childmalutrition

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Child malnutrition in India:Why does it persist?

Report by Sam Mendelsonwith input from Dr. Samir Chaudhuri

help the motherhelp the child...


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Child malnutrition in India CINI

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A estimate ort per cet

o te worls severel

malourise cilre uer

fve live i Iia.This is a shameul stain on a country that, with

China, will be one o the great economic power-

houses o the coming century.

India has made huge strides in the past decades

in warding o the spectre o amine. The Green

Revolution should have gone a long way to tack-

ling child malnutrition, Norman Borlaugs creation

o dwar spring wheat strains in the 1960s meantthat India could eed itsel at last. Better arming

techniques and ood security policies have made

mass starvation a thing o the past.

Yet the problem o child malnutrition remains

critical, and the reasons it deserves concerted

attention are many. Besides the obvious moral

obligation to protect the weakest in society, the

economic cost to India is and will be staggering,

and the global ood crisis this year can only besignicantly worsening the problem12. Moreover,

statistics rom as recently as 2006 may well

underestimate the problem, as rampant ood

price infation takes its toll on many millions o

Indian amilies.

So why are levels o child malnutrition so shame-

ully high in India? What are the contributing

actors? What possible solutions exist?

FACTS:n47 percent o Indias children below the age o

three years are malnourished (underweight).3The World Bank puts the number probably

conservatively at 60 million.4 This is out o a

global estimated total o 146 million.

n47 percent o Indian children under ve are

categorised as moderately or severely

malnourished.5

nSouth Asia has the highest rates and by ar

the largest number o malnourished children

in the world.

nThe UN ranks India in the bottom quartile o

countries by under-1 inant mortality (the 53rdhighest), and under-5 child mortality (78 deaths

per 1000 live births).6 According to the 2008

CIA act book, 32 babies out o every 1,000

born alive die beore their rst birthday.7

nAt least hal o Indian inant deaths are

related to malnutrition, oten associated

with inectious diseases.

nMalnutrition impedes motor, sensory, cognitive

and social development 8, so malnourished

children will be less likely to benet rom

schooling, and will consequently have lowerincome as adults.

nThe most damaging eects o under-nutrition

occur during pregnancy and the rst two years

o a childs lie.

nThese damages are irreversible, making

dealing with malnutrition in the rst two year

crucially important.9

nA close reading o available statistics shows

the problem to be ar rom uniorm.10

1 http://mobile.latimes.com/detail.jsp?key=177180&rc=world&ull=12 The World Bank says micronutrient deciencies could be costing India US$2.5bn per year. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,c

ontentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html3According to A.K.Shiva Kumar, a development economist and consultant or UNICEF (http://www.littlemag.com/hunger/shiv2.html)4 http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html5 UNICEF statistics, ound at www.unice.org/inobycountry.index.html6 http://www.un.org/esa/population/publications/wpp2006/WPP2006_Highlights_rev.pd7 https://www.cia.gov/library/publications/the-world-actbook/rankorder/2091rank.html8 Health Education to Villages, Programmes or Mother and Child Nutrition at www.hetv.org/programmes/nutrition.htm9 Malnutrition causes heavy economic losses, contributes to hal o all child deaths, but can be prevented new World Bank report, March 2nd 2006, at http://web.worldbank.

org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20839585~pagePK:64257043~piPK:437376~theSitePK:4607,00.html10 From the executive summary o the 2005 World Bank report: Disaggregation o underweight statistics by socioeconomic and demographic characteristics reveals which

groups are most at risk o malnutrition. Underweight prevalence is higher in rural areas (50 percent) than in urban areas (38 percent); higher among girls (48.9 percent) than

among boys (45.5 percent); higher among scheduled castes (53.2 percent) and scheduled tribes (56.2 percent) than among other castes (44.1 percent); and, although under-

weight is pervasive throughout the wealth distribution, the prevalence o underweight reaches as high as 60 percent in the lowest wealth quintile. Moreover, during the 1990s,urban-rural, inter-caste, male-emale and inter-quintile inequalities in nutritional status widened.

