Seminar September 2014 the Malnourished Tribal

8/11/2019 Seminar September 2014 the Malnourished Tribal

1/47

The problem

INDIA is uniquely placed on the worlds tribal map, being home to 104 million of the worlds estimated 370 tribalpeople. India is also called the melting pot for races and tribes with nearly 700 distinct tribes (ranging from a

minuscule 44 Onges in the Andaman and Nicobar Islands to over seven million Gonds spread over many states of

central India.) Together they constitute 8.6% of the countrys population the largest proportion in any country

globally. Indias tribals calledadivasi(earliest dwellers), vanya jati(forest castes), van vasi(forest

dwellers),janjati(folk communities),girijan(hill dwellers), adimjati(primitive castes) and constitutionally,

Scheduled Tribes, are covered by protective and positive discrimination policies designed for their welfare and

social and economic upliftment.1

Unfortunately, despite constitutional protection and earmarked budgets they continue to remain among the poorest

and most nutritionally deprived social groups in the country. Poverty rates among Indias tribals are still where the

general population was 20 years ago. The fact that every second tribal in rural India lives in food-insecure conditions

with caloric and protein consumption 25 to 53% below the recommended dietary allowance and consuming a diet

with negligible amounts of milk and fruit leads one to question the implementation of our manifold legislationsand schemes for tribals. Though starvation deaths among tribal children are hardly uncommon, only a few catch the

headlines. If one was to rate nations on the yardstick of chronic undernutrition among children the starkest

manifestation of deprivationIndia would occupy centre stage, housing the highest proportion of chronically

undernourished children globally (61 out of 165 million), with the prevalence being highest among tribal children

(54%).

Field practitioners argue that land alienation, displacement and poor compensation and rehabilitation provisions are

among the core reasons for the prevailing poverty among tribals, which results in household food insecurity and

undernutrition in their children. Activists argue that physical destruction of forests, government monopoly over

minor forest produce, and lack of regulation on access to corporates over resources and wealth that belong to the

adivasis are critical factors contributing to their poverty and subsequent bondage and deprivation. It is undeniable

that the tribals of central India have borne the brunt of displacement as their mineral rich habitats also happen to be

among the best sites for hydroelectric projects. The failure of government to protect tribal rights to their land andresources despite legislation is a major contributor to increasing civil strife, as also deprivation.

However, the present discourse, both official and multilateral, prefers to foreground their lifestyle, food habits,

traditional and cultural practices as key reasons for their chronic undernutrition, and on the forested, hilly and

undulating terrains for poor coverage of public services. Yet, though distance is a factor, the same geographically

isolated tribal domains are also overexploited for their natural resources, thereby weakening the argument of

geographical isolation as a rationale for poor access and coverage of services in tribal areas. It is true that

government servants are reluctant to work in such areas and far too often absent themselves from their official

duties, claiming danger from ongoing civil strife. Nevertheless, extremist violence affects only about one third of

tribal blocks in central India. So why is the remaining two-thirds still underdeveloped and deprived?

Undernutrition in children is influenced not only by food and child feeding practices in the first two years after birth

but also by maternal nutrition before and during pregnancy, narrow inter-pregnancy intervals, gender inequity,household poverty, and other such issues. This makes it clear that any meaningful solution must follow a holistic

approach addressing issues related to nutrition, health, family planning, water and sanitation, poverty alleviation and

women empowerment simultaneously, and the concerned ministries should join hands to plan and implement

effective inter-sectoral interventions and not leave the responsibility to only one or two ministries. The Ministry of

Tribal Affairs (MoTA) being the nodal ministry for tribals can convene various ministries for policy, planning and

programme coordination for tribals to ensure that basic nutrition, health and sanitation and development reaches

them. However, undernutrition is far too often considered to be synonymous with hunger and starvation, a clear
http://www.india-seminar.com/2014/661.htm


2/47

failure to understand the complex relationship between calorific intake and nutritional status. Little surprise that the

solution is sought in food doles.

Although the current scenario appears to be grim, there are worthwhile examples for others to adapt and replicate.

Additionally, Unicefs experience in bringing nutrition counselling, services and support closer to adivasi children

and their mothers, shows that partnerships with non-government organizations can improve outreach in inaccessible

pockets. Equally, that formal engagement with adivasi communities as partners of change is imperative. Investing inadivasi leadership and empowerment, while promoting strategies to improve nutrition, is critical. Otherwise, given

their (tribals) inherent shyness, a result both of unfamiliarity and negative experience with the outside world, and

lack of voice, reflective of poor organization, the adivasi demand for their entitlement(s) would never reach a critical

mass to influence the nature of response.

This issue of Seminardiscusses the complex causes behind nutrition deprivation of tribals, brings to the forefront

broader issues of governance, which cannot be decoupled from trickle down nutrition schemes, and presents

solutions of what works and why in an effort to forge multi-sectoral commitments for improving the food and

nutrition security of our tribal children the youngest, poorest and most vulnerable.

V A N I S E T H I

Children of a lesser god

N . C . S A X E N A

OVER 70% of adivasis reside inthe central region of India, which though resource rich, is home to the poorestpeople who have not benefited from social and economic development to the same extent as people in other regions.

In some cases they may have actually suffered due to the anti-tribal, market oriented forest policies (as they depleted

the gatherable biomass), or resulted in displacement from their ancestral lands. The lack of accountability of

government personnel in these remote and sometimes inaccessible regions has also resulted in poor delivery of all

government programmes, contributing to the utter neglect of the poor adivasis.

It is therefore not surprising that the proportion of adivasis both adults and childrenwho suffer from malnutrition

is far greater than the Indian average. Studies done by Subal Das, Kaushik Bose and Amaresh Dubey indicate that

over half the adivasi adults have a BMI (Body Mass Index) below 18.5, which makes them chronically

undernourished, as compared to 35% of all Indians.1The figures are more dismal for women and children. For

instance, 71% of tribal women in Jharkhand suffer from various degrees of malnutrition. They often face

complications during pregnancy and are at risk of delivering low birth weight babies. Undernutrition of mothers is

usually passed on to children. Some of the reasons for this undernutrition among tribal women are an inadequate dietintake, ignorance, early marriage, poor access to health services and high morbidity due to unhygienic practices and

surroundings.

A 2014 Unicef report2on nutrition and adivasis points out that only 2% adivasi children between 6 to 11 months

were fed complementary foods in the recommended quality and frequency. Of the 634 children surveyed in

Akkalkuwa block of Nandurbar district,3 378 were found to be malnourished and the number of girls among them

was as high as 60%. In 2005, more than 98 children died in just three months and of these 71 children were found to

be severely malnourished. The study also revealed that only 10% of malnourished children figure in government
http://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_the_problem.htmhttp://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_the_problem.htm


3/47

records. In effect, the government is unaware of as many as 90% cases of malnutrition. According to the survey, the

number of third and fourth grade underweight children in April was 188, in May 185 and in June 138; however, the

government records show only 20, 48 and 20 children as malnourished in these months. Under reporting is

facilitated by collusion between field staff and their supervisors, who are thus able to evade responsibility for

improving nutritional outcomes.

There are cases to show that the tribes are denied their right to food. Children of the Birhor tribal community in

Madhya Pradesh do not have access to the right to education and right to a midday meal at the school as the teachers

fear that the Birhor children will pollute the utensils. 4The human rights groups working on the right to food report

that tribal children cannot access facilities provided by the anganwadicentre (AWC) under the Integrated Child

Development Services (ICDS), and the chances of survival of a tribal child are low, with 71.4% of tribal children

being malnourished and 82.5% anaemic.5

More generally, the Supreme Court order issued in 2004 recommended that all new AWCs should be located in

habitations with high Scheduled Caste and Scheduled Tribe populations. Yet, many villages in Khandwa district

where the Korku tribe live in large numbers, do not have AWCs in their areas. More than 60% tribal children in

Jabalpur district were underweight. Micronutrient deficiency disorders such as anaemia and vitamin-A deficiency

were common among them. Unhygienic personal habits and adverse cultural practices relating to child rearing,breastfeeding and weaning were also prevalent among them.6

Another study found that malnutrition among tribal children (0-6 years) in Thane district of Maharashtra was 68.7%

while the incidence of severe underweight was 28.6%. The overall prevalence of stunting in the 0-6 year age group

was 60.4% while that of severe stunting was 38.5%.7

The studies quoted above amply demonstrate that widespread poverty, illiteracy, absence of safe drinking water and

sanitary conditions, poor maternal and child health services, and ineffective coverage of national health and

nutritional programmes are major contributing factors for the dismal malnutrition indicators of tribal communities in

Central India. They also suffer from many communicable, non-communicable and silent killer genetic

diseases.8Their geographical isolation and remoteness further affects the developmental process as qualified healthworkers refuse to work in these areas.

