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Most of world’s stunted children live in India, says Lancet

Jan 28, 2008

India is home to 61 million stunted children – more than half the total number of kids under the age of five and 34% of the world’s young ones. The diminutive growth is attributed to malnutrition during pregnancy and first two years of birth, says The Lancet report, underlining the importance of ‘golden interval of intervention’.

A recent The Lancet study shows that among the 20 countries where four-fifths of all undernourished children live, India is home to the largest number.

The report underlines the importance of the "golden interval of intervention" that ranges from pregnancy to two years of age.

The reputed international journal says these 20 countries lack the political will to put nutrition on their list of priorities – and keep it there.

The study, however, commends the work being done in southern Indian states of Kerala and Tamil Nadu.

The Lancet Series on Maternal and Child Undernutrition – a global, scientific report by a team of public health scientists – underlines the importance of the "golden interval of intervention" that ranges from pregnancy to two years of age. After the age of two, under-nutrition would have caused irreversible damage to the child's development.

"India, with a large population, is also home to the most stunted children. There are 61 million stunted children in India, which is over half (51%) of all Indian children under the age of five years, and 34% of all stunted children worldwide," says the study.

Countless studies and reports generated within India have pointed to the alarming situation of hunger and starvation in the country. The recent National Family Health Survey (NHFS) showed that there has not been much improvement in the nutrition status of children within the last eight years.

There are 61 million stunted children in India, which is over half (51%) of all Indian children under the age of five years, and 34% of all stunted children worldwide, says the report.

While during NFHS-2 (1998-1999), 47% of children under three years of age were found to be underweight, this number decreased by only 1% with 46% of children under three years of age being underweight according to NFHS-III (2005-2006). This means every second child under six years of age is underweight, a statistic worse than that in sub-Saharan Africa.

Further, there has been almost no improvement in the percentage of underweight children in the eight years since NFHS-II.

Statewise scenario

In Madhya Pradesh, Jharkhand, Bihar and Chhattisgarh the percentage of malnourished children is more than half; in Madhya Pradesh, Bihar and Jharkhand this figure has actually gone up since NFHS-II.

Chhattisgarh, on the other hand, has done comparatively well in the last eight years, with a fall in the percentage of underweight children of nine percentage points. Other states where malnutrition among children under three has worsened are Arunachal Pradesh, Meghalaya, Haryana, Nagaland, Assam, Gujarat, Kerala, Sikkim and Goa.

Latest National Nutrition Monitoring Bureau (NNMB) data (2006-2007) shows that there is a deficit of over 500 calories in the intake of 1-3-year-old children and about 700 calories among 3-6 year-olds.

Too little, too flawed

The Integrated Child Development Services (ICDS) scheme is the only government programme in the country that caters to the nutritional requirements and other health, immunisation and early education needs of the most vulnerable groups of people namely children under six years, pregnant and lactating mothers and adolescent girls.

It operates through an anganwadi centre in every village, manned by an anganwadi worker.

The Seventh Report of the Supreme Court-appointed commissioners, which is the latest on the status of compliance of the Centre and states on orders passed by the apex court in the matter, over the past six years, underlines the need for the ICDS programme to reach out to all target populations for greater effectiveness in dealing with the problem of malnutrition.

The Lancet series shows that there are proven effective interventions to reduce stunting and micronutrient deficiency. Among the most effective measures listed are breastfeeding, Vitamin A supplements and fortification.

But despite the Supreme Court playing a key role in monitoring and prodding the government, the status of the ICDS programme is far from encouraging.

According to the commissioners' report, only 35.5% of children under six receive supplementary nutrition under the ICDS. And only around 25% of eligible pregnant women and nursing mothers are being reached under the programme. The worst states are Assam, Madhya Pradesh, Bihar and Jharkhand, where anganwadis barely exist.

With respect to the "golden interval of intervention" pointed out by The Lancet report, the ICDS programme is flawed. There is virtually no emphasis on children below the age of three. The programme focuses on the supplementary nutrition component, which mainly reaches 3-6 year-olds.

And the food tends to be erratic, of poor quality and unimaginatively prepared. Reports of the court-appointed commissioners point out that the 0-3 age-group should have access not just to foodgrain but specially prepared food made from nutritious locally grown cereals, fortified with essential micronutrients.

The Lancet series shows that there are proven effective interventions to reduce stunting and micronutrient deficiency. Among the most effective measures listed are breastfeeding, Vitamin A supplements and fortification.

For maternal nutrition, it is iron, folic acid and calcium supplements. The series says immunisation of pregnant women may have a greater impact than a school meal programme.

Apex court intervenes

The court passed an order in 2006 saying that every child, adolescent girl and pregnant woman should be covered under the ICDS programme in a phased manner, latest by December 2008.

It also asked the government to set up an anganwadi centre in every habitation; this translates to 14 lakh anganwadi centres.

Two years later, 4 lakh centres have still to be sanctioned. The ones sanctioned last year exist only on paper.

If every child under six in 14 lakh anganwadis has to be covered, the government will have to increase its budgetary allocation to the programme by 71%. The government is spending less than Re 1 on every child when it should be spending Rs 2.

Research has also shown that some of the most vulnerable groups within the anganwadi project area are socially excluded and were therefore not included in the anganwadi survey.

These include socially ostracised dalits, adivasis, minority and disabled children and certain economic groups. At an all-India level, only about half the children (56.6%) identified by the anganwadi survey are beneficiaries of supplementary nutrition. As expected, compared with the population of children under six, according to Census 2001, coverage is even poorer.

While there are around 16 crore children in the 0-6 age-group, according to Census 2001, the number of supplementary nutrition beneficiaries is only 5.8 crores, that is, only 35.5% of children under 6 years of age in the country receive supplementary nutrition under the ICDS.

This leaves out over 10 crore children (66%).

Further, in states such as Assam, Bihar, Kerala and Rajasthan the percentage of children getting the benefit of supplementary nutrition is less even than the 40% of eligible children identified in this age-group by the anganwadi survey.

Additional source: Infochange

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