There is also large inter-state variation in the patterns and trends in underweight. In six states, at least one in two children are underweight, namely Maharashtra, Orissa,

Bihar, Madhya Pradesh, Uttar Pradesh, and Rajasthan. The our latter states account or more than 43 percent o all underweight children in India. Moreover, the prevalence

in underweight is alling more slowly in the high prevalence states. Finally, the demographic and socioeconomic patterns at the state level do not necessarily mirror those at

the national level (e.g. in some states, inequalities in underweight are narrowing and not widening, and in some states boys are more likely to be underweight than girls) and

nutrition policy should take cognizance o these variations.

FACTS And MyThS

A ew acts and myths - to begin:


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1MyTh:Iia cilre are better

ourise ta most Arica cilre.

In act, the average rate o malnourishment or

under-3s in Sub-Saharan Arica is 30 percent.

Indias corresponding rate is 37 percent. 30 out o

37 countries in Sub-Saharan Arica report lower

levels o child malnutrition than India. And Bihar

(54 per cent), Orissa (54 per cent) and Madhya

Pradesh (55 per cent) report child malnutrition

rates higher than the maximum reported in

Sub-Saharan Arica by Angola (51 per cent).11

Latest UnICEF statistics o utritio i Iia (nov 08)

nutritio to te top

% o inants with low birthweight, 1998-2005* 30

% o children (1996-2005*) who are: exclusively breasted (


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3Mt: Povert is te causeo malutritio.In act, there is no obvious linkage between levels

o child malnutrition and income poverty. 26 per

cent o Indias population lives below the pov-

erty line, yet 46 percent o children under three

are malnourished. Most Sub-Saharan countries

report higher levels o income poverty than Indiaeven though levels o child malnutrition in India

are consistently higher. And within India itsel, in

1993-4 in Haryana, 35 per cent o children were

reportedly malnourished with 25 per cent o the

population under the poverty line.16 In Assam,

36 per cent o children were malnourished, yet a

ull 41 per cent lived in poverty. In other words,

although the destitute poor have higher rates o

malnutrition than the rich, poverty itsel is not a

sole cause. And the quantity o ood required toadequately eed an inant is aordable or

practically all amilies hal a chapatti or hal a

banana or a boiled potato or a bowl o dal.17

4Mt: Iteratioal growt staars to

assess malutritio skew te results.

Some have argued that Indian children do not

grow as ast or as large as in other places, so

global standards o malnutrition ought not to

apply. However, global standards o height and

weight have in act been applied to Indian

children too, as repeatedly established by the

Nutrition Foundation o India.

5Mt: Its about ot avig

eoug oo.

Between 6-18 months, ood availability within

the household is usually not the critical actor

causing malnutrition. It is more oten inadequate

knowledge about eeding practices that are in the

Simple solutions that save lives

CInI works wit locall traie wome wo go rom ouse to ouse, avisig moters ow to a

supplemetar oos available at ome suc as rice/capatti a al wit mase, locall-grow

gree lea vegetables to a cils iet rom six mots owars, wile maitaiig breasteeig

as log as possible. Te best wa o coveig tis simple message is b saig tat all oe eesis a fstul o oo ever a to meet te calorie a protei gap o a cil uer tree.

Iia moters te to breastee util about two ears a o ot a semi-soli supplemetar

oos to cilres iets, perpetuatig te calorie a protei gap. Uer-utritio, iarroea a

respirator iectios act togeter as a vicious ccle to lea to urter malutritio, iger

morbiit a mortalit i tis age group. CInI breaks tis ccle b traiig a motivatig

moters to access ealt care at te frst sig o illess rom earb ealt cetre a give more

oo to teir cil at regular itervals urig te a to improve te immue respose. A traie

ealt worker as about 100 to 150 suc cilre a amilies uer er irect supervisio a

se moitors teir growt.

Growth monitoring

CInI ealt workers maitai eac cils

growt recor o growt cars retaie

b te parets, a explai to moters te

relatiosip o improve growt to aequate

eeig a care.