It is not only in tribal regions, but even in the so-called mainstream India that progress on nutrition indicators is

disappointing. Perhaps other essays in this issue will discuss this in detail, so we could touch on the main findings

here. First, the commonly held belief that food insecurity is the primary or even sole cause of malnutrition is

misplaced. However, the focus in India is still on food, and not on health and care related interventions.

Second, the ICDS design needs a change.At present it targets children mostly after the age of three when

malnutrition has already set in. Very little of the ICDS resources, in terms of funds and staff time, are spent on the

under-three child,

9

and this lowpriority must be reversed focusing more on improving mothers feeding and caringbehaviour, improving house-hold water and sanitation, strengthening referrals to the health system and providing

micronutrients. The basic nature of the programme should be changed from centre-based to out-reach based, as the

child under three cannot walk to the centre and has to be reached at home. Another advantage of visiting homes is

that the entire family, not just the mothers, are sensitized and counselled.

Third, ICDS faces substantial operational challenges, such as lack of accountability due to lack of oversight and an

irresponsible reporting system. It appears that state governments actively encourage reporting of inflated figures

from the districts, which renders monitoring ineffective and accountability meaningless. Objective evaluation by

NFHS-3 shows that 40.4% of children were underweight in 2005-06, 15.8% being severely malnourished. However,


4/47

the state governments in 2009 reported 13% of children as underweight, and only 0.4% as severely

malnourished.10Although reporting has somewhat improved, yet the Government of Indias (GoIs) website shows

the percentage of severely malnourished children (reported as grade III and grade IV children in the state data) in

March 2013 was 0.07 in Andhra, 0.70 in Assam, 0.38 in Rajasthan and UP, and 0.18 in Tamil Nadu. Where is the

problem then? India is as good as Denmark or Norway!

One district collector, when confronted with this kind of bogus figures, told the author that reporting correct data isa high-risk and low-reward activity! The former prime minister termed governments performance as a national

shame, but was not able to persuade the states to even accept that the problem exists.

And lastly, there are large-scale irregularities in the supply of supplementary nutrition provisioning (SNP) in

violation of Supreme Court orders by engaging contractors for ICDS in many states such as Maharashtra, Karnataka,

Uttar Pradesh and Gujarat.

Arecent evaluation of ICDS in Gorakhpur by the National Human Rights Commission 11showed that despite

Supreme Court orders to provide hot cooked meals, all centres only supplied packaged ready-to-eat food, containing

only 100 calories, as against a norm of 500 calories, with 63% of food and funds misappropriated. Being

unpalatable, half the food ends up as cattle feed. The ready-to-eat food is produced in poor hygienic conditions.Some of the ingredients listed on the packets containing the finished product were out of stock at the time of the visit

and the stocks of maize were barely enough to meet a quarter of the daily requirement.

The Government of India should discourage the distribution of manufactured ready-to-eat food as it leads to grand

corruption at the ministerial level. But unfortunately it has encouraged such tendering by laying down the minimum

nutritional norms for take-home rations (a permissible alternative to cooked meals for young children), including

micronutrient fortification, thus providing a dangerous foothold to food manufacturers and contractors, who are

constantly trying to infiltrate child nutrition programmes for profit making purposes.

Emerging economies have demonstrated that child undernutrition can be drastically reduced: Thailand12reduced the

percentage of underweight children by half (from 50% to 25%) between 1980 and 1986; Brazil reduced child

undernutrition by 75% (from 20% to 5%) from 1990 to 2006; and China reduced child undernutrition by 68% (from

25% to 8%) between 1990 and 2002.13Even Vietnam, a country poorer than India, has seen a reduction in

underweight children from 41% in 1996 to 25% in 2006.14Therefore, nutrition improvement at a national scale is

possible. However, economic growth is not enough; it needs to be coupled with effective policy and budgetary

action, particularly for the most vulnerable: the youngest, the poorest, and the excluded.

In addition to the general shortcomings in the design and implementation of nutrition programmes, there are

structural and specific limitations that adivasis face, as their record on all social indicators seems much worse than

other social groups. These cross-sectoral constraints affecting adivasis are discussed in this concluding section.

When ICDS is not doing well in the country, one could expect even more dismal results in tribal regions, as

discussed earlier in the paper. From the policy viewpoint, it is important to understand that tribal communities arevulnerable not only because they are poor, without any assets and illiterate compared to the general population;

often their distinct vulnerability arises from their inability to negotiate and cope with the consequences of their

forced integration with the mainstream economy, society, cultural and political system, from which they were

historically protected as a result of their relative isolation.


5/47

Post-independence, the requirements of planned development brought with them the spectre of dams, mines,

industries and roads on tribal lands. With this came the concomitant processes of displacement, both literal and

metaphoricalas tribal institutions and practices were forced into an uneasy existence with or gave way to market

or formal state institutions (most significantly, in the legal sphere), tribal peoples found themselves at a profound

disadvantage with respect to the influx of better equipped outsiders into their areas. The repercussions for the

already fragile socio-economic livelihood base of the adivasis were devastatingranging from loss of livelihoods,

land alienation on a vast scale, to hereditary bondage.

What has been the impact of government policies on tribal livelihoods? Where should central and state governments

focus to improve the situation? To answer these questions we quote in detail from a Planning Commission (2000)

document:

As tribal people in India perilously, sometimes hopelessly, grapple with these tragic consequences, the small clutch

of bureaucratic programmes have done little to assist the precipitous pauperization, exploitation and disintegration of

tribal communities. Tribal people respond occasionally with anger and assertion, but often also in anomie and

despair, because the following persistent problems have by and large remained unattended to: land alienation;

indebtedness, relation with forests, and government monopoly over MFPs, and non-implementation of the Forest

Rights Act, 2006; ineffective implementation of Panchayats (Extension to the Scheduled Areas) Act of 1996 (PESA,

1996) for Schedule V areas; involuntary displacement due to development projects and lack of proper rehabilitation;

shifting cultivation, such as podu; poor utilization of government funds; and poor delivery of governmentprogrammes.

Arecent Unicef study (2014) confirmed that land alienation and displacement without adequate rehabilitation have

been important causes for tribal impoverishment.

Many issues that need urgent attention are under the jurisdiction of Ministries of Environment and Forests, Rural

Development, Panchayati Raj, and others, where they often do not get much attention. It is unfortunate that the

Ministry of Tribal Affairs (MoTA) does not give sufficient attention to the important problems of the tribals on the

plea that many of these subjects such as land alienation, displacement and PESA are outside their jurisdiction. Even

so the ministry should play a more activist role in addressing these issues by pursuing adivasi concerns with the

relevant ministries.

When a new ministry is set up to focus on the marginalized people, it is expected that it would take a holistic view

of their problems and coordinate the activities of all other ministries that deal with the subjects impinging on the

work of the newly created ministry. The new ministry, however, takes a minimalist view of its responsibility and

reduces itself to dealing with only such schemes (distribution of scholarships and grants to NGOs) that are totally

outside the purview of the existing ministries. Such an ostrich-like attitude defeats the purpose for which the

ministry was created.

For instance, policies relating to minor forest produce (MFP) are often dictated by a desire to maximize state

revenues, and not the welfare of gatherers, who are often tribal women. However, this issue has never been raised by

MoTA. The revenue interests of Orissa can be judged by the fact that during the period 1989-2001, the state

government earned revenues of Rs 7.52 billion from kendu leaves (KL). The total wages earned by KL pluckers

during the same period was only Rs 3.87 billion. The high incidence of royalties on KL needs to be contrasted with

royalties collected on a major mineral, where labour is organized, e.g. royalties are Rs 30 per tonne on bauxite, but a

whopping Rs 12,000/tonne on KL!

