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How Mizoram Improved Children’s Health Is A Lesson The Rest Of India Needs To Follow

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By Prachi Salve and Saumya Tewari,

Sanitation-india-garbageThe north-eastern state of Mizoram has reported a 13 percentage-point decline in stunting (below normal height for the age) and five percentage points decline in underweight children (underweight and short), according to a new report.

The reason: Improved access to sanitation. As many as 92% households in Mizoram had access to sanitation at the end of the 2011 Census, against 82% during the 2001 census, the India Health Report for Nutrition Security in India, 2015 released last month said.

As many as 522 million people gained access to improved sources of drinking water between 1990 and 2000, said the report, published by the Public Health Foundation of India (PHFI).

Open defecation and inadequate hand washing have been cited as reasons for poor health among children, leading to undernourishment.

India’s 40 million stunted and 17 million wasted children below the age of five are a challenge for a country whose health indices lag its economic growth.

This is the third part in our series on child malnutrition in India based on the PFHI report, where we track the states with worst and best nutrition figures and sanitation data to examine the relation between poor nutrition and hygiene.

While the first part looked at public spending on child health and nutrition, the second part looked at the impact of maternal health on child nutrition.

Not enough being spent on drinking water and sanitation

Poor sanitation makes for unhealthy children, susceptible to water-borne diseases such as diarrhoea, cholera and jaundice.

The United Nations’ Millennium Development Goals (MDGs) had set a target of halving the population without sanitation facilities by 2015. UNICEF launched the Water, Sanitation and Hygiene (WASH) programme in 2006 to promote this goal.

The Government of India has been focusing on improving drinking water and sanitation facilities across the country since 1999.

The Total Sanitation Programme was launched in 1999 by the Atal Bihari Vajpayee government. It was changed to Nirmal Bharat Abhiyan (Clean India Mission) in 2012 and renamed Swachh Bharat Mission in 2014.

Rs 25,387.5 crore ($3.8 billion) has been spent on drinking water and sanitation since 1999-2000, the data show. For comparison, Tamil Nadu Chief Minister J Jayalalithaa sought more money, Rs 25,912 crore, from Delhi, to address the ravages of the state’s December 2015 floods.

More than 93 million households still don’t have toilets

Almost 90% of child deaths from diarrhoeal diseases are directly linked to contaminated water, lack of sanitation or inadequate hygiene, a UNICEF report said.

India’s infant mortality rate (IMR) has come down from 66 deaths per 1,000 live births in 2001 to 42 in 2012 but it is still equal to poorer African countries, such as Senegal (42), Malawai (41) and Ethiopia (43).

Only 47% households in India had toilets, according to the 2011 Census data, an improvement of 11 percentage points over 2001 figures.

As many as 181.5 million rural households were surveyed in 2012 to assess the requirement of toilets in individual households; this survey served as the baseline for the Swachh Bharat Mission.

As on December 22, 2015, 93.1 million households in rural India had no toilets, according to government data.

As many as 46% households in India defecated in the open as of 2013-14, according to data from the Rapid Survey on Children (RSoC). This was an improvement of nine percentage points from 2005-06 data, when it was 55%.

Mizoram’s progress reflected in healthier children

The states that were better-off in terms of child nutrition show a strong co-relation between sanitation and child nourishment.

The best example is Mizoram, where the prevalence of stunting declined by 13 percentage points, and underweight children by five percentage points between 2006 and 2014.

The worst states in terms of nutrition parameters had fewer households with toilets.







There has been little progress in sanitation facilities in the worst-performing states. Figures for stunting have only improved eight percentage points in Bihar, three percentage points in Jharkhand, and there was no improvement in Chhattisgarh. However, there was a decline of 10 percentage points in stunted children between 2005-06 and 2013-14.

After the Swachh Bharat Mission, since 2014, Bihar, Jharkhand and Chhattisgarh have managed to fulfill about 44%, 52% and 50% of the requirement as per the baseline survey.

Sanitation is only one factor affecting nutrition; for instance, data from what was once Andhra Pradesh show that the proportion of wasted children increased by six percentage points between 2006 and 2014, despite an improvement in sanitation.

Studies conducted in the past decade have emphasized on the need for sanitation to improve nutrition.

The example of Bangladesh is often cited. Between 1990 and 2012, open defecation dropped from 34% to 2.5% in that country, accompanied by a reduction in undernourishment, according to a report by International Food Policy Research Institute (IFPRI), the Washington-based think-tank.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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