16Again, Haryana is one o the states with a poor general status o women. There is an adverse sex ratio in Haryana and emale literacy is also particularly low.17 http://www.hindu.com/2007/06/22/stories/2007062250151000.htm


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best interests o the child. As A.K Shiva Kumar

writes, The denial o as little as 200-300 calories

in a young childs daily diet is what makes the

dierence between the normal growth and the

altering that starts the descent towards illness

and death. 18

Working with mothers-in-law

Te lack o appropriate eeig kowlege

wit locall available utritious oos are

ealt wit b CInI-traie ealt workers. A

worker visits te omes regularl to avise

moters o eeig, prevetio o iseases

b aoptig gieic practices, a te use

o sae rikig water. youg bries move

ito te omes o teir moters-i-law o

marriage i most parts o Iia. Uortuatel

moters-i-law ote orce teir augters-

i-law to work too ar urig pregac,

leaig to a egative calorie balace a low

birt weigt iats. CInI ealt workers talk

to moters-i-law a usbas about te

importace o pregat wome gettig a-

equate oo a rest i orer to avoi am-

age ot ol to te moters ealt, but also

tat o teir ubor cilre.

Iia i 2008: A SapsotA walk through the gleaming, towering central

business district o Mumbai tells a tall tale about

prosperity in this country o 1.1 billion people.

In many ways, Indias uture is bright.19 Its

democratic, English-speaking, has had sustained

economic growth and a swelling urban middle-

class, the work ethic and educational level o

which is noticeably draining skilled jobs rom

the West.

The journalist Tom Friedman, a well-known

author and writer or the New York Times,

describes, in his 2005 bestseller The World

is Flat, arriving at the oces o Inosys

Technologies Limited in Bangalore:

You are in a dierent world. A massive resort-

size swimming pool nestles amid manicured

lawns. There are multiple restaurants and a

abulous health club. Glass-and-steel buildings

seem to sprout up like weeds each week. In some

building, employees are writing specifc sotware

programs or American companies; in others,

they are running the back rooms o major

American and European-based multinationals.

The playing feldis being levelled.

It may well be that the orces o globalisation

are outsourcing IT and knowledge-based jobs to

India, and in doing so, building a signicant

and afuent middle-class. But it is ar rom the

whole story. Mumbai, Indias commercial capital

and with Kolkata its largest city, is in many ways

a microcosm o the country. Next to the breath-taking opulence o the down town area and the

booming nancial services industry, lies Asias

largest slum, the bustling Dharavi, home to two

18 http://www.littlemag.com/hunger/shiv2.html19 The 2005 UN Human Development Report states: India has been widely heralded

as a success story or globalization.

Over the past two decades the country has moved into the premier league o world

economic growth; high-technology exports are booming and Indias emerging mid-

dle-class consumers have become a magnet or oreign investors. As the Indian

Prime Minister has candidly acknowledged, the record on human development has

been less impressive than the record on global integration. The incidence o in-

come poverty has allen rom about 36% in the early 1990s to somewhere between

25% and 30% today. Precise gures are widely disputed because o problems withsurvey data. But overall the evidence suggests that the pick-up in growth has not

translated into a commensurate decline in poverty. More worrying, improvements

in child and inant mortality are slowing and India is now o track or these Mil-

lennium Development Goal targets. Some o Indias southern cities may be in the

midst o a technology boom, but 1 in every 11 Indian children dies in the rst ve

years o lie or lack o low-technology, low-cost interventions. Malnutrition, which

has barely improved over the past decade, aects hal the countrys children.


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million people many o whom lack clean

drinking water and basic sanitation. And statistics

aside, its clear to any visitor that so many Indian

children are malnourished, so many Indians are

living beneath the World Banks poverty level o

US$1.25 per day, that India aces a stark reality.Without a comprehensive eort to address child

malnutrition, the countrys considerable

aspirations o becoming a world power in the

coming century will not be realised.

But India is by no means the poorest country on

earth, it doesnt have the lowest lie expectancy

or literacy, or the highest rate HIV/AIDS. India

isnt at war, there is considerable oreign direct

investment, and there is a large buer stock o

ood grains.

So why is the problem so severe in India?

