Is India on target?

Is India on target?

Malnutrition is the most alarming and persistent health problem faced by the world today as per a recent report of the International Food Policy Research Institute. The frightening statistics of infant mortality and retardation raises serious questions about the development models pursued by governments across the globe.

Nearly half of all deaths of children under the age of five are attributable to malnutrition; 155 million children under the age of five are afflicted by stunting caused because they did not get adequate nutrition in the first 1,000 days of their lives (UNICEF). Apart from physical retardation, brain development is also severely affected. Attention and memory deficit, slowness in learning language and social skills and reduced problem-solving ability are likely consequences of malnutrition (WHO).

The retardation caused in the first two years of a child's life prevents the development of his full potential for the rest of his life and the process cannot be reversed by adequate food and nutrition later. Studies have found that pregnancy at too early an age and maternal anaemia results in increased health risks for the mother and the child.

As per the report placed by the UN before the Global Nutrition Summit 2017, half a billion women of reproductive age and four out of 10 pregnant women worldwide suffer from anaemia. Anaemia is estimated to contribute to 20% of maternal deaths, and increase in risk of stillbirth, premature delivery, low birth weight and neonatal mortality (death within 28 days of birth). Iodine deficiency in mothers may cause brain damage and physical retardation in the child.

Though lack of food is the most common cause, ignorance and improper food habits also play a role in malnutrition. As Nobel laureate Angus Deaton pointed out, consumption of carbohydrate-based diet with low protein and fat content is one of the reasons for malnutrition in India. Unhygienic sanitation can cause frequent incidence of diarrhoea and other infections which, too, may result in malnutrition.

India ranks 97 among 118 developing countries in the Global Hunger Index. About 39% of children under the age of five - about 20 million - suffer from chronic malnourishment and India has the highest number of stunted children (48.2 million) in the world (Save the Children Report, May 2017). If this is the case with the sixth largest economy in the world, it is obvious that we have been following a lopsided growth path for decades.

The success achieved in fighting malnutrition by countries like Malawi, Madagascar Guatemala and Bangladesh which are way behind us in economic development and the examples of states like Kerala, Goa, Tripura and Chattisgarh in our own country show that it is possible to accelerate the process of reducing malnutrition by persistent efforts.

The success of persistent efforts is seen at the national level also. Between 2005 and 2014, there was a 20% decline in malnutrition. The number of stunted children under the age of five has come down from 48% in 2005 to 38% in 2016. This reduction was possible mainly due to the Integrated Child Development Services (ICDS). But instead of feeling elated at this success, we should be concerned that children in such large numbers are still undernourished.

The Lancet, one of the world's best known and widely read medical journals, has worked out a package of proven nutrition interventions which, if implemented earnestly, could eliminate malnutrition at an accelerated pace. The first intervention is to ensure improved nutrition to women during pre-conception, pregnancy and post-partum periods.

Secondly, exclusive breastfeeding should be encouraged for the first six months. This could save up to 1.3 million children each year worldwide, ensuring optimal growth and protection from infections. Spreading awareness about the importance of breastfeeding and countering the misleading propaganda of companies selling formula milk products is the need of the hour.

Increasing investment

As the lives and health of millions of children are at stake, investment on schemes for women and child welfare need to be hiked urgently and drastically. Instead, the Union government is on a reduction spree. The budget allocation for ICDS in 2016-17 was reduced by 9.6% from the allocation of 2015-16. Further, the allocation for Mid-Day Meal Scheme, which was 0.74% of the total Union Budget in 2014-15, was reduced to 0.49% for 2016-17.

Those who grudge government spending on welfare schemes, including on healthcare, terming it a relic of time-worn Socialist philosophy, are perhaps not aware that even in the United Kingdom, the citadel of Laissez-faire Capitalism, a fully public-funded National Health Service ensures that patients don't have to spend anything from their pocket.

The same is the case with other European countries. Even in Qatar, a here ­ditary monarchy which is yet to see the dawn of democracy, patients are assured of heavily subsidised but world-class healthcare provided by the Hamad Medical Corporation, the government-run, non-profit healthcare provider. In contrast
to this, India spends a paltry 1% of GDP on healthcare, well below the world average of 5.99%, as per the Economic Survey tabled in Parliament in January 2017.

Policymakers want to substitute government schemes with contributory insurance schemes. But as social activist Aruna Roy asked, when jobs and incomes are shrinking, how will the poor contribute to the insurance schemes?

India, along with 193 member countries of the UN, adopted Sustainable Development Goals in September 2015 and committed itself to end undernutrition by 2030. Health activists are sceptical about India meeting the deadline, going by the progress achieved so far. It is for all to see that the sense of urgency which is necessary to create a tangible impact is sadly lacking.

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