Even when the ministry was asked to oversee the implementation of the Forest Rights Act (FRA), it failed to do so

faithfully.15Despite the fact that the main intention of FRA was to promote community participation and

management, the study shows that community rights over MFP etc, have been recognized in negligible cases.


6/47

Apart from poor utilization of funds, tribals have also suffered because of the poor quality of governance.

Programme delivery has deteriorated everywhere in India, but more so in tribal areas, where government servants

are reluctant to work, and are mostly absent from their official duties. Massive vacancies exist in tribal regions in the

face of acute educated unemployment in the country. A Unicef study on Jharkhand revealed that one of the main

constraints faced by the National Rural Health Mission (NRHM) was a lack of skilled manpower. In the two districts

visited, Sahibganj had less than 50% positions in place, while East Singbhum, with better infrastructure, it was

around 54%. Other major reasons identified by this study for low utilization appeared more due to a lack of systemic

controls, such as lack of monitoring, and lack of understanding among the staff regarding the implementation of

rules.

The law pertaining to involuntary displacement has been discussed since 1998, and although a new law has been

enacted, it has yet to be implemented, though it is well established that tribals suffer most when new projects lead to

involuntary displacement. MoTA should be empowered to pressure the states to change their laws in conformity

with PESA and FRA. A white paper should be prepared by the ministry relating to governance in forest dependent

villages, including huge vacancies and absenteeism of staff. The ministry must develop a meaningful partnership

with advocacy organizations to produce credible reports in order to put pressure on other ministries that ignore tribal

interests.

The outcome of policies and programmes pertaining to the issues that are critical for tribal livelihoods are not

frequently assessed by the concerned ministries. There is perhaps a need for capacity enhancement within MoTA,

and its counterparts in the states, which should periodically evaluate the results of government interventions in tribal

regions. Such reports should be used for advocacy with other ministries, who have been vested with the

responsibility to ensure that basic justice and development reaches the adivasi. These studies should also assess

whether basic services in education, health, or nutrition are reaching the tribal hamlets.

Therefore, a systemic change is needed in the way state tribal departments function; their approach must change

from simply spending budgets through narrow departmental schemes to knowledge based advocacy with other

concerned ministries/departments. MoTA should highlight the failure of governance that deprives the poor adivasis

from accessing elementary services, and put pressure on the concerned ministries and state governments to ensure

better policies and delivery.

The Planning Commission should also regularly monitor the impact of existing policies on the tribal population and

engage itself with the concerned sectoral ministries. In addition to spending financial budgets, departments should

also be conscious of the impact that policies (or the lack of it) have on the marginalized peoples. Policies and

budgetary provisions, despite the rhetoric, have not been integrated so far. Changes in policy or laws are not seen as

an integral part of the development process because these have no direct financial implications. One lesser known

reason for this isolation is that development and planning in India are associated with spending money. That

planning meansexpenditure, and this will lead to development is the mindset behind such beliefs. The Indian

planner unfortunately has still to understand the difference between planning and budgeting. This is where a

systemic change is needed in India. In addition to spending budgets, we need to give equal importance to non-

monetary issues such as institutions, laws and policies.

Footnotes:

1. Subal Das and Kaushik Bose, Nutritional Deprivation Among Indian Tribals: A Cause for

Concern,Anthropological Notebooks 18(2), 2012, pp. 5-16; and Amaresh Dubey, Poverty and Undernutrition

Among Scheduled Tribes in India: A Disaggregated Analysis. IGIDR Proceedings/Project Reports Series, 2009,

Mumbai.

2.Nutrition and Adivasis. Unicef, New Delhi, 2014.


7/47

3. http://infochangeindia.org/agriculture/books-a-reports/malnutrition-amongst-maharashtras-tribals-how-bad-is-

it.html

4. http://www.humanrights.asia/news/ahrc-news/AHRC-STM-129-2009

5. http://www.alrc.net/doc/mainfile.php/alrc_st2010/591/?print=yes

6. V.G. Rao, Rajeev Yadav, C.K. Dolla, Surendra Kumar, M.K. Bhondeley and Mahendra Ukey, Undernu trition

and Childhood Morbidities Among Tribal Preschool Children, Indian J Med Research122, July 2005, pp. 43-47.

7. A.L. Khandare, V. Siruguri, A. Rao, K. Venkaiah, G. Reddy and G.S. Rao, Diet and Nutrition Status of Children

in Four Tribal Blocks of Thane District of Maharashtra, India (nutrition status of children),Pakistan Journal of

Nutrition7(3), 2008, pp. 485-488.

8. R.S. Balgir, Tribal Health Problems, Disease Burden and Ameliorative Challenges in Tribal Communities With

Special Emphasis on Tribes of Orissa, accessed at http://www. rmrct.org/files_rmrc_web/centres_

publications/NSTH_06/NSTH06_22.RS.Balgir.pdf

9. Planning Commission, 2012Report of the Working Group on Nutrition for the 12th Five Year Plan (2012-17),

New Delhi.

10. IAMR,India Human Development Report,New Delhi, 2011, p. 140.

11. http://nhrc.nic.in/Reports/misc/SKTiwari _Gorakhpur.pdf

12. http://www.righttofoodindia.org/data/garg-nandi07thailand-reducing-child-malnutrition.pdf

13. http://www.unicef.org/india/reallives_ 5901.htm

14. http://www.unsystem.org/scn/Publications/SCNNews/scnnews36.pdf

15. http://fracommittee.icfre.org

Height of the problem

D I A N E C O F F E Y a n d D E A N S P E A R S

CHILDREN in India are much shorter than children in other countries. More disturbingly, they come across as much

too short according to international norms for populations of healthy children. Adivasi children are even shorter, on

average, than other children in India. This gives rise to two questions. First, why are adivasi children so short? And

second, why are they shorter than children in other population groups in India?
http://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_n_c_saxena.htmhttp://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_n_c_saxena.htm


8/47

We will primarily discuss existing results in the literature, but will also illustrate these sometimes technical findings

with simple analysis of data on child height. Our discussion of the second question why are Scheduled Tribe (ST)

children shorter than other children in Indiadraws heavily on research that we have done in collaboration with

Ashwini Deshpande and Jeff Hammer.1Our research shows that while the ST-general and Scheduled Caste (SC)-

general child height gaps in India are almost identical, the ST-general gap can be completely accounted for by

observable differences in wealth and material resources, but the SC-general gap cannot. This is because STs tend to

live in different places than other groups, and are therefore exposed to different threats and resources. SCs, in

contrast, are more likely to be mixed into the same villages as higher castes.2These results suggest that the ST

height gap is no special puzzle: ST children are shorter than general children primarily because they are poorer and

live in more remote places with fewer resources.

But why are ST children and general children alike so short? All Indian children, including ST children, are much

too short. They are too short both in the sense that they are shorter, on average, than guidelines for healthy growth

recommend, and in the sense that being too short matters for health and economic outcomes. Children in India are

also much shorter than even children in other countries of similar or lower levels of economic development.

Population height is largely determined by early-life net nutrition. Here, net means nutrition that is consumed, net

of losses due to energy expenditure, malabsorption, parasites and disease.3The relevant early-life period in a childs

lifefrom conception to two years of ageis sometimes characterized as the critical first 1,000 days. Physical

height is not the only part of a child growing in early life: brains and bodies, skills and cognition are all developingand shaped by health and net nutrition. Children who do not experience the health and net nutrition in the first 1,000

days that allows them to grow to their genetic height potential are also unlikely to grow to their genetic cognitive

potential.

