Children’s Health

The mandatory measles–rubella (MR) vaccination drive initiated in schools by the Indian government in October 2019 has raised questions regarding whether informed consent was sought from parents prior to vaccination and its legal implications. This article presents a comprehensive picture of informed consent processes, ethics, and the law, and the need for evidence prior to implementing national vaccination policies. In the case of a combination vaccine such as the MR vaccine, we see that the rubella vaccine gained entry to India’s universal immunisation programme (UIP) without clear scientific evidence on its disease burden and in the absence of public demand for such a vaccine by piggybacking on another universal vaccine (measles).

How have wealth inequalities in child nutrition changed in the major states of India between the last two rounds of the National Family Health Survey? The temporal change in the likelihood of child stunting in the poorest quintile of households vis-à-vis the richer quintiles is examined. Alternative measures of wealth inequality in child nutrition, based on the ranking of the households’ wealth scores (namely the concentration index and the extended concentration index), are also used to see how the magnitudes have changed. The poorly performing states have not only retained the last ranks in terms of average stunting, but have also faltered in the reduction of stunting during the decade under study. In three of these states, the improvement in child stunting has disfavoured the poor by all measures. Comparing the concentration index and the extended concentration index for the two rounds, it is found that inequality in stunting has increased in all the states excluding Uttarakhand. This calls for immediate policy attention, since children from the poorest households in the backward states seem to suffer from the dual burden of the state effect and the class effect.

Despite the law to prevent child marriage, the practice remains unabated in the country due to deep-rooted social and cultural norms. The cohort analysis of data from the National Family Health Surveys suggests that the prevalence of child marriage was around 58% during the decades of 1970s and 1980s, and it started declining, albeit at a slower pace, reached to 46% by 2000. The first decade of the 21st century witnessed faster decline with 21% of the girls aged 18–23 years marrying below 18 years of age, as per the estimates for the most recent reference period. The assessments of the government’s conditional cash transfer scheme to enhance value of the girl child seem to have influenced the attitudes of the parents, rather eliminating child marriage. The government’s cash transfer schemes needs revamping and is recommended to be routed through the educational system in the form of fellowships for higher studies and, in particular, vocational studies of the girls, rather than disbursing cash incentives to the family of the beneficiary girl.

Four states—Bihar, Chhattisgarh, Odisha, and Uttar Pradesh—together account for around 45% of stunted children in India. The existing literature makes a case for delivery of a host of specific interventions referred to as the direct nutrition interventions, along with sector-wise or systemic interventions, to bring about significant reductions in prevalence of stunting among children. An analysis of the delivery of DNIs in the said states shows that apart from the decline in fiscal priority for the DNIs during 2014–15 to 2017–18, there are also significant resource gaps for some of these interventions, which underscores the need for enhancing fiscal priority for these interventions.

Reminiscent of poverty debates, serious undernutrition in India risks becoming a measurement quibble, unless we talk about unequal development gains and the answerability of governments towards less empowered citizens. Based on the simple counting of food consumed by 240 households and conversations with women, this article explores the contrast between local knowledge of what constitutes a “good diet” and the deficient meals consumed by people in Odisha, a state in eastern India. Effective interventions need to look beyond “maternal responsibility” and address entitlement uncertainties and gender inequality, in order to ensure essential nutrition and good health of vulnerable groups such as women and children.