Infant Mortality Rate has reduced to 47 from 58 in 2005 and Maternal Mortality Rate has declined from 254 during 2004-06 to 212 in 2007-09. High achievers are Orissa, Rajasthan and Bihar where infant mortality has dropped by 13 or more points since 2005?NRHM 2011
Around 23% of Indian children were wasted. At the same time, there has been very marginal change in the percentage of children who are underweight from 43%. Also 70% of children have anemia, primarily linked to poor nutrition?NHFS 2007
Indian statistics on child health in India have little new to show. Government officials in central ministry of women and child development are naturally surprised about the ruckus created by the Hunger and Malnutrition (HUNGaMA) report by a non-government foundation, last week.
As the clips above show, the data has been around them. But since the report has been released by the Prime Minister, government officials would not like to comment on this.
Instead when we meet Dr Shreeranjan, joint secretary in the ministry of women and child development, he shows the distance the government has covered in a very short span of time. Reeling out numbers easily he says before 2004, the presence of Integrated Child Development Services (ICDS) scheme or Anganwadi centres in India was about 40%. ?So if we go by the 96% figure mentioned in the HUNGaMA report, you can see how fast the coverage has grown?.
He is correct. Money was a major constraint for the Indian state till about 2003, when the growth rate of the economy picked up. ?Between 1975 and 2005, about six lakh centres were operational, but in the last six years itself, the number has more than doubled to 12.94 lakh?, he says. He also tells us that between the 10th and the 11th five-year plans, the allocation for ICDS also went up from about R10,500 crore to around R44,400 crore.
Yet, there is no doubt that the scale of child malnutrition in India is a ?national shame?, as Manmohan Singh himself said at the release of the report. The numbers are not new, they just show the distance India has to travel. However, if one delves deeper into the report, the linkages between malnourishment and other social indicators like education and awareness levels among mothers, sanitation, and clean drinking water seem to be clearly established. With the survey including Anganwadi centres as well, it can be employed to a great extent by the government in overhauling and accelerating the development of its flagship ICDS scheme.
A cursory glance at the findings of the survey tells the ever-so-told and the obvious story: As many as 42% children under the age of five in the 100 districts (100FD)lying at the bottom of the child development district index developed for UNICEF in 2009 are underweight. And that?s not all, 59% children are stunted (chronically malnourished) and half of the children suffering from stunting are severely stunted. With a sample size representing almost 20% of Indian children?almost 110,000 children, more than 74,000 mothers and almost 3,200 Anganwadi centres?the survey throws alarming findings that had even the PM worried and concerned. And that reflected in the knee-jerk reaction from the ministry of women and child development (WCD), with minister Krishna Tirath coming out and saying that a ?sincere note? of the report has been taken and that the ministry has ?sought about R2 lakh crore in the next five-year plan for ICDS, which is four times the amount sanctioned in the previous plan? to restructure the scheme. However, Tirath added that since HUNGaMA is a civil society survey, it needs to be ?validated? by following it up with the government?s National Family Health Survey (NFHS), which was last done in 2005-06.
Never mind the obvious data on malnutrition, let?s take a look at the findings with a focus on mothers? education and awareness levels vis-?-vis children?s malnutrition. The report states that in 100 focus districts, 66% mothers did not attend school and rates of child underweight and stunting are significantly higher among mothers with low levels of education. In fact, 92% of the surveyed mothers had never heard the word ?malnutrition?. ?The prevalence of child underweight among mothers who cannot read is 45% while that among mothers with 10 or more years of education is 27%. The corresponding figures for child stunting are 63% and 43%, respectively? the report states. Also, while the survey found the presence of Anganwadi centres in 96% of the villages in the focus districts, 61% of the centres had dried rations available, and 50% provided food on the day of the survey, and only 19% of the mothers reported that the Anganwadi centre provided nutrition counselling to parents. On sanitation and health, consider this: Only 19% mothers in 100FD said that their family members wash their hands with soap after using the toilet, in spite of the fact that more than 98% of the households in the 100FD have access to soap. Preference for government health centres was 16.5% in 100FD while it was 45.2% in the six best districts (6BD). As many as 43.1% rely on ?untrained health providers? in 100FD, which was an occurrence of just 0.2% in 6BD. In general, while Angawadi centres had an almost 100% presence in all the 112 surveyed districts, they were better equipped and more services were accessed at these centres in 6BD as compared to 100FD where they were primarily used for very basic services like immunisation (85.8%). In 6BD, advanced services were accessed more?62.9% mothers sought nutrition counselling, 80.4% accessed growth monitoring for children, and 59.1% accessed health referral services, while 100FD fared poorly at 18.5%, 21.2%, and 20.6%, respectively.
