Demonetisation, the slowdown of the economy over 8 quarters (2018-19 and 2019-20), the pandemic, the loss of jobs, homes and livelihoods, the migration of millions and the recession (Q1 and Q2 of 2020-21) have greatly impacted the nutritional status of our children.
Here is an India beyond Delhi, Singhu on the Haryana-Delhi border, the stock markets, the RBI and the TV channels. That is the real India, populated with real people who do physical work every day in factories and fields, in homes and on the streets, to keep body and soul together. Like every other human being, they eat, sleep, love, marry, procreate, laugh, cry and die. A very large number among them also struggle, all through their lives, with poverty and unemployment. Those two words — poverty and unemployment — separate the poor, middle-income and advanced countries. The only goal of a developing country like India should be to wipe out poverty and unemployment. By last count, the proportion of people of India classified as poor or BPL (below the poverty line) was 28 % (UNDP). By last count, the unemployment rate was 9.9 % (CMIE, for week ending December 13, 2020).
Only relevant metrics
Do the governments, central and state, care? In my view, the lasting contribution of the UPA governments (2004-2014) was lifting 270 million people out of poverty. All other measures and programmes are impactful when they were taken or rolled out, but become part of the normal after some time. For instance, the two-step devaluation done in July 1991 cut the path toward a market-determined exchange rate but, today, a market-determined exchange rate is taken as so normal that describing it as a path-breaking reform (which it was) will hardly cause any eyebrows to be raised.
Persistent poverty and unemployment have terrible consequences. One of them is malnutrition among children. Every government rolls out programmes — Integrated Child Development Scheme, Midday Meal Scheme, POSHAN Abhiyan and so on. Huge sums of money are allocated in the Budget, and it is claimed they are spent. There is a watchdog agency — the National Commission for Protection of Child Rights. Health and nutrition levels are measured through periodic surveys. The last one was the Comprehensive National Nutrition Survey (CNNS, 2016-2018) done jointly by the Ministry of Health and Family Welfare and the UNICEF.
The findings are worrying. (see table)
The clinical effects of malnutrition are manifold: impaired pancreatic, liver, thyroid and immune functions; loss of liver function; respiratory and intestinal infections; and decreased cardiac output, decreased appetite, lethargy and long term developmental effects. Malnourished children and adolescents are at higher risk for impaired growth (Black, 2013).
Why malnutrition? Stunting and wasting are signs of chronic/acute undernutrition that reflects failure to receive adequate nutrition over a long period. Wasting may result also from inadequate food intake. The first 1000 days is considered the most important period to intervene to prevent the lifelong damage caused by malnutrition. The highest prevalence of stunting was found in Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh (37-42 %) and the lowest in Goa and Jammu & Kashmir; higher in rural areas; more likely among children in the poorest wealth quintile; and more likely among scheduled castes/tribes.
The CNNS must be read along with the National Family Health Survey (NFHS). NFHS-4 was conducted in 2015-16 and NFHS-5 in 2019-20. A Fact Sheet was released by the government a few days ago. Between NFHS-4 and NFHS-5, the proportion of severely acute malnourished children has worsened. Ms Dipa Sinha of the School of Liberal Studies, Ambedkar University, writing in the (The Hindu, December 15, 2020) observed that “we are likely to see an increase in prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.” She quoted the WHO which has said that stunting is “a marker of inequalities in human development.” India’s HDI rank dropped by one in 2019.
Food, but not to eat
It is clear that the design and execution of programmes such as ICDS, Midday Meal Scheme and POSHAN Abhiyan are flawed. They have failed despite the fact that we have bumper harvests year after year. The stock of wheat and rice in September 2020 were 478 LMT and 222 LMT respectively, plus 109 LMT of unmilled paddy. The irony is that farmers produce mountains of food grain, the FCI and other agencies procure extensively, the tax payers cheerfully bear the cost of procurement and storage, yet our children do not get enough food to eat! None of the above is surprising. They accord with what is common knowledge. What is surprising that few in any government — and none in the present central government — talk about these persistent problems.
Demonetisation, the slowdown of the economy over 8 quarters (2018-19 and 2019-20), the pandemic, the loss of jobs, homes and livelihoods, the migration of millions and the recession (Q1 and Q2 of 2020-21) have greatly impacted the nutritional status of our children. The anthropometric indicators, including malnutrition, have got worse. Where does the responsibility lie? The sign on the desk of President Harry Truman read, ‘The buck stops here’.