W are malutritio levels

i Iia so ig?According to the National Family Health Survey

(NFHS-3) carried out in 2005-06, child malnutrition

rates in India are disproportionately high. TheNFHS-3 is the third pan-India survey conducted

since 1992 (covering 200,000 people rom

15-54 years, and the denitive guide to Indian

health statistics).

The results are sobering: 46 per cent o children

under three are underweight, compared with 28

per cent in Sub-Saharan Arica and 8 per cent in

China another country with an enormous rural

poor population. In addition to the 46 per cent

who are underweight, 39 per cent are stunted, 20

per cent severely malnourished and 80 per cent

anaemic. More than 6,000 Indian children below

the age o ve die every day due to malnourish-

ment or lack o basic micronutrients such as

vitamin A, iron, iodine, zinc or olic acid.

So important is the provision o micronutrients

to children in the developing world, that the

Copenhagen Consensus 2008 has listed it as the

top development priority o this year.20

Crucially, its necessary to look beyond income

levels, economic expansion, conventional poverty

levels and ood availability, none o which explains

in itsel the causes o the problem in India.

Is unding the problem? Well, even though

children orm a substantive third o Indias billion-

plus population, their share in the Union budget is

a mere 4.86 per cent, according to the Womens

Feature Service, and out o which, 70 per cent is

allocated or education, and only 11 per cent or

health. Theres no doubt a shortall in unding or

child health is a problem.

Micronutrient work

CInI collaborates wit Microutriet Iitiative

Fouatio i Iia to elp improve te istri-

butio a cosumptio o Vitami A a Iro-

olate supplemets or wome a cilre

i some o te poor states i Iia suc as

Jarka, Cattisgar a Maur Praes.

20 The Copenhagen Consensus is a theoretical exercise rst carried out in 2004 when a group o the worlds top economists got together to prioritise issues and solutions

aecting 10 global challenges. I a sum o money ($50bn at the time) were available to address needy issues, what would be the most eective way o using it? The panel oeight economists included ve Nobel Laureates. Thirty proposals were considered. The result was a ranked list o 10 solutions. These were considered the most cost eective

ways o achieving results. The rst list had as its top our priorities the control o HIV/AIDS, the provision o micronutrients to address malnutrition (iron deciency anaemia),

trade liberalisation, and the control o malaria (using chemically treated bednets).

The aim is to repeat the Copenhagen Consensus exercise every our years. The new list or 2008 comes up with 30 ranked solutions that would be addressed i $75bn were

available. The top our solutions are, as mentioned, micronutrient supplements or children vitamin A and zinc), ollowed by the Doha development agenda on trade, micro-

nutrient ortication (iron and salt iodisation), and expanded immunisation coverage or children. (Taken rom www.developmentratings.com, a charities rating agency which

provides an excellent guide to charities which are doing a great deal with too ew unds, and which advises on ecient philanthropy)


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Is the problem specic to India? No:In act, its

part o a wider regional anomaly. Fity per cent

o children across South Asia suer rom

malnutrition. So is it thereore cultural in origin? In

1996, Indias pre-eminent physician-nutritionist,

Proessor Ramalingaswami, along with Drs.

Jonsson and Rohde, wrote an article entitled

The Asian Enigma. At the time, there wasinsucient prior research, and no clear

consensus on the underlying causes o

malnutrition. Ater considering various theories

including high rates o vegetarianism in South

Asia the researchers placed the blame

predominantly on the extremely low social

status o women relative to men in South Asia

(compared, say, to Sub-Saharan Arica).21

The status o women is readily linked to child

nutrition. A malnourished mother will give birth

to a baby o low birth weight the single most

important predictor o child survival.22 Common

practices such as allowing all the males o the

household to eat rstgoes some way to

explaining the 83 per cent rate o iron deciency

anaemia among Indian women (compared to 40

per cent in Sub-Saharan Arica).This problem is

compounded by the need or pregnant women to

be cared or, by ensuring proper nutritional diet

and reducing the burden o work during

gestation. Child rearing is usually the

predominant responsibility o mothers. In other

words, a pregnant mother who has childrenalready suers an even greater risk o a

malnourished child ater birth. And according to

the International Food Policy Research Institute,

a womans control over resources within the

household also aects her children. Numerous

studies have shown that income or assets con-

trolled by women are more likely to be spent on

items that benet children and themselves, such

as ood, clothing and health care, than assets

controlled by men.24 Very revealing is the statistic

provided by the NFHS-3 that malnutrition among

Indian children below the age o three born to

illiterate mothers (55 per cent) is more than

twice the level (26 per cent) reported among

mothers who have completed more than ten

years o schooling. As a mothers educationper

se cannot conceivably aect the health o a

child, this number speaks a great deal: both child

malnutrition and education are strongly correlated

with womens social status.

