How Can We Tackle Malnutrition In India’s Marginalised Communities?

India ranks 102nd among 117 countries, in the recently published, Global Hunger Index 2019. In 2018, India was 103 out of 132. In 2017, India was at 100 out of 119. Despite being the highest growing, developing country, what made India stagnant in the Global Hunger Index? A major embarrassment is that India is now behind its neighbours – Nepal, Pakistan, Sri Lanka, Bangladesh and Myanmar in the Report.

The hunger problem in India is serious, and the marginalised communities are the worst affected. Despite India’s 50% increase in GDP since 1991, it has failed to address the Human Development Index, which is a grave concern for a developing country like ours.

More than one-third of the world’s malnourished children live in India. (Source: “Putting the smallest first”, The Economist). Since the adoption of neo-liberal economic policy, India has witnessed a significant inequality among its population. The poor are getting poorer, and the rich are getting richer, which is a global scenario in first world capitalist countries and the third world developing countries.

One of the major causes of malnutrition is growing economic inequality. And In the case of India, it’s not just economic inequality, but religion and caste also play a major role.

The hunger problem in India is serious, and the marginalised communities are the worst affected around the globe.

What Is Malnutrition? 

Malnutrition is a violation of a child’s right to survival and development, and its consequences often remain invisible until it’s too late. As UNICEF puts it, malnutrition is a kind of an unseen emergency but it has a million faces.

According to UNICEF, malnutrition can be defined as:

  • “A child who never reaches full height due to poverty, poor sanitation, lack of breastfeeding and limited access to nutritious foods.
  • A young woman who becomes anaemic during her pregnancy and gives birth to an underweight baby who later faces developmental delays.
  • A child rendered blind by vitamin A deficiency.
  • A child who becomes obese through overconsumption of low-quality food.
  • A desperately thin and wasted child, at imminent risk of passing.”

Malnutrition is more than a lack of food; it is also a combination of various factors, such as insufficient protein and micronutrients, poor care and feeding practices, inadequate water, sanitation, frequent infections or disease, and inadequate health services.

It can lead to a low weight-for-height (wasting) or a low height-for-age (stunting) or sometimes to a combination of both. According to the Global Nutrition Report 2018, a third of the world’s stunted children, an estimated 46.6 million, under five years of age, who have low height for their age, live in India. India is also home to about 25.5 million wasted children; a strong predictor of under-five mortality.

How Does Malnutrition Affect India’s Marginalised Communities?

The nutritional problem in marginalised communities, in India, is full of obscurity, and their habitat and socioeconomic conditions also influence the condition. A majority of people live in rural India.

Poverty, lack of awareness of government schemes, illiteracy, and poor accessibility of health care are the major obstacles in eliminating malnutrition among the marginalised communities. The level of malnutrition is consistently high among Scheduled castes, Scheduled Tribes and Other Backwards Classes, as compared to other castes and the general population.

“Among these social groups, stunting is highest amongst children from the Scheduled Tribes (43.6%), followed by Scheduled Castes (42.5%) and Other Backwards Castes (38.6%). Whereas Prevalence of wasting is highest in Jharkhand (29.0%) and above the national average in eight more States (Haryana, Goa, Rajasthan, Chhattisgarh, Maharashtra, Madhya Pradesh, Karnataka and Gujarat) and three UTs (Puducherry, Daman and Diu and Dadra and Nagar Haveli).

Prevalence of underweight is also highest in Jharkhand (47.8%) and is above the national average in seven more States (Maharashtra, Rajasthan, Chhattisgarh, Gujarat, Uttar Pradesh, Madhya Pradesh and Bihar) and one UT (Dadra and Nagar Haveli).” (Sources: FNSA, 2019, WHO).

Malnutrition is a killer in the mainly tribal-dominated states, like Jharkhand. It has always been a hazard for the Tribal Community, followed by the Dalit Community and other ‘backward’ castes. The common reasons for the prevalence of malnutrition are interconnected or complementary to each other. Economics plays a crucial role. After all, families need money to be able to provide a healthy diet and sanitary living conditions.

A mother feeds her malnourished child in the Nutritional Rehabilitation Centre of Sheopur district in the central Indian state of Madhya Pradesh. Credit: REUTERS/Reinhard Krause.

In India, the unequal distribution of resources is a highly significant problem among rural populations. A majority of the marginalised population are involved in agricultural labour and mostly depend upon the informal sector. Besides income, an absence of health and nutrition awareness is another cause of malnutrition.

The government has taken various initiatives to prevent this problem – these include the Public Distribution System, Mid-day Meal Scheme, ICDS, Village and Child Development Centres, and The Integrated Child Development Services (ICDS) Scheme. These schemes have benefitted people, including children, pregnant women and lactating mothers.

However, problems are being observed in ensuring supply of quality food, and uniform distribution. Anganwadi centres were established under ICDS, to provide basic healthcare education and services across the country. But the problem here is that many of the workers are not skillfully trained, so they are unable to play an effective role in addressing the problem of malnutrition. And often, the mothers are blamed. A lack of organised orientation programmes and technical knowledge are major causes of the failure of policy implementation.

Often, even after developing a decisive nutritional scheme, we have seen the failure in service delivery. The economic and political factors tend to interfere with the very purpose of nutritional programmes. Needless to say, in a country like India, where a majority of people live in such vulnerable conditions, adequate funds are needed for the successful implementation of any nutritional scheme.

Both the Union and State Governments should configure more sustainable nutrition schemes to tackle the malnutrition problem. Most importantly, I believe an educated mother can be the sole driver to take care of her child. So, the government should give special importance to mother awareness programmes, relating to food and nutrition.

As ICDS and Anganwadi centres are the primary institutions in service delivery, the government should be more invested in their training.

The state government, civil society, and NGOs have to adopt a comprehensive and coordinated, multi-sectoral approach, to account for the varied nature of local-level challenges. Our civil society must respond responsibly, to demonstrate better governance to eliminate malnutrition.

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