When done right, under-5 malnutrition deaths can halve in hospital settings and by giving readymade therapeutic foods to women in community setting. “We give therapeutic packages to mother for the SAM baby when they leave, but they take it home and share it with the entire family, so it gets over in a day,” says Pathak.
In his Niti Ayog address last week, Microsoft-founder Bill Gates said, “If I had one wish that I can get rid of any disease, any health problem, I will pick malnutrition. That’s saying a lot because there are other challenges, such as HIV, malaria and TB. But malnutrition causes the greatest problem, not only for the child who dies but the kid who survives, who never fully develops physically and mentally.”
If India wants to make the most of its demographic edge, its young population must meet its nutritional and development indices.