21 www.ipri.org/pubs/abstract/131/rr131ch07.pd22 www.ipri.org/media/BeijingPlus10/brieIndia.pd23 http://www.hindu.com/2007/06/22/stories/2007062250151000.htm24 www.ipri.org/media/BeijingPlus10/brieIndia.pd

Need for medical professionals in India to learn about malnutrition

Te natioal Rural healt Missio lauce recetl as allocate resources to correct te ef-

ciecies i ealt care eliver a access i all parts o te coutr. Uortuatel, little empasis

as bee give to malutritio i tis programme. Te teacig o malutritio is grossl ia-

equate i meical a ursig scools. Tis leas to octors a urses i te ealt care sstemrelegatig utritio care to ieticias a utritioists.

Early marriage and underweightbirths

Earl marriage i aolescet girls, wo are

malourise temselves a ave ot et

attaie psical a metal maturit, leas

to earl pregac a birt o uerour-

ise cilre. CInI tries to elp break tis

ccle b workig wit oug people a teir

parets to ela marriage a ela frst

pregac.

Most inants, as stated earlier, get malnourished

between six and 18 months o age. A.K. Shiva

Kumar puts it succinctly: This raises three

important issues relating to the care o the child

six-month-old babies cannot eat by themselves;

they need to be ed small amounts o ood

requently. Feeding a[n]inantis time-consuming.

Many rural women simply do not have the luxury o

time to eed inants. The task is oten entrusted to

an older sibling who understandably may not have

the required patience to eed an inant. 23


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The link between womens status and child

malnutrition took a long time to be empirically

established. The IFPRI has been running one o

the most signicant modern studies on eective

strategies to reduce malnutrition. The IFPRI

along with the Department o International Health

at Emory University sought to address the

shortall in empirical research with a 2003study.25 The study brought together data rom

36 developing countries, spanning over 100,000

children under the age o three, and a similar

number o mothers.

The study identied three actors contributing to

the nutritional gap between Sub-Saharan Arica

and India. The most important was womens

status, ollowed by sanitation and urbanisation.26

No eective solution will be complete without areal eort to address womens low social sta-

tus in particularly rural India. This issue so

oten ramed in rights discourse, is integral or

health promotion, and human rights and health

advocacy groups would do well to recognise their

overlapping objectives and to work together.

Another clue lies in low birthweights. Birth-

weights below 2,500 grams have been ound to

be very closely associated with poor growth notonly during inancy but throughout childhood.

Estimates or India reveal that 20 to 30 per cent

o babies all into this category. The underlying

health and nutritional status o the mother also

closely tied to social status is the main cause o

low birthweight. According to NFHS-3, close to a

third o Indian women suer rom Chronic Energy

Deciency, and have a Body Mass Index27 o less

than 18.5.

CINIs holistic approach

CInI starte i 1974 as a utritio a ealt-ocuse orgaisatio. For te last te ears, eucatio

as bee iclue i its missio a, alog wit protectio is beig itegrate ito all its activities.

Ver ew ealt-ocuse orgaisatios take up te callege o eucatio as it ivolves a massive

eort to re-eucate existig ealt workers to te mportace o eucatio.

Tackling health, nutrition,

education and protection issuesGivig a practical sape to te rigts

base approac, CInI as starte settig

up Woma a Cil Friel Commui-

ties (WCFC) i populatio groups o rougl

10,000. CInI works closel wit te local

govermet, electe represetatives (i.e.,

via te Pacaat political sstem i rural

areas a via urba a local bo members

i cities) wo are traie b CInI to access

services relate to ealt, utritio, euca-

tio a protectio rom te existig gover-

met sources. Te commuities esure tat

o cil is let out o scool; tat te are i

a protecte eviromet a ot beig use

as cil labourers or beig trafcke; a

tat all wome a cilre ave access to

prevetive a curative ealt a utritio

care services.

