By Komal Ganotra:
India represents one of the largest number of malnourished children in the world and performs dismally on all child nutrition indicators. Under-nutrition in infants and young children leads to growth failure, lowered resistance to infections, increased rates of morbidity, increased risks to survival, impaired growth and poor school performance. Thus, a lack of proper nutrition during childhood has tangible long-term impacts on the mental and physical development of individuals.
The ages 0-6 lay the foundation for the growth of children into healthy and productive adults. It marks a crucial phase for a child, as 80% of the brain development takes place during this time. An emphasis on proper and effective nutrition in this age is not only important but necessary. This involves a commitment both to the children and the mothers. The inter-generational cycle of under nutrition ensures that an undernourished mother gives birth to an undernourished child, experiencing cumulative growth and development deficits largely irreversible in nature. Ensuring a healthy start for children in this age group requires a multi-dimensional approach centered around nutrition, comprehensive immunisation and medical care, pre and post natal healthcare for mothers while focusing on social development and capacity building.
Recognising the crucial importance of a holistic emphasis on the age group 0-6, the Integrated Child Development Services (ICDS) Scheme, a centrally sponsored national flagship scheme of the Government of India, aims at addressing health, nutrition and the development needs of young children (0-6 years), pregnant women and nursing mothers.
However, despite government efforts and schemes, the nutrition figures in the country pose a grave concern. Under the ICDS Scheme, the Anganwadi Centres aims to provide the requisite nutrition, health services and care to children and mothers. According to the Ministry of Women and Child Development, in 2012-13 while 13,73,349 Anganwadis were sanctioned, 34,617 were still not operational and 33 % of the children in the country were not covered under the Anganwadis.
This comes to prominence all the more in remote areas. To highlight the gravity of the scenario, we consider the story of Pancho, a 6-year-old girl who belongs to the Saharia tribe, living in a village in district Baran, Rajasthan. Pancho was diagnosed to be severely malnourished. The village is 40 km away from the block headquarter in Shahabad and about 120 km away from district headquarter in Baran. The primitive tribe has been residing in Baran district for years now after being forced to move out of their original habitat, the forests. The abject poverty that the tribe lives in is striking.
Children bear the brunt of the deprivation, and as families struggle for sustenance, providing nutritious food to children is a distant reality.
The village has an Anganwadi which is accessible as well as operational yet there is no visible impact of its services in changing the nutritional status of children like Pancho. The problem lies not only in the irregularity of services and a lack of access but also the ignorance of the parents, who often fail to understand the severity of the condition of the child. It was only when a local NGO, Prayatna Sanstha, which works in partnership with CRY, noticed Pancho in one of their community visits early last year, did her condition come to light. After being counseled by the NGO, the community collective and Child Protection Committee the parents took to the child to the Malnutrition Treatment Centre (MTC).
While the treatment and special care at the centre lead to improved nutrition status of the child, she fell back into the malnutrition trap after 2-3 months, owing to inadequate nutrition and care at home. It was only after convincing her parents and prolonged treatment at the District Hospital in Baran, that Pancho is on the road to recovery.
The cases of malnutrition in Baran have been reported multiple times in the past yet children like Pancho suffer from nutritional deficits and there is little state intervention. This does raise questions on the nature and outcomes of growth monitoring and the required intervention thereafter.
To reach out to such children effectively, what we need is a well-defined system for management of malnutrition, which would involve the convergence of all stakeholders; not just Anganwadis but the health care centers, hospitals and MTCs as well. While ICDS is a well-designed programme and we have functional Anganwadis running in most places, bottlenecks in service delivery and community outreach pose a challenge in its proper implementation. The quality of services needs to be improved, with strict emphasis on growth monitoring of children and flagging off possible cases of malnutrition.
With improved service delivery of ICDS, preventive rather than reactive approach to tackle malnutrition, better community outreach, the nutrition status of children in the country will surely witness a significant change. Investing in our children in the age group of 0-6 will translate itself into long-term positive returns, and pave the way for a healthier and happier nation.