FIGURE 1

Average Child Height by Population Group

This is one reason why height is important for adult economic outcomes: taller people are, on average, paid more

because taller people have greater cognitive achievement, since the same early-life health that allowed them to growtowards their height potential also allowed them to grow towards their cognitive potential. 4In India, the height

cognitive achievement gradient is even steeper than in developed countries, where it was first studied by economists,

suggesting that profound deficits in early-life health and net nutrition are particularly important factors shaping the

distribution of human capital in India.5


9/47

Because height is so important, the puzzle of child height in India has received much attention. It is an apparent

paradox, called the Asian Enigma, that children in India are shorter on average than children in sub -Saharan Africa

even though children in Africa are poorer, on average. In prior research, we have shown that the India-Africa gap in

average child height can be completely statistically accounted for by the fact that Indian children are exposed to

particularly poor sanitation: almost every Indian child lives near many people who defecate in the open, and because

population density is high, this open defecation is especially threatening for child health.6We will draw on this

research and related papers in this discussion note: sanitation is one of many factors that importantly limit the

growth of adivasi children.

Here, we study child height in India using the third round of the National Family Health Survey (NFHS). In

particular, we use data on 39,864 children under five for whom height-for-age was measured. Although this is the

most recent Demographic and Health Survey (DHS) in India, it is almost a decade old; India has not adequately

invested in even knowing just how stunted its children are. Throughout this essay, we use the DHS categorization of

children into four categories: ST (or Adivasi), SC (or Dalit), OBC (Other Backward Classes), and general. 7This

means that we are ignoring religion, a critically important dimension of social distance in India. Of the 6,548 ST

children in the DHS with height-for-age data, a plurality (3,023) are identified as Christian, and most others (2,769)

are identified as Hindu. This method has the disadvantage of grouping together middle and high caste Hindus and

Muslims into the general category; this is awkward, but is unlikely to change our findings.

The two basic facts that we attempt to explain are presented in Figure 1. First, essentially all children in India are

much too short. The vertical axis is average child height-for-age, or height relative to a healthy population. Negative

numbers represent children who are too short, and all of these numbers are importantly negative. Second, ST

children are substantially shorter than general children. A further observation, noted by Coffey, et al., 8is that ST

children have almost the exact same average height-for-age as SC children; however, these similar levels of

deprivation seem to have very different explanations.

This comparison may appear unfair: 95% of ST children in our height sample live in rural places, while only 65% of

general caste children do, and only 75% of all children in the sample. Because rural children are importantly shorter

than urban children (by 0.41 height-for-age z-points), is there still an ST gap when we compare ST children withgeneral caste children from rural areas? Yes, there is: rural ST children are still 0.38 z-points shorter than rural

general caste children. Although rural residence accounts for 19% of the ST-general height gap, there is still 81% of

the gap left to explain. Rural homes are only a small part of the gap.

More than a billion people worldwide defecate in the open without using a toilet or latrine. India, with some of the

worlds worst stunting, also has one of the very highest rates of open defecation: more than half of the Indian

population does not use any toilet or latrine, and most people worldwide who defecate in the open live in India.

Worse still, high population density in India means that children are especially likely to be exposed to neighbours

germs: the same amount of open defecation is more harmful to early-life health where population density is greater.9

Researchers have long recognized that disease is an important part of early life net nutrition, and therefore disease

control has historically been an important part of improvements in height. 10In a recent study of the historical

increase in European heights, Hatton11found that improvements in height occurred when disease control (measured

as infant mortality) improved. Evidence in the medical and epidemiological literature has documented that germs in

faeces can stunt childrens growth. This is in part due to diarrhoea, parasite infections, energy spent fighting disease,

and possibly in part due to enteropathy,12which is a change in the lining of the intestines13that may make it harder

for the body to use nutrients. New observational evidence is consistent with the idea that enteropathy may lead to

stunting.14Econometric papers focusing on cause and effect have also shown a causal link from sanitation to child

height.15


10/47


11/47

to open defecation is one of the reasons ST children are so short, relative to healthy norms. Second, the vertical

distance between the lines suggests that, even at the same level of exposure to open defecation, and even looking

only within rural India, ST children are still shorter than general children. 19Sanitation alone cannot account for the

ST-general height gap.

Of course, this figure by itself is not enough to prove that open defecation has a causal effect on child height: places

with more open defecation almost certainly have more of other health hazards too, on average. Nevertheless, weknow that open defecation is indeed bad for child height, from the totality of a literature that uses multiple

identification strategiessuch as randomization, fixed effects, discontinuities, and instrumental variables and that

also impacts related outcomes such as haemoglobin levels,20infant mortality,21and cognitive achievement.22

To understand why two population groups differ in some outcome, economists use decomposition methods. These

techniques decompose the average difference in outcome between two population groups into the part that can be

explained by other observable differences between the two groups and the part that is still left unexplained after

taking those differences into account.

FIGURE 3

Decomposition of ST-General Height Gap

A classic application is the U.S. wage gap between whites and blacks: blacks are paid less, on average, than whites

in the U.S. labour market. How much of this difference in wages can be explained by the fact that blacks have, on

average less education? Often, the part of the difference that is left over and cannot be explained by the differences

in inputs is interpreted as an effect of discrimination, although in fact it could be an effect of any factor that is not

accounted for in the decomposition. So, if blacks are still paid less even at the same level of education, skills, and

experience, an economist might interpret this as evidence of discrimination.

We apply similar decomposition techniques to the height gap between ST and general children. This section followsCoffey, et al. (2014), in which we perform a similar but more detailed decomposition of these height differences.

We will proceed step by step, first asking what fraction of the general-ST gap can be explained by the mere fact that

STs are more likely to live in rural places; then adding the difference in exposure to open defecation, and finally

adding a measure of relative wealth and poverty. For this analysis we will differentiate between richer and poorer

children simply by using the division of the population into asset wealth quintiles that is included with DHS data. In

Coffey et al. we use a more detailed accounting for wealth and poverty differences and find similar results.


12/47

Figure 3 graphs the decomposition results. Each bar after the first is the remaining unexplained height gap after the

listed variables are accounted for. As we have already argued, rural or urban location can account for very little of

the height gap. While differences in sanitation can account for more of the height gap, there is still an important

smaller gap left to be explained. The five wealth categories, however, can completely account for the ST-general

height gap, even without taking rural location and sanitation into account.23Therefore, in this statistical accounting

sense, the fact that ST children are shorter, on average, than general children can be completely accounted for by the

fact that they are poorer. Presumably, this is in part because they live in more remote locations with fewer resources,

but this decomposition cannot assess this directly.

The decomposition result above suggests that ST children are shorter than general children in large part because

they are poorer. Of course, this does not estimate any sort of impact of any sort of policy, and tells us little about

what sort of improvements in the material environment of ST children might make them richer or healthier most

effectively.

But the ST-general height gap is only 22% of the more important gap between ST children and the healthy reference

population. Therefore, the most important question may not be what can be done to make ST children as tall as

general children, but what can be done to make ST children grow to healthy heights. The graph above, along with a

large and growing body of evidence, suggests that reducing the amount of open defecation to which ST children areexposed will help them grow taller. Improving sanitation is a particularly appropriate policy recommendation

because sanitation is a public good and open defecation has negative externalitiesmeaning bad effects on other

people. In public economics, such externalities are a classic situation requiring public action to achieve a good

outcome.

Improving sanitation is an important step towards helping Indian children grow taller, but it will not be easy. Open

defecation in India has remained stubbornly resistant to policy initiatives. New evidence suggests that the fraction of

people in India who defecate in the open has declined so slowly that it has not kept pace with population growth.

Spears shows that most people in India live in a district where their exposure to open defecation density increased

between the 2001 and 2011 census rounds.24Many people in India do not believe that open defecation is harmful,

and some even prefer to defecate in the open. There is no clear, ready-made solution to the problem of sanitationbehaviour change in rural north India. Widespread child stunting demands that we get busy experimenting with

many different ways to address open defecation.

Footnotes:

1. Diane Coffey, Ashwini Deshpande, Jeffrey Hammer and Dean Spears, Unpublished research on differences in

child height across population groups in India, available on request. 2014.

2. Among SCs, social rank can account for height gap that remains after controlling for economic factors.

Additionally, we find that after controlling for material resources, SC children are no shorter than general castechildren when they live in villages where they are not outranked by higher caste people.

3. Angus Deaton, Height, Health and Development,Proceedings of the National Academy of Sciences104(33),

2007, pp. 13232-237.