25 The importance o womens status or child nutrition in developing countries; Research Report 131. Washington, D.C. International Food Policy Research Institute (IFPRI)26 The dierence in womens status between India and Sub-Saharan Arican was not ound to be that large. Instead, results showed that the negative impact o womens low

status in South Asia on child nutrition was much more severe. That is, it is the nature o womens low status in India which aects their ability to nurture their children.27 The BMI is the ratio o weight in kilograms to the square o the height in metres.


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The Nutrition Foundation o India undertook a

signicant study on this issue.28 Several actors

have been associated with intrauterinegrowth

retardation (IUGR) and consequent low birth

weight (LBW), including maternal anaemia and

under-nutrition, low age at marriage, short

inter-pregnancy interval and inections. Multiple

micronutrient deciencies may co-exist in the

pregnant woman and interact, with eects on

various pregnancy outcomes.

The ndings? The percentage o new-borns

with birth weights below 2.5 kg were 36.3, 18.2

and 6.1 respectively in three groups: control,

experimental group with iron olate, and iron

olate with green leay vegetable (GLV) supple-

ment. The study showed a positive and signi-

cant impact o iron olate supplementation on the

birth weight o the babies. The study showed that

an important part o the nutritional management

o pregnant women will consist in ensuring that

their dietary intake o GLV is adequate.

So again, any sustained eort at reducing child

malnutrition must begin with a reduction in

womens malnutrition and improvement in

womens health generally.

The public health service or its shortall, espe-

cially in poorer, rural areas is a major actor too.In 2005-06, according to the NFHS-3, only 44 per

cent o children aged 12-23 months were ully

immunised; only 26 per cent o children with diar-

rhoea were given oral rehydration salts. Less than

two thirds (64 per cent) o children suering rom

acute respiratory inection or ever were taken to

a health acility. And antenatal care is severely

lacking. The NFHS-3 demonstrates a worryingshortall: barely hal (51 per cent) o pregnant

women receive at least three antenatal visits, and

perhaps even more shockingly only 48 per

cent o births during 2005-06 were attended to by

a trained birth attendant.29

Ater birth as well as during pregnancy, the

NFHS-3 reveals causes. Breast milk is vital to a

child in the early years o lie, but it is insucient.

Ater 4-6 months, it must be supplemented by

solid oods. Despite this, only 23 per cent o sam-

pled children under the age o three were breast-

ed within an hour o birth and less than hal the

babies (46 per cent) up to ve months old were

exclusively breasted. Only 56 per cent o children

aged between six and nine months received the

necessary combination o breast milk and solid

or semi-solid ood. With this adverse start in lie,

undoing the damage is dicult. Education in the

importance o breasteeding and the provision o

solid or semi-solid oods will be crucial to bring

Indias levels o child malnutrition anywhere close

to acceptable global standards.

Adolescent girls help others whilegetting support to stay in education

I Kolkata slums, CInI works wit oug

Muslim girls wo are provie stipes to

access ig scool a uiversit eucatio. Iexcage, te are expecte to go o ome

visits i teir eigbouroo to motivate

moters to breastee, a supplemets to

te cilres iets, a accompa tem to

seek ealt care rom public acilities. Te

teac parets to provie stimulatio to teir

cilre troug simple teacig ais, sogs

a aces. Tese teeage girls are wiel

respecte i teir commuities a ave

gaie cofece tat will serve tem well ite uture.

28 http://nutritionoundationondia.res.in/research8.asp29A doctor, nurse, woman health worker, auxiliary nurse midwie or other health personnel.


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vulnerable populations in states with the highest

malnutrition.

The report observes, too, that more attention has

been given in the ICDS to increasing coverage

than to improving the quality o service delivery,

and to delivering ood rather than changing amily-

based eeding and caring behaviour. To quote the

report: This has resulted in limited impact.

There is, crucially, a mismatch between the inten-

tions o the program, and its actual implementation.

