India ranks 100th out of 119 countries in the Global Hunger Index 2017. The National Family Health Survey 4 2015-16 (NFHS) shows that about 38% of the children in India are stunted, 21% are wasted and close to 36% are underweight. Yet malnutrition does not figure on the agenda of our policymakers. In fact, the Centre’s allocations to the Integrated Child Development Services (ICDS) declined almost 10%, from Rs. 15,502 crore in 2015-16 to Rs.14,000 crore in 2016-17. ICDS is the country’s flagship program to improve child nutrition. In the face of reduced allocations, states will grapple to overcome malnutrition.

 

Also read: How to put India ‘on course’ to fight malnutrition

 

Karnataka is the worst faring southern state, as reported by NFHS 4. To illustrate, the survey states that 36% of the children in Karnataka are stunted, 26% are wasted and 35% are underweight. What’s more, there has been a minuscule reduction in the percentage of underweight children, and an increase of 8.5% in percentage of wasted children since NFHS 2005-06. A notable decrease was observed only in stunted children, from 43% to 36%. Karnataka is doing marginally better than the national average of stunted at 38% and underweight children at 35%, but compared to the national average of 21% for wasted children, it has a significantly higher proportion of wasted children. At 71,61,033, children between 0 to 6 years of age constitute over 11% of the total population in the state (Census 2011). In that context, the statistics paint an abysmal picture. 

 

The state’s poor regional performance in child nutrition can be partially attributed to the apparent district level disparities. A ranking of the districts in Karnataka, based on an index of stunted, underweight, wasted, shows districts in the north Karnataka region to be the worst affected. The regional imbalance in Karnataka clearly indicates that not all children in Karnataka are benefiting from the numerous schemes operating in the state. 

READ: For a more nutritious India

 

This October, Karnataka launched the Mathru Poorna Scheme under which pregnant and lactating women will get one nutritious meal for 25 days in a month. It also intends to institutionalise supply of eggs, and milk in Anganwadi centres. The objective is to ensure that the woman, who owing to cultural factors, tends to eat last in the family and shares the take home ration with the entire family, receives adequate nutrition. The ICDS scheme, universalised by the orders of the Supreme Court, caters to 58.26 lakh beneficiaries. Supplementary Nutrition, Immunization, Health Check-up, pre-school education, referral to doctors, Nutrition and Health Education are the services provided to children, adolescent girls, pregnant and lactating mothers. Thus the life cycle approach of monitoring the health of a child right from when it’s in the womb to 6 years of age is taken care of. Karnataka was the first state to implement Comprehensive Nutrition Mission which integrated multi-sectoral programmes that have an impact on malnutrition such as anaemia, Vitamin A, immunization, water and sanitation etc. 

 

If all these instruments are in place, where is Karnataka falling short? At the crux of malnutrition lies a triumvirate of gender, agriculture and education. The social and cultural environment in India is not conducive to the health of the mother and child. Excessive demands placed on the time and energies of women as well as the low status of women ensure that their access to nutrition is limited. Gender biases that exist in households result in lesser amount of food allocated to the women and girls. Restricted access to a rich diet in pregnancy automatically impacts the child to be born. Further, adolescent girls in India too must be provided protein, iron, vitamins and other micro-nutrients to ensure a healthy reproductive growth. The entire community has to be mobilised, not just mothers as the schemes are currently doing, to change these social norms. Engaging communities at the grassroots levels into dialogues and discussions on nutrition and health is imperative.

 

Secondly, targeted interventions for mothers that fill knowledge gaps regarding child nutrition must also be given priority. Studies indicate that the education of parents, especially the mother has a direct impact on dietary choices and nutrient intake of the household. Given the low literacy rate among women, it is all the more required that mothers be counseled on better child care practices. The vast network of Anganwadi centres and workers can prove instrumental in this regard. Building capacities of mothers as well as other family members, via implementation of Information, Education and Communication activities, to make the right decision for the child, will go a long way in improving child health.  
 

Thirdly, it is important to acknowledge that agriculture affects nutrition in tangible ways. It is after-all a source of income and increases ability to provide a nutritious diet to infants, children and pregnant and lactating mothers. A low agricultural productivity adversely impacts the dietary intake of the household. Climate change and excess usage of chemical and fertilisers have reduced agricultural output. Thus, to combat malnutrition in children, programmes and policies must also aim at enhancing agricultural productivity. 

 

The right of a mother and child to good health and well-being is not negotiable. Malnutrition not only affects the physical attributes of a child, but also has an adverse impact on cognitive development affecting the productivity of the individual in the long run, especially in terms of learning outcomes and financial prosperity. Concerted efforts of the mother, extended family, community and the government are central to improving the health of the children and thus achieving equitable outcomes. The plethora of policies and programmes that are in place will be effective only when we address these underlying issues.