Talking about the survey, Rohini Mukherjee, team leader, HUNGaMA Survey Report told FE ,?Stunting is really alarming. Other areas that need immediate attention are less than satisfactory performance of Anganwadi centres and abysmal knowledge and awareness among mothers. Also, we need to understand the importance of data. Nutrition data is extremely important and needs to be monitored, analysed and acted upon regularly.?
A point that almost was the basis of the need for the HUNGaMA survey was the lack of regularly updated nutrition data in the country. In this regard, Shreeranjan told FE that the WCD minister has already written to states urging them to form nutrition councils at the state and district levels and to conduct regular periodic state-wide nutrition surveys. In fact, highly placed sources say that the ministry had had consultations with the health ministry to include nutrition data in the Annual Health Survey (AHS) in 284 districts to which the latter agreed. However, this data set was excluded in the 2010 AHS findings that were released in 2011. According to the official statement issued by the WCD ministry, the nutrition data is ?still awaited?.
Another issue, which has been written about earlier in this newspaper, has been the proposition that there might be a problem with the reference sample that is used by the WHO in its age-weight standards for malnourishment. This argument is being made by Arvind Panagariya of Columbia University who has been proposing that the WHO norm to calculate undernourishment or stunting is based on averages drawn from populations that are taller and heavier than Indians. Panagariya uses a restrictive sample from NHFS 3, a sample of ?elite? children, and says that 15% of these children are stunted according to the WHO standards, which draws some scepticism to the very basis of the data. However, Shreeranjan says that the government has been taking cognisance of such propositions and that?s why rather than completely accepting the WHO standards, only the age-weight standards have been adopted, and not weight-height and age-height standards. ?We have taken cognisance of it and have had informal discussions with nutritionists as well on these concerns. But it is important for us to streamline our data as per some international benchmark so that similar scan be compared. From our end we have taken care by only going for the age-weight standard. But it remains a matter for further research,? he said.
As for what the government takes home from the HUNGaMA survey report and the future action plan, apart from the already mentioned plans on regular data collation and seeking more funds, the WCD ministry is working on recommendations made by the PM?s Nutrition Council including a multi-sectoral programme to address maternal and child malnutrition in 200 high burden districts. There are plans to strengthen the ICDS scheme by introducing an Anganwadi helper to focus on early childhood education and awareness. A nationwide information, education and communication campaign against malnutrition featuring actor Aamir Khan is also in the works. The proposed National Food Security Bill has also been listed among the efforts being made by the government. However, the biggest lesson and reference point for the government is that a convergence of efforts in various spheres is required to tackle the problem. It?s not just a hunger issue really. As the PM himself noted in his address while releasing the HUNGaMA report, ?Policy makers and programme implementers need to clearly understand many linkages?between education and health, between sanitation and hygiene, between drinking water and nutrition?and then shape their responses accordingly. These sectors can no longer work in isolation of each other. Health professionals cannot solely concentrate on curative care. Drinking water and sanitation providers cannot be oblivious to the positive externality of their actions. The school teacher needs to be aware of the nutritional needs of the adolescent girl. And above all, the Anganwadi workers should be aware of their contribution to nation-building by focusing on the care of our young citizens.?