4. 4. Anne Case and Christina Paxson, Stature and Status: Height, Ability, and Labor Market Outcomes, Journal of

Political Economy116(3), 2008, pp. 499-532.


13/47


14/47


15/47

ancestral territories, and their ethnic identity, as the basis of their

continued existence as peoples, in accordance with their own cultural

patterns, social institutions and legal system.

This historical continuity may consist of the continuation, for an extended

period reaching into the present of one or more of the following factors:

* Occupation of ancestral lands, or at least of part of them;

* Common ancestry with the original occupants of these lands;

* Culture in general, or in specific manifestations (such as religion, living

under a tribal system, membership of an indigenous community, dress,

means of livelihood, lifestyle, etc.);

* Language (whether used as the only language, as mother tongue, as the

habitual means of communication at home or in the family, or as the

main, preferred, habitual, general or normal language);

* Residence on certain parts of the country, or in certain regions of the

world.

Other relevant factors:

On an individual basis, an indigenous person is one who belongs to these

indigenous populations through self-identification as indigenous (group

consciousness) and is recognized and accepted by these populations as

one of its members (acceptance by the group).

This preserves for these communities the sovereign right and power to

decide who belongs to them, without external interference (United

Nations 2004).

A second problem we have in understanding indigenous well-being, including nutrition, relates to the way in which

we measure health. In Occidental or western medical science, for example, health is evaluated with measures such

as mortality and morbidity. In nutritional terms, nutritional status is measured with anthropometric indicators such as

weight for height, weight for age and height for age.

Most indigenous groups do not conceptualize their health and well-being in these terms at all. They often do not

regard health as anindividualphysical state but as a state of community and ecological well-being, and often

indigenous concepts of health include a spiritual component. This is particularly important in terms of foods and

medicinessome foods may be spiritually important and this importance is greater than their direct value for

nutrition. The same is true of medicines.

This is extremely important to understand when we discuss indigenous nutrition as it becomes simplistic, and often

misguided, to look at indigenous nutritional health simply in terms of western concepts such as mortality and

morbidity, or measures used in anthropometry. Interestingly, and also important to understand, in many senses

indigenous definitions of health are closer to the World Health Organization definition of health as, a state of

complete physical, mental and social well-being and not merely the absence of disease or infirmity , than current

measures used by western medical science.


16/47

Bearing in mind first the complexity of defining indigeneity, it is estimated that globally there are more than 370

million self-identified indigenous peoples in approximately 70 countries. This comprises over 5000 cultural and

linguistic groups, who form the basis of the worlds linguistic, genetic and cultural diversity. These peoples are often

the original inhabitants of the lands where they live, but are now usually in a minority within the current nation

states where they live. The largest concentration of indigenous peoples internationally is in Asia and the Pacific an

estimated 70 per cent of all indigenous peoples live in this region.

Indigenous wisdom internationally and within this region is under threat. In a globalized world, traditional

knowledge can be eroded, and ecosystems put to service of international economic processes such as mining,

resource extraction, and deforestation.

A majorLancetseries on global indigenous health in 2006 identified several key themes that define the well-being

of indigenous peoples. Lack of data is very important: indigenous identity is highly contested, and where indigenous

peoples are recognized, data are rarely routinely collected or disaggregated. Where data exists, evidence suggests

that in all settings indigenous peoples suffer poverty, marginalization, extreme ill health, and many population

groups are at risk of demographic extinction. Indigenous peoples concepts of poverty, development and health

differ from western models. Rarely focusing on individual well-being or on traditional poverty indicators,

indigenous peoples see their social and physical well-being as intimately linked to that of the wider community andthe resources of the ecosystems in which they live. Sociopolitical factors linked to marginalization and colonialism,

and relationships with land and environment, are seen as fundamental determinants of indigenous poverty, well-

being and health.

In many settings, there is a basic lack of evidence on indigenous poverty, health and well-being, particularly for

those in isolated settings, and indigenous peoples have often been overlooked in national programmes on poverty,

health or education. If we look specifically at the Asian region, here are approximately 260 million indigenous

peoples. They live in the following 17 countries throughout the region. If we now turn then to the countries of South

Asia, including India, Nepal, China and Burma, indigenous peoples in the region sustain a wealth of cultural and

ecological diversity, largely based on their highly diverse indigenous cultures living in remote forest and mountain

ecosystems.

It is only now being understood that the bio-cultural treasure of South Asia is maintained by the regions indigenous

peoples. This treasure includes foods and medicines of direct importance to human well-being, but also includes a

history of indigenous spiritual beliefs which have influenced Asian philosophy and religion for millennia. Directly,

indigenous peoples hold knowledge about foods and medicines from their lands of origin that are important for them

and the peoples of the region, but globally Asian bio-culture contains foods, medicines and knowledge that have

been used for centuries throughout the world.

Many countries in Asia have incredible cultural diversity. In India, for example, 461 ethnic groups are recognized as

Scheduled Tribes (STs)which can be considered as a way of defining indigenous groups in India. In mainland

India, STs are usually referred to as adivasis,a controversial and often pejorative term which has been widely

criticized but is still in use. These groups have an estimated population of 84.3 million, and comprise approximately

8.2% of the total population. It should be noted, however, and this relates to our former point about data, there aremany more ethnic groups in India who are not officially recognized. It may be that as many as 635 indigenous

groups exist in India and the largest concentrations are found in the seven states of Northeast India, and central

tribal belt stretching from Rajasthan to West Bengal.

Indigenous peoples in this region experience discrimination, expulsion from their lands, and displacement to urban

settlements where they lose access to their cultural heritage and their traditional foods, practices and languages.


17/47

They are often unable to access health services and are stigmatized when they try to use their traditional medicines.

In many countries, indigenous communities are considered backward and are treated as second class citizens, just

as the adivasi are in India.

Despite these challenges, indigenous peoples in the region continue to maintain their cultures and languages, and

hold a wealth of knowledge about their ecosystems, local indigenous medicines and foods. Nutrition of indigenous

groups in their local forest and mountain environments is often good, but deteriorates on contact with outsidepopulation groups and with displacement and acculturation into mainstream societies.

Astudy of indigenous nutrition in Arunachal Pradesh, India, found that the Adi indigenous community, living in

remote regions of the mountainous state, maintained an intimate knowledge of foods and medicines that they could

access from their ecosystem. Members of the same communities, but in closer contact with mainstream society, had

lost a significant amount of traditional knowledge about their foods and medicines and were unable to access those

that they did remember from childhood or family. Important local traditional foods included: cereals and millets,

rice boiled and as wine, and mirung (finger millet) as wine; legumes principally boiled; vegetables including ongin

(Cleroden-drum colebrookianum), pettu (Bras-sica), kopi (Solanum torvum), kopir (Solanum khasianum), and ange

(Collocasia), fermented bamboo shoot. They also eat fruits including banana and pineapple, meat and local fish and

use spices such as ginger and chilli.

Forest ecosystems in Asia are incredibly important for the nutrition of indigenous peoples. Forests cover 26% of all

land area in Asia and comprise 740 million hectares. This sounds an extensive area, but in fact Asia has the lowest

proportion of forest cover per capita in the world, with only 0.2 hectares per person, and this is rapidly being

encroached by deforestation and population growth.

Despite threats to the forest ecosystem in Asia, indigenous groups have lived and learnt from the forest for millennia

and they utilize a wide range of forest products for both direct nutritional benefits and for indirect support of their

agriculture and well-being. This includes products from trees and plants including fruits, berries, leaves, seeds, nuts,

barks, mushrooms and from forest wildlife, insects and wild animals and grubs. Indirect benefits for nutrition

include fodder for livestock, fuelwood and charcoal and stabilizing agricultural products. Forest foods are also a

source of income for indigenous peoples with products such as jams, wines and dried fruit and insect products.

Forests and mountains also have an incredible and valuable spiritual component for indigenous nutrition and well-

being, not only in Asia but also internationally. For example, a study of indigenous use of forest plants in Nepal

found that more than 80 different plant species and their products were required to perform religious and cultural

festivals. The nature of species varied from annual herbs, climber, palm trees, shrub to big sized trees and their parts.

