ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Policy Complementarities in Achieving Universal Immunisation Coverage in India

The role of two policy pillars in achieving immunisation coverage of essential vaccines in India is examined by assessing the funds disbursed by the centre to the state governments under the Universal Immunisation Programme and the available physical health infrastructure in the states. It is found that funds by themselves are ineffective in improving vaccination coverage but are effective in conjunction with the available infrastructure. This finding has important implications for achieving full immunisation coverage, which stems from the sharing of responsibilities between the central and state governments under India’s federalised system of government.

Child Protection and Preparedness in COVID-19 Epoch

The COVID-19 pandemic and the ensuing lockdown has meant immense hardship for many sections of society. For children, and especially those from the marginalised communities, the impact has been harsher. They will also face increased risks and hardships in the post-lockdown period. A look at what can be done to deal with these hardships.

Measles-Rubella Vaccine

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).

The Injustice of Child Mortality

A Shot of Justice: Priority-Setting for Addressing Child Mortality b y Ali Mehdi, New Delhi: Oxford University Press, 2019; pp xxiv + 247, ₹995

Changing Wealth Inequalities in Child Nutrition in Indian States

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.

Frequently Asked Questions on Child Anthropometric Failures in India

The National Family Health Survey is analysed to develop critical insights on child anthropometric failure in India. The analysis finds non-response of economic growth on nutritional well-being and greater burden among the poor as two fundamental concerns. This calls for strengthening developmental finance for socio-economic upliftment as well as enhanced programmatic support for nutritional interventions. The gaps in analytical inputs for programmatic purposes also deserves attention to unravel intricacies that otherwise remain obscured through customary enquiries. On the one hand, this may serve well to improve policy targeting, and on the other, this can help comprehend the nature and reasons of heterogeneities and inequities in nutritional outcomes across subgroups. Strengthening the analytical capacities of programme managers and health functionaries is recommended.

Trends, Differentials and Determinants of Child Marriage in India

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.

Child Undernutrition in India

The child undernutrition estimates from the Comprehensive National Nutrition Survey, 2016–18 reveal that many Indian states have made substantial decline, reversing their poor past record in wasting, ranging from 7 to 14 percentage points within just 30 months. Is it really possible to make such a large decline in such a short span of time? Or, does this point to an anomaly in data or estimation?

Fiscal Challenges in Scaling Up Nutrition Interventions

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.

Rethinking Effective Nutrition Convergence

The National Nutrition Mission has explicitly recognised the multisectoral nature of the challenge of malnutrition and has made “convergence” one of its key pillars. However, it does not yet have sharp operational clarity on how stakeholders can ensure that multiple programmes reach the same mother–child dyad in the first 1,000-day period. The article illustrates how data on co-coverage of interventions can be used to plan for and assess the success of efforts to strengthen convergence.

Hidden Hunger, Burdened Women

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.

Deploying the Power of Social Protection to Improve Nutrition

The nutritional status of women and children in India continues to be poor. In this paper, we discuss how three major flagship social protection government programmes—the Targeted Public Distribution System, the Mid-day Meal Scheme, and the Mahatma Gandhi National Rural Employment Guarantee Act—can be made more nutrition sensitive. We discuss three potential approaches to making these programmes deliver better nutrition outcomes. These are strengthening governance and operations so that the programmes achieve their basic goals of improving food security and poverty; integrating nutrition goals and actions for each of these programmes; and leveraging the reach and scale of these programmes to also deliver specific nutrition interventions via these programmes, especially the tpds.

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