India suffer malnutrition amidst plenty

More than two-thirds of India's pre-schoolers are malnourished and it is safe to assume that most of those affected are girls, writes R. Dev Raj of Inter Press Service.

NEW DELHI (IPS): No one in Chattarpur, a Delhi suburb, could believe that their affluent neighbor, Malti's infant sons were malnourished. As the wife of a prosperous confectioner it could not have been for lack of food.

But then even nutritionists are unsure as to why child nutrition is far worse a problem in South Asia than elsewhere in the world. In fact, half of the world's malnourished children are to be found in just three countries Bangladesh, India and Pakistan.

Estimates made by the National Nutrition Monitoring Bureau indicate that more than two thirds of India's pre-school children are moderately or severely malnourished. Actions aimed at the problem occur too late since malnutrition peaks around 24 months of age pointing to poor infant care.

Top nutritionists like Dr. V. Ramalingaswami and Dr. Jon Rohde, UNICEF chief in India say that even for poor families on the sub continent food availability is not as much of a problem as the lack of money, time and energy to get it on the table. Contributing factors are poor hygiene and extreme patriarchy which deprives females.

The fact that Malti herself suffered severe anemia offers a clue to what experts call the "integrational cycle of transmission of malnutrition," which begins with a malnourished girl child who grows up to become an unhealthy mother.

Malti would have continued anemic except that she was discovered by workers of the Parivar Seva Sanstha, a Marie Stopes affiliated NGO which launched a pilot project on the social marketing of iron tablets in the area. She said her husband was too busy to worry about her state of health.

Supported by UNICEF and the Delhi state government, the project aims to raise the nutritional status of women and adolescent girls and develop an appropriate model for replication in other parts of the country, says project manager Manisha Suneja.

"Nutritional anemia is a major micro nutrient deficiency in India and is estimated to affect over fifty percent of pregnant and lactating mothers across India and could be responsible for 20 percent of maternal deaths," she said.

The last National Family Health survey conducted five years ago estimated India's maternal mortality rate (MMR) to be 4.48 per thousand although it is well known that a very large number of maternal deaths especially in the rural areas go unreported or unrecorded.

At Chattarpur's local dispensary, run by the Municipal Corporation of Delhi (MCD), Dr. S. Rai Chief Medical Officer confirms that up to ninety percent of her patients are anemic. "Pregnant women are no exception and we give them iron and folic acid," she says.

Dr. Rai is excited by the project. Although her dispensary functions from a large two storey it does not even have a functional laboratory. Most Chattarpur residents seek treatment at expensive private clinics. If they cannot afford it they take a bus ride to the nearest Primary Health Center (PHC).

But Payal, a housewife with a five month old son says the doctor at the PHC could not even diagnose her pregnancy. "He treated me for worms. The fact that I was carrying Akash was discovered only six months into the pregnancy," she said. Payal never received iron tablets and the effects are apparent in Akash's lack of vitality and frequent illnesses contributed by Chattarpur's crowded and unhygienic conditions.

Malti and Payal come from different income strata in Chattarpur but both have children born to them with low birth weight in a pattern familiar to nutritionists in which poor growth extends through childhood accompanied by lowered intelligence levels. That is if the child survives at all given that 90 per cent of neonatal deaths occur among underweight babies.

A four year study covering 7,109 live births to women registered for antenatal care and confinement at the prestigious All India Institute of Medical Sciences (AIIMS) reported 26 percent low birth weight babies.

Another study among slum dwellers in Delhi showed that 38 percent of children born to them were less than 2,500 grams at birth or severely underweight.

"Low birth weight indicates that the infant was malnourished in the womb and that the mother was malnourished during her own infancy, childhood, adolescence and pregnancy," says Dr. V. Ramalingaswami, who currently holds the title of National Research Professor.

According to Dr. Ramalingaswami, proper nutrition is not only about availability of food but also good sanitation and most importantly a caring environment which is grossly missing especially in the case of the girl child with disastrous consequences for the future of the community.

In South Asian countries girl children are commonly discriminated against in all matters including the best portions at meal times. They are married off early and often spend the rest of their lives in subordination to men or older women in situations where care is lacking.

Poor nutrition lowers resistance of all children and makes them prone to disease. In turn, disease depresses the appetite and inhibits absorption of nutrients and unless managed properly leads to a typical downward spiral of frequent infection and poor growth.

In India, government recognition of the spiral is evident from a recent pamphlet which says that "inadequate prevention and management of diarrhoeal and acute respiratory and other infections which interact with dietary intake among under twos result in a vicious cycle of malnutrition".

For the last twenty years the government has been running the Integrated Child Development Services (ICDS) which now covers 400,000 of India's 600,000 odd villages and is meant for children under six years of age.

Taking advantage of food surpluses the government in recent years introduced a mid day meal scheme for all school going children.

But then according to Dr. Kamal Islam, Head of Nutrition at UNICEF's Country office here the problem lies not in policies but in their actual implementation with close supervision on the ground. "There is obviously a serious gap somewhere."

Window A: The last National Family Health survey conducted five years ago estimated India's maternal mortality rate (MMR) to be 4.48 per thousand although it is well known that a very large number of maternal deaths especially in the rural areas go unreported or unrecorded.

Window B: Poor nutrition lowers resistance of all children and makes them prone to disease. In turn, disease depresses the appetite and inhibits absorption of nutrients and unless managed properly leads to a typical downward spiral of frequent infection and poor growth.