The plants ranged from purely wild to domesticated plants and trees. The accompanying image shows animals,

plants and birds pictured on an ancient mural in central China.

Things change for indigenous peoples when they are displaced from their forests and mountains in Asia. This is

often due to deforestation or major projects including mining and road expansion. As these changes occur,

indigenous peoples are often displaced to towns and cities in Asiawhere lifestyles are very different, and major

inequalities exist between the urbanites who have managed to achieve western lifestyles and the vast majority of city

dwellers in Asia who live in unhealthy low income settlements, where conditions are poor in terms of water,

sanitation and housing. This has impact on nutrition and indicators for low income urban peoples are as poor or

poorer than their rural counterparts. Indigenous peoples arriving in these towns and cities rarely move into wealthy,

healthy areas and almost always end up in the low income settlements as displaced peoples.


18/47

In western biomedical terms, there is a vast difference in indicators of health and well-being between isolated

indigenous groups who are able to maintain their culture and access to their ecosystem, and those forced off their

lands and distanced from their culture and traditions. Indigenous community members who are displaced to urban

settlements often experience the worst of both the worlds of modernity and antiquity. They find it difficult to adapt

to urban life and even harder to maintain their cultural traditions and access to traditional foods. They also lose

touch with their important spiritual contact with the mountains and forests.

Traditional mural in China.

What does the future look like for indigenous peoples in Asia? There are major issues of population growth,

urbanization, massive inequalities and increasing deforestation and destruction of ecosystems. All this will

potentially impact negatively on the well-being of indigenous peoples unless governments protect them from the

impacts of these massive development policies. Ironically, if Asian governments do not protect the 260 million

indigenous peoples in thousands of cultural and linguistic groups, the region and the world will lose a vast amountof cultural diversity and wisdom. We stand at a crossroads to choose whether to protect or abandon those who have

protected and cared for the forest and mountains ecosystems of Asia for millennia.

Alongside this bleak picture, the international stage has been changing. The crucial role played by indigenous

peoples and local communities has increasingly been highlighted in global environmental and development policy

processes, including the United Nations Convention on Biological Diversity (CBD) and the UN Framework

Convention on Climate Change (UNFCCC). In January 2011, the International Union for Conservation of Nature

(IUCN) met with indigenous representatives and conservation organizations to discuss conservation priorities in the

context of indigenous rights. The 2011 meeting concluded with a call to reinforce IUCNs multi -level process

(encompassing international, regional, national and local levels) to assess and advance the implementation of the

new conservation paradigm.

Specifically, they call for assessments in protected areas with indigenous peoples that can specify recommendations

to address gaps between the observed practices and the new conservation paradigm. A major challenge is how to

bring indigenous communities to local and international policy tables, particularly given their relatively isolated

existence in remote forest locations, where normal communication technologies do not reach. Isolated in many

settings, but increasingly in contact with modern society to the detriment of health and well-being, the nutrition of


19/47

indigenous peoples in Asia will ultimately depend on their ability to maintain their healthy ecological and

sustainable lifestyles with their access to biodiverse environments and cultural traditions. The world has an

enormous amount to learn from these communities and stigmatizing, marginalizing and displacing them is the last

thing we should be doing.

References:

P. Durst, Inedible or Incredible: Asia Pacific Forests for Improved Nutrition and Food Security. FAO, 2009.

International Work Group for Indigenous Affairs http://www.iwgia.org/culture-and-identity/identification-of-

indigenous-peoples

H.V. Kuhnlein, B. Erasmus and D. Spigelski (eds.), Indigenous Peoples Food Systems:The Many Dimensions of

Culture, Diversity and Environment for Nutrition and Health.Food and Agriculture Organisation, Rome, 2009.

United Nations. The Concept of Indigenous. Backgroundpaper prepared by the Secretariat of the Permanent

Forum on Indigenous Issues. Workshop on Data Collection and Disaggregation for Indigenous Peoples. D. o. E. a.

S. Affairs. United Nations, Secretariat for Indigenous Peoples. New York, 2004.

Women and nutrition security

G O V I N D K E L K A R

OF the numerous studies on nutrition in India, only a few pay attention to womens assetless gendered position in

social institutions, not appreciating that without substantial improvement in womens socioeconomic positio n it

would be difficult to achieve nutrition security. Most state schemes and development projects tend to focus on

womens responsibility in the provisioning of nutrition, without giving attention to enhancing their freedom from

male dependency in resource management and a systemic subjugation embedded in socio-cultural norms. This

article explores the growing concern for womens access to justice with gender asset equality among Indias

indigenous societies.

Research has increasingly highlighted that asset disparities between women and men affect agricultural productivity

and food/nutrition security, and that womens work in agriculture and production of food goes unrecognized and

social norms about womens work limit their unmediated right to access fores ts, land, finances and newtechnologies. This, in turn, skews distribution of economic growth and promotes structures of power and inequality

that deny marginalized people, such as indigenous peoples and indigenous women in particular, access to justice and

effective control over their lands and forests.

According to recent reports, close to 870 million people of the 7.1 billion people in the world (1 in 8) suffered from

chronic undernourishment in 2010-20121and the consumption level of almost 680 million people across both urban

and rural areas in India fell short of its poverty line of Rs 1,336 per capita per month. 2Rough estimates suggest that

1.3 billion people lack access to electricity and 2.7 billion people rely on traditional biomass for cooking food. 3
http://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_carolyn_stephens.htmhttp://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_carolyn_stephens.htm


20/47

Estimates show that 70% of these are women/girls who have much lower right to production assets: land, house,

new technologies, as well as representation in political and economic decision making. Further, women have the

primary responsibility for the production of food and procurement of energy and water. Surprisingly enough, the

invisibility of these tasks in systems of national accounting, and womens marginal access to rights to own and

control productive assets, show the massive and complex nature of gender inequality. Close to half the population is

kept under control with systemic violence within the home and outside, and their dependency is maintained by

traditional institutions and state policies.

Following the post 2015 development agenda discussions, civil society groups across the Asia-Pacific region have

drawn attention to the inter-country global inequality as well as rise in intra-country inequality in the emergent

economies. For example, the pattern of economic growth in China since the 1980s and in India since the 1990s has

worsened inequality within the country, possibly a result of a shift from agriculture to industry and from rural to

urban areas.

Discussing the growing intra-country inequality in the rising powers of Asia, a recent study noted that the Gini

Coefficient increased by 24% in China and by 16% in India during the decade of the 1990s.4Significantly,

disproving the Kuznets curve (i.e., income inequality falls as society modernizes), Thomas Pikettys analysis of

accumulation and distribution of capital worldwide shows that inequality has increased in the last 30 years almost

everywhere, including the United States. The history of inequality is shaped by the way economic, social and

political actors view what is just and what is not, as well as by the relative power of those actors and the collectivechoices that result.5

Indigenous peoples arguably constitute among the most vulnerable populations for a variety of reasons. Most

notable is their substantial dependence on natural resources, making them vulnerable to changes in the quality and

quantity of natural resources. They encounter additional challenges as they often face discrimination and live in

secluded communities. Frequently denied access to decision making processes, the ecological systems upon which

they depend are increasingly controlled by non-indigenous peoples and corporations.

The 2006 Human Development Index (HDI) for Scheduled Tribes (adivasis) in India shows that their HDI is almost

one-third below that of the Indian average and, on an international scale, they fall among the poorer countries of

Africa.6

They are subject to displacement in the name of development projects from which they derive little or nobenefit. Often they suffer legal discrimination, viz. in peninsular India, where they are subject to non-judicial forms

of punishment and imprisonment. Given limited access to education, health facilities, new technologies, agricultural

inputs, credit and infrastructure development, their economies have remained virtually cut-off from the countrys

economic growth and technological development.

Their vulnerability to food and nutrition is attributable to the iniquitous relations of gender and power embedded in

the larger social, political and economic institutions that determine, inter alia, legal rights and ownership, customary

and religious practices, and economic, business and livelihood options. Among adivasi women, for example, access

to land, credit, and resources can be further restricted, going beyond the already limited access to indigenous peoples

on the whole, such that they may experience inequality in the market and workplace even within their communities,

all of which further exacerbates exclusion and poverty. This is clear when examining indigenous womensownership and control of assets, participation in decision making processes, production of food, gender roles in the

household and local economy and womens risk of gender based violence.

