By Simon Denyer, Updated: Wednesday, December 26, 8:04 AM
BANSWARA, India – Stung by the realization that it faced a child malnutrition crisis worse than in most African countries, India is finally waking to the scale of the problem.
Progress is still slow and political will still patchy, but there are signs that a new approach to fighting malnutrition is just beginning to reap dividends.
Efforts to improve rural health and education have combined with an expansion of a child welfare program that employs nearly 2 million village health workers to focus on maternal and infant health and nutrition. A rural jobs plan has helped raise wages in the countryside and new programs are educating adolescent girls, nearly half of whom will marry before age 18, about feeding and hygiene.
There are indications it could be starting to pay off. An independent survey of malnutrition in 100 of India’s least-developed districts released in January showed the first signs of progress, with the proportion of underweight children falling to 42 percent, a drop of 11 percentage points.
... Maharashtra is home to India’s financial capital, Mumbai, and is the country’s economic powerhouse. Still, malnutrition rates did not begin falling significantly until the state government started showing the political will to tackle the problem head-on.
Nationally, the wake-up call came in 2007 with the realization that a decade-and-a-half of buoyant economic growth had scarcely dented child malnutrition rates, which remained higher than the average in sub-Saharan Africa. Nearly half of Indian children under age 5 were stunted and underweight for their age, a government survey released that year showed, permanently impairing their mental and physical development.
But in a country where many middle-class Indians find the subject of malnutrition rather boring, it took the idea that India was underperforming — not just compared with Africa but also with neighbors like Bangladesh — to embarrass the government into action. In 2007, Prime Minister Manmohan Singh called it a “national shame” and a failed strategy began to be reevaluated.
The notion of a "national shame" is old-fashioned, but it can be effective. If you are behind Bangladesh, you really need to get to work.
The family’s situation is just one illustration of what nutritionists call a perfect storm of factors driving India’s malnutrition crisis. Many children are born to teenage, anemic, malnourished mothers; feeding practices are poor; and the environment they live in, a crowded country where 600 million people have no access to toilets, is rife with fecal matter.
Health programs were largely missing infants in the first two years of their lives, when malnutrition usually sets in and causes permanent mental and physical damage, Aguayo said.
Fewer than half of Indian children start nursing within their first 24 hours, receiving water rather than the early, antibody-rich breast milk that helps protect against infections, and most spend their first few years subsisting on protein- and vitamin-poor diets of just rice or bread. The fact that economic growth has still not trickled down to the poorest communities and the low status of Indian women are also major factors.
In Banswara, village health workers blame rampant malnutrition on the prevalence of child marriages. Sundari, Jitendra’s mother, got married at the age of 13 to a man she describes as a “good for nothing drunkard.” She said she spends most of her day cooking, washing, cleaning and fetching firewood or water for her in-laws, or trying to earn money as a day laborer in local fields.
Even now, India’s progress in fighting malnutrition fails to impress many experts.
Save the Children and World Vision recently ranked India alongside the Democratic Republic of Congo and Yemen at the bottom of a global Nutrition Barometer for its commitment and performance.
While the nation frets constantly about whether economic growth and the stock market are up or down, the government has not collected data on child malnutrition since 2004 — something Purnima Menon of the International Food Policy Research Institute calls “mind-boggling.” ...
Spending comes easily to the government, critics say, but setting up mechanisms to monitor performance and raise accountability seems far less instinctive.