India may well be `Shining' to the world at large but when it comes to its children's health the picture is far from glossy. The recently released National Family Health Survey (NFHS-3), the third pan-India survey conducted since 1992 (covering 200,000 people from 15-54 years), highlights some sobering facts on this front.
According to the survey, conducted between December 2005 and August 2006, a whopping 45.9 per cent of India's under-three kids are underweight, 39 per cent are stunted, 20 per cent severely malnourished, 80 per cent anemic while infant mortality hovers at 67 per 1,000. More than 6,000 Indian children below five years die everyday due to malnourishment or lack of basic micronutrients like Vitamin A, iron, iodine, zinc or folic acid. Overall, India hosts 57 million - or more than a third - of the world's 146 million undernourished children.
Shockingly, even sub-Saharan Africa has a better record of child malnourishment at 30 per cent while China records eight per cent and Pakistan 37 per cent.
Even as we celebrated World Food Day on October 16, a few months ago - preening over our overflowing granaries and plentiful agricultural produce - it is disquieting to note that a massive 440 million people languish at the bottom of the economic pyramid in India and about 500,000 children are born deformed each year due to vitamin/mineral deficiencies. India's child sex ratio is still a nettlesome 927 girls for every 1,000 boys while even some of the poor African countries (Nigeria at 965 and Ghana at 964) fare better - as does neighboring Pakistan with 958.
It is unfortunate that even though children form a substantive third of India's total population of over 1 billion-plus, their current share in the Union budget is a piffling 4.86 per cent. Even out of this, nearly 70 per cent is marked for education while health manages a modest 11.43 per cent. Small wonder, malnourishment, illiteracy, feticide and child labor are rampant across India.
Says Chennai-based development scientist Dr Sree Sridharan: "Despite a spurt in India's GDP from 3.6 per cent in the 1970s to nine per cent in 2006, proportionate spending on children has gone up only marginally from 2.11 per cent in 2002 to 4.86 per cent. If this isn't skewed development, what is?"
While sociologists rue India's iniquitous social development - despite six decades of independence - doctors are worried about its physical repercussions. Elaborates pediatrician Dr Suresh Kasana of Spring Meadows Hospital, New Delhi, "Malnourishment needs urgent attention in our country because during the first two years of a child's life, the problem is irreversible. It severely retards a child's cognitive, physical and emotional growth and has a cascading effect on his/her productivity in adult years."
Experts reiterate that child malnutrition is not only responsible for 22 per cent of India's disease burden - and for 50 per cent of the 2.3 million child deaths in India -- but is also a serious economic hazard. More than 2 billion people worldwide suffer from vitamin/mineral deficiencies of which 30 per cent live in India. According to economists, these deficiencies will cost the Indian economy a whopping Rs 2,770,000 million (US$1=Rs44 ) over the next 10 years in lost human potential.
"India should be worried," notes Werner Schultink of Unicef. "It is going to be difficult for India to use its human resources to develop the nation without making improvements on its health front."
Intriguingly, the number of undernourished children below three years has ratcheted up in some Indian states; and the state's per capita income is not directly proportionate to the nourishment children receive.
In Manipur, for instance - where the per capita income is Rs 12,230 (up from Rs 10,300 in the 1980s) - there is 28 per cent malnutrition, while Gujarat (with a per capita income of Rs 21,276) has 45 per cent. Similarly, Orissa's malnourishment figure is 50 per cent with a per capita income of Rs 10,103 while Maharashtra at Rs 24,736 has malnutrition levels of 51 per cent. Kerala's per capita income is Rs.21,310 and that of Karnataka Rs.18,324 while their malnutrition levels are 27 per cent and 44 per cent respectively.
Similarly, the percentage of underweight children in Gujarat (one of India's richest states) had upped to 47 per cent from 45 per cent seven years ago. In Uttar Pradesh - India's most populous state - the percentage of anemic children under three had risen to 85 per cent from 74 per cent in 2001.
`The Focus On Children Under Six' (FOCUS) Report, recently brought out by the Citizens' Initiative for The Rights of Children Under Six (CIRCUS), emphasizes the serious need to review issues of children's growth and health if India is to avert a national development crisis. With nearly half of its children malnourished, points out the report, India is in the same league as the poorest of the poor nations like Cambodia and some African countries.
But even though government data highlights that India's infant mortality rate has waned, and more pregnant Indian women are seeing doctors, India is still struggling to match its dramatic economic progress with a corresponding improvement in its people's - especially children's - health. What's more, there is glaring and persistent inequity between the health of rural and urban India, and the awareness of health issues among men and women, who in most parts of India remain second-class citizens.
According to Minister of State for Women and Child Development Renuka Chowdhury, the problem of children's malnutrition can only be tackled through holistic, coordinated interventions in the areas of food security, health, sanitation, safe drinking water, nutrition, family welfare and poverty alleviation.
This would involve several steps, including the expansion of the current number of community development or anganwadi centers (AWCs) under the Integrated Child Development Scheme (ICDS) - from the current 600,000 to 1,400,000 - and doubling of financial norms for supplementary nutrition from one rupee to two per beneficiary per day. Chowdhury also recommends that all SC/ST slums and hamlets be provided with AWCs.
One of the democratic world's biggest childcare initiatives, the ICDS mandates immunizations, supplementary food and medical check-ups for children and pregnant women through a network of thousands of state-funded community workers. Fifty million children aged six and below are covered under this Rs 45 billion ($1bn) outreach programme.
However, 110 million children still remain outside the programme's ambit, which was meant to expand its reach gradually but has not because of India's population explosion. Also, efforts to provide nutritious food to children through the scheme have been marred due to rampant corruption. In some states like Uttar Pradesh, for instance, children's ready-to-eat food has even been diverted to feed cattle!
It is time to realize that tackling children's malnutrition is no child's play. It is a serious problem that needs to be addressed through greater synergy between the Centre, state and NGOs. Indeed, if India wants to continue with its upward trajectory of economic growth, it can ill-afford to bypass the vital issues of its children's health, survival and happiness.