The transfer of forest management out of community hands and into private companies or individuals has resulted in

greater socio-economic disparity in many forest societies. Income generated from forests and power is accumulated

under local elites, who have commonly excluded women and the poor from usufruct, ownership and control rights to


21/47

land and forests. Hence, forest based adivasi and indigenous societies have in many cases experienced enhanced

gender inequalities.7

Among the matrilineal Khasi, for example, womens status has traditionally depended on their claim to and

ownership of ancestral property. Womens ownership of land, however, is no longer the determinant feature of the

Khasi property system, in large part due to privatization. In some villages, formerly community owned forests are no

longer deemed to constitute ancestral property in the process of registration. Instead, the land may be deemed self-acquired property, the right to which is governed by different principles and controlled by me n who legalize

ownership. In other villages, however, forests were privatized and the land was divided and distributed to those

whose lands or households were adjacent to the forest, and titles given in the names of women and men.8

Alongside the legalities of ownership, rules governing resource use have been changed in land and forest

management. In the traditional systems of the Khasi, Jaintia and Garo in India, and Mosuo in Yunnan, China, for

example, womens ancestral property was managed by her uncle orbrother. The direct role of the maternal uncle or

brother remained even after the men married into other clans. This was possible since marriages often took place

within the same village. But, increasingly husbands are effectively managing land and forests, as well as the capital

they generatea key economic resource for households. This capital, however, may also be deemed self-acquired

property and thus passed on from father to son, bypassing the traditional matrilineal economic system. While

women in landholding Khasi families are in a better position than if they were completely property-less, the rise of

the timber industry has enabled men, as husbands, to increase control of the familys economy.

In landless Khasi families, the main source of cash income is wages from logging, typically earned and controlled

by men, which has contributed to male domination in these households. During field visits in 2006, 2008 and more

recently in 2011 in Jharkhand, Chhattisgarh and Andhra Pradesh, India, women often cited threats by their husbands

including beatings and expulsion from the houseshould their husbands demand but be denied money for liquor.

The women, without claim to land or the house, had little with which to bargain. Comparatively, being thrown out of

the house is something that a house owning Khasi woman is not likely to be subjected to.9The Nagas, on the other

hand, are patrilineal where women have no inheritance rights over land and housing.

The linkage between womens exclusion and inequality can appear self-evident. Less evident, however, are the

multiple interdependent causes of vulnerability of women resulting from inequality in gendered social systems

among indigenous peoples. The only case of a woman becoming a Gaon Buri (village elder) near Dimapur has been

strongly opposed by the Federation of Gaon Buras of Nagaland. On the other hand, there are cases in Arunachal

Pradesh of woman being designated as gaon buris.10Discussing the image of the Khasi male, Tiplut Nongbri

captures the complex reality through a poem.11

A new world comes rolling in heralding the epoch of father and son

Yet mans position remains unchanged

His power/authority gains greater height

In his natal home he is the revered mama

In his conjugal home, the father

It is for us to take good care

To bring the maternal uncle and father together


22/47

Among adivasis, women can be further marginalized within their traditional institutions as they often have little

representation or voice in village councils. While amendments to Indias Constitution in the 1990s which

decentralized governance, like the Panchayati Raj Extension to Scheduled Areas (PESA), mandate that women shall

have one-third reservation in local government institutions, this has not been implemented in a number of states

including in adivasi areas. Male leaders in adivasi communities defend practices that exclude women from decision

making in the communities; even in matrilineal communities of Meghalaya in India, and Mosuo in China, women

are excluded from the village councils.

Patricia Mukhim, a Khasi woman writer and journalist, observed that the recent introduction of formal village

management systems, which reinforce mens role as community managers, limits womens participation in

community-level decision making processes regarding natural resource management, including management of

forests and land. We can also attribute this control by men to the establishment of once fallow lands as village

reserved forests, and the associated flow of funds into the village through development projects like the IFAD

funded Northeast India Natural Resource Management Project, which have also served to increase mens control

over the economy, even though their knowledge of the local economy is limited since they neither play much of a

role in production nor in marketing of agricultural produce. 12

These power relations fit easily into the marketplace. In Khasi and Jaintia Hills of Meghalaya, for example, adivasiwomen are frequently at the mercy of more powerful traders who control the movement of goods in the market,

resulting in women losing a lucrative enterprise since it has passed on to male hands because of womens exclusion

from markets. Compounding this, the role of women in subsistence and barter has increasingly been devalued with

the expansion of market structures. One notable exception to this trend is in the wool-based enterprises of some

mountain communities, such as in Uttarakhand, which are now moving into monetary economies.

There are, however, a few examples of advances in adivasi womens empowerment. In the villages of East Khasi

Hills, Meghalaya, for instance, a number of cases were reported in recent years where Khadduh the youngest

daughter who is traditionally obligated to provide support and succour to all members of the family has asserted

her claim to full ownership and management rights of her parental property. These claims were made in response to

attempts by the uncle or brother of the Khadduh to claim the family income and/or trees for their personal benefit.

Another example is the initiative of a forest cooperative woman leader Kalavati Devi. While president of the

Primary Forest Produce Cooperative Society in Bajawand block of Bastar district from 1996-2000, Kalavati initiated

reform of the policies that govern distribution of harvesting allocations and payment for tendu leaf, commonly used

in the bidi trade. Harvesting allocations granted via collection cards, were traditionally issued to the male head of

the household, even if the woman was the primary collector of the tendu leaf. After much political bargaining, the

policy was changed so the collectives member (i.e., the person, typically a woman, who harvested the tendu leaf)

would be issued the card as well as the related payments. As a result women are now better positioned to control the

income from tendu leaf sales; household savings have reportedly increased, and women have gained influence over

the cooperatives decisions on the sale of tendu leaf. These policy changes have spurred the growth of the

cooperative and enhanced the participation of women members in particular, who now have an opportunity to regain

some control over forests, and their livelihoods.

The weakening of traditional norms among adivasi and indigenous peoples, along with the growing visibility of

women in the marketing of agricultural products and in the public sphere overall has angered some men who have

called for womens return to domesticity. On the other hand, women having grown familiar with new gender roles

and realizing the implication of the loss of control over land and other productive natural resources, are now

demanding greater autonomy and independence. This underlying social context should be understood in cases where


23/47

women suffer gender based violence, including the continued and in some areas increased violence against women

in forest areas through such practices as demonizing of women as witches and witchcraft persecution.

In sum, this trend towards loss of control by indigenous women over natural resources and the compounding loss of

relative power in relation to men, can largely be attributed to four significant constraints: ( a) interventions from

outside the communitysuch as colonization, privatization, and globalizationwhich have by and large been

extractive and exploitive; (b) fragility of indigenous economy and production structures; (c) weakening of traditionalinstitutional mechanisms which could mitigate the damage; and as is typical in gendered relations, (d) a power

differentiation between women and men reinforced by social, economic and political structures, whereby women

have restricted voice and efficacy in community affairs, as well as limited and often exploitive external contacts.

What then can be the process of correcting gender inequality and nutrition insecurity among indigenous households

and communities? The first step is to recognize the need for transformative change in hierarchy and power between

women and men for individual rights to access ownership and control of land, forests and other assets. Indigenous

societies, like many non-indigenous societies, are characterized by womens unpaid, unrecognized household and

care work, social subordination of women and its close links with violence against women and unequal access to

ownership and management of productive assets.

A central concern is about womens ownership of land, and why land is key to address food and nutrition security.

First, social and economic justice suggests that those who work in fields should have the right to own and manage

the fields. In India, 79% of rural women work in agriculture, and state level studies show that less than 10% have

some kind of land titles in their names. Second, womens unmediated (not through the house -hold or its head) right

to land is important for better productivity and efficiency of resource use. Several studies in recent years 13have

pointed out that secure and inalienable user rights with full control and ownership is necessary for spurring

investment in food production and nutrition security. Based on a number of cases in Africa, researchers have pointed

out that if women had similar access and inputs to land as the men, they could increase yields on their farms by 2.5-

4%. And this in turn could reduce the number of malnourished and hungry people in the world by 12 to

17%.14Third, womens control and ownership of land, house and household income, enables them to use it for their

own well-being as well as for other household members, children in particular. Fourth, asset distribution yields

superior outcomes to income distribution. Land or asset ownership provides a meaningful basis for overcoming

distortions in the functioning of the market and for restructuring unequal relations between women and men, withaccess to economic rights, technology, healthcare and governance.

