A matter of national shame

Malnutrition in India

Financial Times
August 23 2007

At a health centre in India’s Madhya Pradesh state, three-year-old Rajkumar clings to his mother, a woman named Anita whose youth is hinted at only when a smile cracks her weathered face. Rajkumar wails when his mother moves away slightly, standing by himself on the cot where she sits.


I am unsure whether he is crying for his mother or because it is painful to stand: his legs are matchstick thin – merely the width of two of my fingers. Rajkumar weights only 5.9 kg (13 pounds) when he should weigh 12 kg. His hair is brittle, light brown – another tell-tale sign of malnourishment.

Nearby, another mother looks on from amid the rows of cots lined up across the large room. She cradles her baby, whose head dwarfs his frail, doll-like body.

Severely malnourished children like Rajkumar and their mothers are sent to health centres like this one by government health workers who work, with assistance from Unicef, in surrounding villages at ”anganwadi” – half-day pre-schools where children are fed, immunised, weighed, and monitored. If left untreated, children at this stage are likely to die from infections that plague their weakened bodies. Indeed, more than half of all deaths among under-fives are linked to malnutrition, says the World Health Organisation.

At the health centres, launched by Unicef and the Madhya Pradesh state government a few years ago, mothers are counseled on nutrition and hygiene. At this town clinic in Shivpuri district, about five hours from Delhi by train, children and their mothers are fed and monitored for two weeks.

At an anganwadi in a small hamlet miles from the health centre, children sing cheerful songs and crowd the floor of a simple shack. There they eat a daily lunch prepared from local ingredients on a wood-burning hearth. Today it is a meal of soy, groundnuts, rice, potato, onion, mint, oil and salt. The anganwadi also acts as a resource centre for mothers: its walls bear posters with bright cartoons that warn of polio and anemia.

Government-run anganwadi have been in place for three decades. The network has been expanded as part of a national plan to improve children’s health. In recent years Unicef has stepped up its presence in landlocked Madhya Pradesh, or ”Middle State”, which has some of the worst levels of malnutrition among already alarming national numbers.

An astonishing 46.3 per cent of all children under the age of three in India are malnourished, and nearly 80 per cent are anemic, according to the government’s National Health and Family Survey of 2005-06. There has been marginal improvement since 1992-93, when 51 per cent of under-threes were underweight. But in Madhya Pradesh, figures have worsened from 55 per cent in 1998-1999 to 60 per cent in 2005-2006.

The statistics are stupefying given India’s ambition of becoming a global power. It is hard to take that aspiration seriously with almost half the country’s infants malnourished during critical years of cognitive and physical development. Even if Rajkumar lives to adulthood, he may be mentally and physically stunted. One wonders how India will reap the much-touted ”demographic dividend” of its youth where half of its 1.1bn population is under the age of 25.

Aid agencies say it is difficult to fund projects to combat the pervasive problem of malnutrition because of ’fatigue’ among donors. But India’s malnutrition ranks far worse than sub-Saharan Africa’s average rate of 27 per cent for children under the age of five, an ugly fact that rouses officials from complacency.

Manmohan Singh, India’s prime minister, condemned malnutrition as ”a matter of national shame” in his Independence Day address last week. Mr Singh ambitiously urged eradicating malnutrition in five years, and said communities must help ensure that corruption does not divert funds from the needy.

Of course, this is all much easier said then done. The challenges are starkly laid out during this visit to Madhya Pradesh. The state’s large population of 60m is scattered across thousands of villages with dirt roads and limited or no electricity, making them difficult and expensive for health workers to reach. Low literacy of 60 per cent makes it is hard to spread knowledge through pamphlets and posters.

Many mothers simply don’t know how to care for infants in the absence of adequate education. Only 55 per cent of mothers in Madhya Pradesh deliver in hospitals – though that’s an improvement from 26 per cent a few years ago – so most lack advice from healthcare professionals from the start. Anita, for example, says she didn’t know Rajkumar was malnourished in spite of his emaciated state.

Most rural diets are dominated by grain, which is inadequate for a growing child who needs protein, vitamins and minerals. Lunch at the anganwadi cannot compensate for a paltry diet at home.

But even if they have money, accessing better food is a major challenge for rural families. The nearest open-air markets are miles away and transport is not readily available. Supermarkets, so ubiquitous in the developed world, seem like a bizarre fantasy while standing among the low, mud-walled homes in this village in Shivapur.

Superstitions and taboos also are deeply ingrained in local culture. Anita admits she did not breastfeed her son in the first critical days after her birth because her mother-in-law discouraged her.

Yet there are glimmers of hope. Back at the town health centre, a casual labourer named Papku sits with his 10-month old son who is stricken with diarrhea. Sleeping next to the infant on the cot is Papku’s three-year-old son, Krishna, who was admitted to the centre a year ago weighing just 6 kg. After his parents were counseled on proper nutrition, Krishna’s weight has doubled to 12 kg (26.5 pounds) in a year. The boy looks robust and meaty although his father earns only Rs60 ($1.50) a day to support his family of six, which includes his wife and three young daughters.

Given his modest means why did Papku have five children? Papku matter-of-factly states that even after his eldest son was born, he wanted two sons in case one died. It is a jarring explanation. But the pragmatic answer reflects life for Papku and his family – and hundreds of millions like them across India.

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