The Union Cabinet recently approved a multi-sectoral nutritional programme proposed by the Ministry of Women and Child Development to reduce under-nutrition in 200 districts across India. The 1,213 crore initiative will incorporate several schemes to curb malnutrition among children below the age of 3 years, and tackle anaemia in young girls and lactating mothers. 

This nutrition initiative comes against the backdrop of several recent statistics and debates in the media on high levels of child malnutrition in India. In January 2012, Prime Minister Manmohan Singh released the “HUNGaMA Survey Report 2011”prepared by Naandi Foundation that covered 112 districts across India. According to the report, 42.5 per cent of children under five years of age are underweight (low weight for age); 58.8 per cent are stunted (low height for age), and 11.4 per cent are ‘wasted’ (low weight for height).

The alarming figures led Prime Minister Singh to call it a “national shame”. In the “Global Hunger Index 2013”, India scored 21.3 on the level of hunger, placing itself in the category of “alarming levels” of hunger. Apart from India, Haiti and Timor-Leste are the other two non-Sub-Saharan African countries that fall under this category. The report also highlights that South Asia is home to the largest number of hungry people in the world, followed by Sub-Saharan African countries.

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Bangladesh that showed high rates of malnutrition until recent times has taken significant steps to improve nutrition, and quantity and quality of food intake. Progress has been made in cereal and non-cereal food production to ensure food security. Educational campaigns on exclusive breastfeeding and hygeine have helped the country to tackle malnutrition. In addition, Bangladesh is one of the 42 countries that are part of the “Scaling up Nutrition” (SUN) movement to implement nutrition specific approaches and interventions to curb malnutrition. India is not a part of the SUN movement.

Thus, what was previously dubbed by researches as the “Asian Enigma” to refer to the phenomenon of South Asian countries falling behind in standards of child growth despite economic growth, now seems to be modified into “Indian Enigma” or the “Indian Paradox” to reflect upon the phenomenon of India having a large number of under-weight and stunted children despite a growing economy.

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The UN has estimated that about 2.1 million Indian children die before they reach the age of five years from preventable illnesses such as diarrhoea, malaria, typhoid, pneumonia and measles.

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Stunted children are susceptible to infections due to a weak immune system. When they grow up to adulthood, they are likely to have a risk of obesity, diabetes, high blood pressure, and heart disease. Stunting also results in impaired cognitive ability, fatigue, loss of interest and curiousity, and failure to learn motor skills, which results in stunted children falling behind their healthier counterparts, and eventually dropping out of school.

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Child malnutrition is directly related to malnutrition among women, says a study titled “Child Malnutrition and Gender Discrimination in South Asia” by Santosh Mehrotra, who is a former Regional Economic Advisor for Poverty (Asia) for UNDP. Poor health of a woman during her infancy, childhood and teenage years leads to low birth-weight of her child. Consequently, children who are born with low birth-weight often experience poor health during their infancy and childhood.

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A BMI of less than 18.5 is an indicator of chronic energy deficiency. The study states that 36 per cent of Indian women fall short of that number.  The study further says that on average 52 per cent of Indian women suffer from mild, moderate or severe anaemia which is the underlying cause of maternal mortality and perinatal mortality.

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“It is important to target women not only when they are pregnant, but otherwise as well,” said Dr. Amit Sengupta from Delhi Science Forum. “Women are discriminated right from birth, so by the time they reach adulthood, they are already malnourished,” he said.Santosh Mehrotra says in his study that in most poor households, women and young girls eat the leftovers after the males in the family have eaten their meals.

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Another cause for stunting and under-weight children in India is aruged to be a consequence of a larger sanitation problem of open defecation. Dean Spears, a visiting researcher at the Delhi School of Economics, has argued that stunting as a phenomenon among Indian children could be linked to open defecation. Spears says that children are exposed to the germs in faeces when those germs are released in the enviornment during open defecation. This exposure to the germs causes children to suffer from diarrhoea and environmental enteropathy (causing chronic changes in the intestines of the children and preventing the body to absorb and use nutrients). Thus, leaving the children stunted.

In his study titled “Open Defecation and Childhood Stunting in India: An ecological analysis of new data from 112 districts”, Spears says that according to the 2011 Indian census, 53 per cent of Indian households did not use any kind of toilets. He further says that Bihar has had a higher rate of open defecation in the past ten years than any other country, and that Uttar Pradesh alone is home to 12 per cent of all the people worldwide who openly defecate.

He argues that the rate of open defecation in India has been higher than that of Congo, Ethiopia, Angola, Zambia, South Africa, Rwanda, Kenya, Ghana and many other Sub-Saharan African countries.

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Dr. Vandana Prasad from Public Health Resource Network said, “Many factors contribute to child malnutrition. Lack of food, lack of good quality and diverse food, lack of child care services, malnutrition among the mothers, open defecation… but it becomes problematic when one reason is highlighted as the primary reason.”

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