A couple of years after I first entered the Lok Sabha, a discussion with some development sector practitioners and a leading political journalist and other MPs led to the birth of the Citizens’ Alliance Against Malnutrition. While so much is said about the inability of politicians to work together on any issue, here was one that met with the approval of MPs from all parties: the critical issue of child malnutrition, a challenge that needs to be tackled immediately and collectively. According to Unicef data, one out of every three malnourished children in the world is in India.
Over the last few years, some of us have realised that we could channelise the enthusiasm and energy of young MPs and work with other stakeholders to eliminate hunger and malnutrition from India. As part of the Alliance, we have travelled to remote corners of the country to get an insight into how we are faring in this war and what could be done to better our efforts. It was important for us to observe the functioning and delivery of the schemes run by the states and the Centre. Most of these were surprise visits and I am happy to report that anganwadi centres exist in almost all parts of the nation. Our interactions with local communities have, however, made us wonder if young pregnant women have adequate and easy access to information on nutrition and counselling for pregnancy-related issues.
It is widely acknowledged that any nation with a large number of hungry and malnourished individuals cannot flourish as an economy. The current economic climate makes this an even more pressing problem. As the world economy gravitates further towards recession, health and education sectors should not suffer. Historically, emerging economies have cut expenditures in these sectors as a way of dealing with financial crisis.
Many parts of India suffer from both hunger and malnutrition, resulting in some of the highest under-five mortality and maternal mortality rates in the world. The 2005-06 National Family Health Survey showed that 20% of children under five years of age were wasted (acutely malnourished) and 48% were stunted (chronically malnourished). The problem here is that a malnourished child does not attract the same kind of attention or care as a physically challenged child does because she appears normal, especially if other children in that age group also appear to be physically similar. How often do we see children with bloated bellies and stick-like legs and yet remain unconvinced about remedial action because they are seen to be normal?
The reasons for the wide prevalence of this problem include bad feeding practices (a narrow focus on carbohydrates), low awareness about balanced diet, lack of availability of certain categories of food in parts of the country, inadequate advice from healthworkers, only partial success of programmes to tackle malnutrition and under-nutrition (because of corruption), inadequate budgeting for child development programmes, and a rather troubling limited focus on nutrition as arising only from food (ignoring sanitation, clean water, iodised salt, etc).
A report called ‘Hungama’ (HUNGer and MAlnutrition) by the Naandi Foundation, which will be released on Tuesday, brings out important facts that should be addressed to tackle these problems. This survey, for the first time, has captured the voices of nearly 100,000 mothers and covers district-level data of 100 districts. The data shows a positive change in child nutrition in India but also suggests that rates of child malnutrition are still unacceptably high in many parts. At the household level, malnutrition starts very early in life for many children. In fact, I believe that malnutrition starts in the womb of the mother itself. An under-nourished woman is certain to deliver an underweight baby. As one would expect, this problem is more acute among children from low-income families. However, it should also be noted that rates of child malnutrition are significant among middle and high income families too. The girl child is worst off as gender discrimination is common when it comes to allocation of food resources. We must focus on the needs of young mothers and the girl child if we want to seriously tackle hunger and malnutrition.
While there has been many successful interventions to eliminate hunger and malnutrition, we must now focus on some easy ways to implement some cost-effective methods. The multiple government schemes could be integrated into one single nutrition plan for children, women and marginalised groups. The focus on early years of a child’s life is critical — giving colostrum to the newborn and exclusive breastfeeding for the first six months of a child’s life can make a huge impact.
It’s surprising that in a country where traditionally there has been an emphasis on mother’s milk, we have forgotten the value of this precious gift. We must reinforce the advantages of breastfeeding.
Financial security for poor households is also critical in protecting them from hunger and starvation. All these solutions, however, are ineffective if we do not have the latest data, especially in districts where the problem is severe. We have to strengthen our ability to routinely and accurately capture data on nutrition at all administrative levels. An important partner in our fight against hunger and nutrition is the anganwadi worker — this group is doing an incredible job, but we must improve their capacity to work in the field through better training and equip them with technology to capture better data.
The government is serious in its efforts to eliminate hunger and malnutrition, but needs the support of multiple stakeholders — international organisations, NGOs and civil society. The Food Security Bill has a number of provisions that will tackle some of these problems. While it may take some time for this to become a reality, we must not forget that there are few countries in the world, if any, that have made access to food a right for every citizen.
The Alliance hopes to rope in various states and initiate large-scale programmes to demonstrate how we can reverse malnutrition. It is reassuring that this effort has got support from across the political spectrum and perhaps is in some way a small demonstration of how despite opposing political ideologies and electoral rivalry, politicians can rise above their differences and align to champion a cause that will lead to a healthier and happier generation of Indians. Together, we hope that we can make a positive and tangible impact on the millions of children and young adults who are suffering from lack of adequate and good quality food.
Sachin Pilot is minister of state for telecommunications and IT and a member of Citizens’ Alliance Against Malnutrition
The views expressed by the author are personal