Behind the Numbers

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From the National Family Health Survey II conducted in 1998-99, we know that over 47 per cent of children under the age of three in India display severe to moderate undernutrition (weight for age), with serious consequences for proper mental and physical development. If the millennium development goal of halving undernutrition by 2015 is to be achieved, the average rate of reduction of undernutrition needs to make rapid strides; the present rate of 1.7 per cent per year is simply too slow. In India, researchers have found that in the period between the previous two National Family Health Surveys (1992-93 and 1998-99) the percentage of underweight children below three years of age came down by only 0.8 per cent annually. The results for the most recent NFHS, which has just been completed, are unlikely to show any dramatic change since the late 1990s as all the other indicators also point to a continuation of the earlier trend.

The reasons for the slow progress in reducing the prevalence of undernutrition in children have been analysed mostly in terms of proximate causes: weaknesses in delivery services, faulty feeding practices and poor maternal health. Though the Integrated Child Development Services (ICDS) programme was intended to incorporate a multi-pronged approach to undernutrition, its central thrust remains supplementary nutrition, to the neglect of other aspects such as immunisation, antenatal services, advice on feeding practices, and health monitoring and referrals, which have a significant impact on overall health. The reach and distribution of the ICDS has also been criticised: states with the highest prevalence of undernutrition among children below six years of age, namely, Uttar Pradesh, Bihar, Rajasthan, Orissa and Madhya Pradesh, tend to be the most sparsely covered by the programme. In addition, it is precisely the age bracket that has the highest levels of undernourishment (0-3 years) that is not adequately targeted through ICDS. The malnutrition that sets in at this critical time of development becomes difficult to reverse later on. Aided by low birth weights, faulty feeding practices and the fact that 36 per cent of women between the ages of 15 and 49 years who are ever married suffer from chronic energy deficiency, the cycle of undernutrition is perpetuated.

However, there is a need to go beyond a more or less technical approach to the problem of undernutrition. In other words, the effects of major socio-economic changes, including increasing urbanisation, structural transformation of the economy and displacement, and their relationship to undernutrition need to be better concretised. The starvation deaths reported in Kashipur in 2002, for instance, were linked to the government’s acquisition of forest land that had served the tribals for generations as a food source. In West Bengal and Kerala, starvation deaths have been reported among workers in the tea gardens as the industry goes through the doldrums due to low commodity prices. In Madhya Pradesh, the largescale displacement of dam oustees and lack of livelihood opportunities has affected the nutritional status of a generation of children, though its explicit articulation might not be readily available. In metropolises such as Delhi, the relocation of entire communities living along the banks of the river Yamuna to make way for “redevelopment” has disrupted the lives of children and impoverished their families.

What is being argued then is that a political economy of undernutrition can perhaps serve to trace the specific contours of what is now merely passed off as the “cost of development”. Achieving target reductions in undernutrition means little when the specificities of the situations that create and perpetuate malnutrition are ignored. These concerns also need to find a reflection in the development plans of states and relief and rehabilitation packages, so that policy-making is not hampered by a watertight departmental approach. Some introspection on the part of state governments on this count is called for. EPW

Economic and Political Weekly May 6, 2006