Tackling the evil of malnutrition

The comment that “malnourishment is a national shame” by the prime minister has succeeded in drawing some attention to this otherwise neglected indicator of the nation’s real progress.

  This important issue has been pushed to the wayside in our rush and frenzy to be known as a ‘superpower’ and desire to gloatingly sit rubbing shoulders with the most developed in the comity of nations.  However, the PM’s remark has made audible some civil society voices, which were shouting all the time about the grave neglect of this aspect of true development but were drowned in the prevailing din of the frenzied rush.

Several recent social audits across the country, notably in Karnataka and Bihar, are now bringing to light that the flagship Integrated Child Development Services (ICDS) to combat malnourishment - shielded from active scrutiny for several decades due to the lack of importance given to it - has become a den of corruption and a milch cow for a few who are, in effect, stealing food from the mouths of babes, and are directly responsible for causing the national shame of malnourishment.

Wrong lessons

Look at what lessons in correct behaviour we are providing to the 3 to 5-year-olds who attend anganwadis, as part of their pre-primary education package. The tiny tots are taking their first steps into a world of everyday corruption and we are teaching them to accept this as the reality for the rest of their life.

The first lesson being given to these tots is that it is good for them to “adjust” to the rain and heat in their anganwadi centres (AWC) run in a kachha bamboo or similar structure since their future life will be anyway full of such vicissitudes.  Ebullient 3-5 year-olds are not to feel deprived if they find no toys or learning materials at the centres. They should instead get used to sitting with their finger on their lips in dark, dingy and cramped structures and not exercise their natural desire to explore the world by moving about. 

They should learn early in life not to expect luxuries such as drinking water and toilets at their AWC and rather get used to defecating next to the road-side drain.  They should not complain if they are not fed the prescribed menu of hot cooked food and should be content with half-cooked laddus from ready-mix powders that stick in their throat and give them diarrhoea.

As a result of civil society pressure and a PIL to address the severe child malnourishment and deaths in Karnataka, the Justice NK Patil committee, set up by the High Court, has recommended an interim action plan.
 
Lackadaisical attitude

Forced to act, the Health Department organised health camps in the entire state on 15 July 2012 amid great fanfare to identify malnourished children in the State. Janaarogya Andolana - Karnataka (JAAK) found that the department, given its lackadaisical attitude, had however not given doctors a nutritional rehabilitation protocol to follow for the identified severely malnourished children.

Even if a nutritional rehabilitation centre is set up, one wonders what will happen to the child once it returns home after its stay there. 

What is to prevent the child from relapsing into malnourishment if the long-term causes of its malnutrition are not addressed?  What if the ANM and anganwadi worker return to their old ways of not visiting the slum and weighing children once the PIL runs its course? And there is again no doctor at the PHC when the mother next takes the child for a check-up?

What if the mother needs to work full-time to keep the family running but there is no full-day anganwadi close to her house and her employer has provided no crèche to look after her child until she returns from work?

Will the child get enough calories if the parents have been classified as ‘above poverty line’ and be denied food grains at the ration shop because the poverty line has been fixed so unrealistically low? 

Can parents afford to buy dal, eggs, fruits and vegetables for the child if the minimum wages that are fixed, or paid, is a starvation wage rather than a living wage?  Can the mother prevent the child from getting diarrhoea and losing its ability to absorb food if the water she gets in the slum is contaminated by the sewage and garbage surrounding it? 

Hopefully, the Justice NK Patil committee will address these long-term structural causes of malnourishment and enable the tiny tots to regain their lost faith in adults to provide them a life they deserve.