Ownership is a bundle of rights. Along with ownership there is a need for further developing technical skills.

Capacity development is not just a technical skill; it is a combination of knowledge, marketing and management

skills alongside the effective right to own land and other productive assets. What is important to understand is that

womens asset/land ownership is most likely to change gender based power dynamics within the home and outside,

thereby creating an egalitarian society. As pointed out by Thomas Piketty, Knowledge and skill diffusion is the key

to overall productivity growth as well as the reduction of inequality both within and between countries.

A recent workshop in Delhi on adivasi women recommended support for capacity building in alternate livelihoods:

(i) upgrading of traditional knowledge and skills and revitalizing then in areas where they have been lost; ( ii)introduction of new knowledge and technologies to support womens access to expanded markets; and (iii) womens

unmediated access to collective or individual ownership of resources, including land, housing and finances. This last

is seen as a means to empower women and increase their economic security for better provision of food and

nutrition of the young and not so young adivasi women and men. For example, in Chinas agriculture system, it has

been seen that through policies that improve womens access to technologies and credit, indigenous women have

been more likely to increase efficiency in their use of renewable energy, and more secure access to forest resources

has resulted in lower rates of deforestation.


24/47

Culture is neither historically given; nor is it static. Rather, it is part of the ongoing process of socio-economic and

political change. Womens movement, like any other social movement, creates its own culture and new social

gender norms. Such new social norms or cultural configurations also create social conflicts or possible

contradictions arising from existing and newly created norms. Thus, new social and gender relations and norms

operate in a dialectical way, introducing the germs of change that new movements may carry.

Initiatives to implement gender-responsive policies can influence change in the slow-moving institutions of social

and cultural norms. Hence, the state policy has a definite role to play in creating enabling and empowering

conditions for women to advance their agency for nutrition security with womens unmediated rights to land, forests

and management capabilities.

Footnotes:

1. Food and Agriculture Organization, The State of Food Insecurity in the World, 2012.

(accessed on 17 June 2014).

2. McKinsey Global Institute, From Poverty to Empowerment: Indias Imperative for Jobs, Growth and Effective

Basic Services. Mumbai, 2014.

3. McKinsey Global Institute, 2014, ibid; International Energy Agency, Modern Energy for All.

(accessed on 17 June. 2014).

4. Dev Nathan and Sandip Sarkar, Global Inequality, Rising Powers and Labour Standards, Oxford Development

Studies42(2), June 2014, pp. 278-295.

5. Thomas Piketty, Capital in the 21st Century.Harvard University Press, Cambridge, 2014.

6. Sandip Sarkar, Sunil Mishra, Harishwar Dayal and Dev Nathan, Development and Deprivation of ScheduledTribes,Economic and Political Weekly, 18 November 2006.

7. Govind Kelkar, Dev Nathan and Pierre Walter (eds.), Gender Relations and Forest Societies in Asia: Patriarchy

at Odds. Sage Publications, New Delhi, London and Thousand Oaks, 2003.

8. Dev Nathan, Northeast India: Market and the Transition From Communal to Private Property, in Dev Nathan,

Govind Kelkar and Pierre Walter (eds.),Globalisation and Indigenous Peoples in Asia: Changing the Local-Global

Interface. Sage Publications, New Delhi, London and Thousand Oaks, 2004.

9. Govind Kelkar, Adivasi Women Engaging with Climate Change. UNIFEM, IFAD and The Christensen Fund,

New Delhi, 2009.

10. Jarjum Ete and Julie Bazeley, Local Governance in Arunachal Pradesh. Rome, IFAD, mimeo; Dev Nathan,

Ganesh Thapa and Govind Kelkar,Market and Indigenous Peoples in Asia: Lessons from Development Projects.

Oxford University Press, New Delhi, 2012.

11. Tiplut Nongbri,Development Masculinity and Christianity: Essays and Verses From Indias North East.Indian

Institute of Advanced Study, Shimla, 2014.


25/47

12. Patricia Mukhim, Retrieving Indigenous Traditional Practices of Khasi Indigenous Tribes of Northeast India.

Unpublished report, 2008.

13. ILO,Economic Security for a Better World. International Labour Organization, 2004; Food and Agriculture

Organization, The State of Food and Agriculture 2010-2011: Women in Agriculture: Closing the Gender Gap for

Development. FAO, Rome, 2011; World Bank, World Development Report 2012: Gender Equality and

Development. World Bank, Washington D.C., 2011.

14. FAO, 2011, ibid.

Ensuring a civil life

Y O G E S H J A I N , A N J U K A T A R I A , R A M A N K A T A R I A , R A C H N A J A I N a n d R A V I N D R A K U R B U D E

When I give food to the poor, they call me a saint. When I ask why the poor have no food, they call me a

communist.

Dom Hlder Cmara,

Catholic Archbishop of Olinda and Recife, Brazil, circa 1990.

THE general belief is that adivasis face a greater burden of illness for which care is often compromised due to the

inaccessibility of health facilities and inadequate personal resources. It is also felt that adivasis are affected mainly

by infectious diseases; other conditions like cancer, diabetes, mental illnesses and heart disease are uncommon

among them.

Unfortunately, there is only scattered information on the actual burden and patterns of illness that afflict adivasis.

For example, even for a serious and important illness like tuberculosis, reliable information about its prevalence

amongst adivasis is scarce. Data comparing the patterns of these illnesses between tribals and non-tribals sharing the

same geographical space is just not available. The situation becomes worse when one talks of the unequal

distribution of determinants of these illnesses such as food, public health systems, roads and safe drinking water.

What is the reason for this apparently high burden of disease that manifests itself in such a severe form? Could it be

attributed to deprivation? Or genetic factors? Or cultural factors that could influence people in choosing to seek

health care, select food choices or adopt a certain lifestyle?

Not just thisdiscussions on tribal health often concentrate on the exotic nature of many rare and genetic illnesses

they suffer from. Let us take the example of sickle cell disease. This is an inherited blood disorder that developed

due to a strong survival instinct when people in central India were exposed to the deadly falciparum malaria parasite.

Those who inherit a single gene from one of the two parents are partially protected from this serious form of

malaria, while those who inherit the gene from both parents suffer this painful and potentially fatal illness. Both

adivasis and non-adivasis in central India face the brunt of falciparum malaria equally; yet this disease affects

adivasis more severely because of their inability to access adequate health care.

Similar beliefs are held about their nutrition as well. While many people know about the frightening figures on the

high levels of hunger among adivasi adults and children, there seems to be little concern about how that affects

overall health, how prone they are to falling sick and even when treated, whether they can recover quickly. The
http://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_govind_kelkar.htmhttp://www.india-seminar.com/2014/661.htmhttp://www.india-seminar.com/2014/661/661_govind_kelkar.htm


26/47

stunting of both the physical and intellectual potential that may result, particularly when a young tribal infant or

toddler suffers such food deprivation, does not seem to give sleepless nights to the policy planners.

At Jan Swasthya Sahyog (Peoples Health Support Group) in rural Bilaspur, where we run a community hea lth

programme accessed by people from over 2500 villages of north-central Chhattisgarh and eastern Madhya Pradeshfor their major health needs, we observed illnesses that people suffer from through the lens of hunger. While we

have provided for some unmet needs of health care and nutrition support through focused interventions, especially to

under three-year-old children, we see our larger role, and that of other civil society organizations working in adivasi

domains, as advocates of these perspectives and in providing solutions.

In this essay we share some specific observations about these links with the objective of debunking commonly held

myths, as well as suggest some solutions to nutrition and health problems in adivasi and other poor rural

communities.

Overall,

Documents

Seminar September 2014 the Malnourished Tribal