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India's child malnutrition puzzle

One of the least talked about issues in the debate on India's demographic dividend is child malnutrition.

Updated: Apr 29, 2011, 04.51 AM IST
Neeraj Kaushal, Associate Professor of Social Work, Columbia University

One of the least talked about issues in the debate on India's demographic dividend is child malnutrition. India is home to about a third of the world's underweight and stunted children under the age of 5. A child under 5 is almost twice as likely to be chronically underweight in India as in sub-Saharan Africa.

Sadly, the impressive economic growth of the past decade has made only a modest dent into the obstinately high incidence of severe underweight and stunting of children in the country.

Poverty is one obvious underlying cause. But it does not explain the wide difference in malnutrition between India and sub-Saharan Africa. Unicef data show that about 47% of Indian children under 5 are underweight; the corresponding figure for sub-Saharan Africa is 24%.

The overall poverty rate is lower in India than in many sub-Saharan countries. Besides, the incidence of child malnutrition in India remains high even in non-poor families. According to data from the National Family Health Survey for 2005-06, a quarter of all children below the age of 3 in the wealthiest 20% of families are stunted and 20% chronically underweight.

Of course, children living in families with lower incomes and wealth are at a much higher risk of being malnourished. But the incidence of severe underweight and stunting in non-poor families is not trivial.

What then explains this puzzle that India has much higher rates of underweight and stunting of children than countries with higher poverty and relatively stagnant economies? Is it per capita food availability? No, India has somewhat higher per capita food availability than countries of sub-Saharan Africa.

Is it higher mortality among children under the age of 5 in sub-Saharan Africa? Yes, but only to some extent. Mortality among children under 5 is 140 per 1,000 in sub-Saharan Africa and 66 per 1,000 in India.

A back-of-the-envelope calculation would show that about a third of the gap in chronic underweight among children in India and sub-Saharan Africa is due to higher child mortality in the latter, which simply removes from the data a large number of undernourished children in sub-Saharan Africa.

What explains the remaining two-thirds of the gap? Are we Indians less caring about our children than people in sub-Saharan Africa? Is there something in our traditional social and cultural values and practices that hurt the health and welfare of our children? The answer, sadly, is yes.

In 1996, Vulimiri Ramalingaswami, Urban Jonsson and Jon Rohde wrote a commentary for Unicef investigating the various possible determinants of child malnourishment and concluded "the exceptionally high rates of child malnutrition in South Asia are rooted deep in the soil of inequality between men and women."

How? Here it is worth repeating how the three experts on child health and nutrition reached this conclusion. They studied weights of children at birth in India and sub-Saharan Africa. In India, a third of the children have low birth weight; in sub-Saharan Africa, only one sixth.

A child's birth weight is an indicator of the health and nourishment of the mother when she is pregnant as well as her overall health and nourishment as a child and while growing up. Most African women gain 10 kg of weight during pregnancy, but women in South Asia gain only half as much. They also found that while about 40% women in sub-Saharan Africa suffered from iron deficiency, as many as 60% women in South Asia and 83% of pregnant women in India were anemic.

Dr Ramalingaswami and his co-authors also found a major difference in the feeding practices of children in the two regions. In sub-Saharan Africa, the proportion of breast-fed children aged to 6-9 months receiving complementary foods was almost two-thirds; in South Asia, less than one-third.

Indeed, age-wise pattern of undernutrition studied in a World Bank report on South Asia published in 2006 shows that most of the growth retardation occurs early in life. The difference in length-for-age and weight-for-age between Indian and South African children begins to widen around the time the child is three to four months of age. The report finds that most of the retardation in growth in India occurs either during the pregnancy or during the first two years after birth.

Critics often argue that the economic reforms have failed to reach the poor and deprived sections of society. But malnutrition also prevails in families that are neither poor nor deprived. While it is true that the implementation of government programmes such as the ICDS needs a lot to be desired, and such programmes are not aimed at changing gender relations at home.

A sustained long-term dent in child undernourishment can only be achieved by improving the health, opportunities and rights of the mother, the primary caregiver of children. Not just legislative rights but rights to participate in decision-making both at home and outside it, opportunities for social interactions, rights to improve their lives through education and employment.

The historical pattern of the state and status of women in India reveals that it is largely unrelated to economic growth. Let's look at sex ratio - a number that has been much discussed since the release of the provisional 2011 census results. At 914 women per 1,000 men, the sex ratio at birth is the lowest since Independence. In two of the richest states, Punjab and Haryana, preference for the boy child results in many families abort the girl child or kill her soon after birth. But the story does not really end there.

Women's subjugation continues throughout their lives. One would hope that an adverse sex ratio would increase the value of women in society. Alas, our beliefs are too deeply embedded in traditional cultural norms to allow us to respond to the forces of demand and supply.

Also Read

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Poverty, mother's health behind child malnutrition in India: Study

Child malnutrition declines in India but still a long way to go

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