Child malnourishment and stunting in India: Getting the basics right

Malnourishment affects more than just an individual or a family; it affects the growth of the nation as a whole, writes Tejasvini Akhawat

Healthy children are the reflection of a healthy nation. The physical and mental well being of children cannot be disregarded since we are referring to the future of this country that must not lack on health grounds, to say the least. From accomplishing space innovations and scientific inventions to nuclear reactors and IT advancements, here is a proposition for India to pause and get its basics right. Child malnourishment and stunting poses a serious challenge to the rapid economic growth of the country and stains its international image as well.

Classically defined, malnourishment refers to children having low weight for their age and stunting to children having low height for their age. As per the recent report of National Family Health Survey (NFHS)-4, conducted by the Ministry of Health and Family Welfare in 2015-16, 35.7 per cent children under five years of age are underweight and 38.4 per cent are stunted. Despite the significant decline from the 2005-2006 standards, the absolute number remains quite large, making India the land of the highest number of stunted children in the world and one of the world's highest demographics of children suffering from malnutrition. It is worse than Sudan and North Korea. 

Malnourishment and stunting retards the mental and physical growth of children and hampers their capability of achieving full and healthy development. Malnourishment also causes increased risks of nutrition-related chronic diseases, such as diabetes, hypertension, and obesity in future. It makes children susceptible to tuberculosis that yields fatal consequences as well as reflects negatively on the image of the nation (as it is called the poor man’s disease). Stunting is associated with an underdeveloped brain that has diminished mental ability and learning capacity. Apart from physical deterioration, it also leads to poor cognitive and emotional development of a child, resulting in underwhelming school performance in childhood and reduced earnings in adulthood. Unfortunately, malnourishment and stunting are unlikely to be reversed after the age of five and two respectively. Thus, malnourishment and stunting serve as the indirect cause for high child mortality rates, high maternal mortality rates, lower Gross Domestic Product, slow development of the country, perpetual cycle of poverty, illiteracy, worsening conditions of the demographic dividend of India, and many integrated developmental problems.

The evident reasons for child malnourishment and stunting are mainly undernutrition, lack of intake of micronutrients, inadequate food, worm infestation, repeated infections, inappropriate sanitation and related diseases. Unclean water and poor sanitation are direct factors for diarrhoea, which remains the key reason for malnourishment amongst children. The rate of practicing open defecation is highest in India, which results in poor absorption of nutrients for children and weakening of their immune systems. Therefore, water, sanitation and hygiene collectively called as WASH factors are responsible for 88 per cent of all diarrhoea cases in children. There are also many interrelated and interdependent components for child malnourishment and stunting, such as environmental pollution, ignorance and illiteracy, impoverished reproductive health of the mother, inadequate antenatal care, diminishing change in food habits, poverty, social-economic disparity, unsafe drinking water, food shortage etc.

Inadequate intake of food is vivid from the fact that world’s one-fourth hungry population lives in India. Food insecurity stems from the conglomeration of low-income levels, unemployment, low purchasing power, lack of access to food and inadequate supply of quality food. To stabilise food and nutrition security for child nourishment, food fortification becomes crucial. As per the World Health Organization (WHO) report, environmental pollution in the forms of water, soil and air causes child malnourishment that ultimately leads to child mortality. Furthermore, the children are adversely affected by indoor pollution that happens due to energy insecurity in India. Thus, the complexity of the issue necessitates a cohesive and holistic approach to resolve this multi-faceted problem.

Restoration of nourishment in the early formative years of children is pivotal and immediate steps are required in this direction at the earliest as this issue is time-bound. The target should be to cure them at the initiation. Moreover, prevention is better than cure and hence, India should aim for preventive measures to ensure that factors leading to this situation are eradicated left, right and centre. Successful implementation of direct intervention schemes aimed against child malnourishment is a must since they can create an enormous difference in the healthy projection of the next generation. Water and sanitation programs should be designed to reduce the reach of germs in infants and young children. Nutrition education and awareness can be an excellent way to teach children and adolescent girls to maintain hygiene, improve sanitation, intake healthy diets, consume foods rich in nutrients. Ways to take care of infants should also be taught. Sanitation campaigns, observing Village Health and Nutrition Days, and performing arts can be used to educate the people about hygiene, inculcate a healthy behaviour and moderate their mindset.

Moderating food prices and promoting income support policies will yield better results in fixing malnourishment due to poverty. Sustainable agricultural practices and diversification of food baskets for women and children; procuring and producing local food will lead to both overall cost reduction and curb corruption. Higher spending on socio-developmental factors such as health and education will ensure higher levels of employment and hence, increased incomes and GDP. In 2016, the contribution of India’s GDP to health sector was a little over 1 per cent which is well below the global average of around 6 per cent. However, the National Health Policy 2017 commits to increase the public health spending to 2.5 per cent of its GDP. This would also alleviate social deprivation and bridge the health equity gaps.

Malnutrition is the single largest contributor to disease in the world. Therefore, treatment of critical childhood diseases through the Universal Immunization Programme (UIP) of Mission Indradhanush is being supported to provide vaccination for children and pregnant women. The Government must place sincere efforts in eliminating child malnourishment and stunting from the country because firstly, India is a welfare state and secondly, to boost robust economic growth. Schemes such as Integrated Child Development Scheme, Indira Gandhi Matritva Sahyog Yojana, Rashtriya Bal Swasthya Karyakram, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakaram and MAA are reaping positive results with the assistance of ASHA workers and Anganwadi centres. Complementary schemes such as PDS, Swachch Bharat, construction of toilets are providing multi-dimensional solution to this problem.

Besides the government, many new players such as NGOs, INGOs, private sector, international forums, local self-governments, civil society etc can contribute in diminishing child malnutrition. India is a signatory to the Sustainable Developmental Goals and goals 2, 3, and 6 constitute the solutions for it. Acting on the SDGs and regularly monitoring its implementation is indispensable and provides India a wonderful opportunity as its health objectives are mirrored in the SDGs. In the relevant words of MoWCD, ‘malnutrition is complex, multi-dimensional and inter-generational in nature, needing convergence of interventions, coordination and concerted actions from various sectors’. It calls for integration of different ministries, more nutrition-sensitive and nutrition-specific interventions and a fine balance between economic growth and human development index, as it is only then that the country can truly prosper and secure wealth from its health.

The author is a postgraduate in International History from the Graduate Institute of International and Development Studies, Geneva, Switzerland, and is currently pursuing an internship with the Speaker’s Research Initiative (SRI), Lok Sabha Secretariat, Parliament of India, New Delhi