Yet not everyone agrees on the eectiveness o

ICDS. The Nutrition Foundation o India is more

equivocal and even positive:

Wats bee trie?In 1975, the Integrated Child Development

Services (ICDS) was rst implemented. It is a

major programme to tackle malnutrition and the

ill health o mothers and children which ollowed

the adoption o a National Policy or Children.

This programme is now the single largest

programme or the countrys children. Yet more

than thirty years later, its perormance remains

unsatisactory. Examining its ailings is the best

approach to nding new strategies or dealing

with the problem.

In August 2005, at about the same time that the

NFHS-3 was being compiled, the World Bank

produced a weighty report on the subject o

Indias child malnutrition.30 It examined Indias

successes and ailings through the prism o the

Millennium Development Goals (MDGs) halving

the prevalence o underweight children by 2015

as a key indicator o eradicating extreme poverty

and hunger. The World Bank reviewed the ICDS,

nding that although it had been successul in

many ways, it was yet to make a signicant

dent in child malnutrition. It advocated the

development o the skills o grass-roots workers

an ecient management system, and recom-

mended public investment in ICDS be directed

towards the younger children (0-3) and the most

Te Wor Baks figs iclue:nThe ocus on ood supplementation has been

to the detriment o other important tasks

such as improving child-care behaviour and

education on amily ood budgeting;

nInsucient ocus has been given to the young-

est children (0-3) who could benet the most;

nChildren rom wealthier households have

participated much more than poorer ones;

nThe ICDS has only partially succeeded in

preerentially targeting girls and lower castes

(who are at higher risk o under-nutrition);

nAlthough program growth was greater in

under-served than well-served areas during the

1990s, the poorest states and those with the

highest levels o malnutrition still have the lowest

levels o program unding and coverage.

The ICDS programme aimed at providing oodsupplementation or vulnerable groups such as

pre-school children, pregnant and lactating women,

covers nearly all blocks in the country. The Midday-

mealprogramme aimed at improving the dietary

intake o primary school children and reduction

in the school dropout rates has been operationa-

lised throughout the country. Over decades, health

inrastructure and manpower has been built up and

there is universal access to essential primary health

care. National programmes or tackling anaemia,

iodine defciency disorders and Vitamin-A

defciency are being implemented.

30 Indias Undernourished Children: A Call For Reorm And Action, August 2005.


11/11


Page 11

As a result o all these interventions, there has

been a substantial reduction in severe grades o

under-nutrition in children and some improvement

in the nutritional status o all the segments o

population. Kwashiorkor, marasmus, pellagra,

beriberi and blindness due to severe vitamin-Adefciency have become rare. However there are

still many problems to be tackled and there is a

need to accelerate the pace o improvement in

nutrition and health status o the population.31

But it has its own recommendation:

Dietary diversifcation, better coverage under the

national anaemia control programme, massive

dose vitamin. A administration, universal access

to iodised and later iron and iodine ortifed salt

are some o the interventions that could help the

country to achieve rapid reduction in micronutrient

defciencies. 32

Despite what incremental improvements may

have taken place and taking into account the

diculty o acquiring reliable statistics in an

enormous country o limited literacy and con-

siderable bureaucracy there can be no doubt:

A concerted, cooperative, more thoughtul and

more eciently targeted eort is required to pullIndia once and or all out o poverty, and to give

hundreds o millions o current and uture Indian

children a real shot at sharing the wealth o the

new and miraculous Indian economy.

31 http://nutritionoundationondia.res.in/ao%202007/FAO2007/11%20Summary%20and%20Conclusion/11%20Conclusion%20.pd32 http://nutritionoundationondia.res.in/ao%202007/FAO2007/11%20Summary%20and%20Conclusion/11%20Conclusion%20.pd

Sam Mendelson is the ormer deputy editor oFinancial World magazine, ormer programme director at the Centre or

the Study o Financial Innovation and has recently returned to the UK ater a year travelling through thirty countries

including an extended time in India. He has written extensively orFinancial Worldand consults orMicronance without

Bordersand other NGOs.He holds a Masters degree in public international law rom University College London.

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