Bihar improves on malnourishment, poverty but schemes falter on ground

About 50.54 percent of Sapaul’s population is poor, as per multidimensional poverty index released by Niti Aayog in 2023.

On a recent morning at Sadanandpur village in Sapaul district of Bihar, Sarita Devi is cradling in her arms her two-year-old daughter Pinki, who is smaller than her age would suggest, her skin stretched tight over bones. Pinki is at an age when she should be walking and running; but most of the time, she just sleeps in the arms of her equally weak mother.

People wave during an NDA election rally in Lakhisarai. (X)

Opposite Devi’s hut is a ramshackle single-storey concrete structure with a roof , but no walls, surrounded by paddy fields; this is the hot meal distribution centre (anganwadi). It is not operational due to rains and is being used to dry clothes. “No children have come today due to rains,” explains Devi who serves as the centre’s cook. She is paid ₹1,200 every month and she cooks the food for children at her home.

Devi and Pinki, both anaemic and underweight, are trapped in the cycle of poverty and poor health in one of India’s most malnourished states, where about 41 % of children are underweight, 43 % show stunting (low height for age), and nearly 23% are wasted (low weight for height), according to National Family Health Survey of 2019-20.

Devi’s village falls in the Saraigarh block and has dubious distinction of having most malnourished children in Sapaul district, which, according to data provided in the Lok Sabha on July 25, has the highest proportion of underweight children in the state. Around 30% of the children in the district are underweight as compared to 24.09% for the state and about 43% are stunted as compared to 48% for the state.

To be sure, a comparison of two NFHS surveys (2015-16 and 2019-21) shows that Bihar has improved on two parameters --- the proportion of stunted (from 43% to 36.8%) and underweight (41% to 35.8%) children --- and deteriorated on two others, the proportion of wasted children (20.8% to 21.6%) and those with anaemia (from 63.5% to 69.4%).

Despite the improvements, the NFHS surveys show that Bihar has the highest share of underweight children in India followed by Gujarat. Bihar also ranks the second highest in anaemia in the 15-49 age group after Gujarat. Around one fourth of women in this age group have lower than normal body mass index (BMI), indicating nutritional deficiency that passes from mother to child.

Devi, 32, is from the cobbler Dalit community that is part of the extremely backward communities, with limited access to quality food, healthcare and education due to age-old poverty, and is anaemic and underweight. Her husband, Ramji Sardar, works as a migrant labourer in Punjab and just earns enough to run the house. “We don’t have much land here. So, I go to Punjab to work in the paddy fields. That is seasonal work,” Sardar said. Back home Devi has to take care of the household, small farmland and their three children including Pinki and works in farms of local farmers. “Government gives free ration, which feeds us,” said Sardar, in support of Bihar chief minister Nitish Kumar.

He added that they don’t have enough money to buy nutritional food and are dependent on the anganwadi centre for 40 children for providing one decent meal to Pinki.

“They cook small amounts of pulses and sometimes give a bit of milk to children,” said 14-year-old Radha, a village girl, who runs away as soon as anganwadi centre in-charge Dulari Devi arrives. Interestingly, Dulari Devi has no clue about the food being cooked and served to children. As she is saying this, her husband Amit Kumar butts in and says proper food is cooked and served to all children.

“About 40 children are enrolled and 28 of them are malnourished. On average, 32-35 children come every day. We provide them hot cooked meals as per government guidelines,” he claims, showing his phone through which he uploads the information about children’s health on a state government portal, Aangan, introduced in 2018. He runs the anganwadi on behalf of his wife.

However, some of the villagers admit that food is not being served on a regular basis to children.

The Sadanand village anganwadi centre demonstrates the systematic problems the state government faces in implementing the Poshan Abhiyan under the National Nutrition Mission, which provides for holistic food and healthcare even in remote parts of Bihar such as this village, , where about 80% of the 400 residents are identified as poor by the state government.

About 50.54 percent of Sapaul’s population is poor, as per multidimensional poverty index released by Niti Aayog in 2023, which is based on NFHS of 2019-21. In Sapaul the poverty has fallen by 13% percentage points since 2015-16.

Kamayani Swami, who is on the advisory board of trade union Jan Jagran Shakti Sangathan, says poverty and malnourishment numbers in Bihar is higher than what NFHS shows. “The high malnourishment is because of underemployment within the state, high migration and poor nutrition awareness. It is directly related to the high rate of poverty seen in the traditionally backward Kosi region. That is the reason that Sapaul and Araria are most affected.”

She suggests that Bihar needs to learn from the southern states such as Tamil Nadu that have successfully implemented nutrition programmes in childcare and schools through a dedicated cadre. “Bihar needs to make child nutrition programmes universal to have better impact and provide better allowances to those taking care of mothers and their children.”

Devi is not unhappy with the government’s nutrition schemes. “She is at least getting something,” she says, pointing to her daughter, and hoping her health will improve over time.