The nutritional level among children in India worsened over the last five years, showed the latest National Family Health Survey (NFHS) released earlier this week. Eighteen of the 22 states and Union Territories (UTs) recorded a rise in the percentage of children under five years of age who are stunted, wasted and underweight compared with 2015-16, reversing decades of gains, reflected in the previous rounds, conducted in 2005-’06 and 2015-’16.
States including Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh – which had lowered their rates of stunting in the previous decade – have reported a rise in stunted children in the fifth round of the NFHS (2019-20) survey. Sixteen states and UTs out of the 22 surveyed recorded a rise in the percentage of children under five years who are severely wasted and underweight in comparison to NFHS-4, the data showed.
The National Family Health Survey – a chief source of health data in India – covers over 400,000 households and collates data on marriage, fertility, vaccinations, nutrition and health status, among other indicators. India already has a poor score on the global hunger index – ranking just above 13 countries out of a total of 107, including North Korea, Haiti, Afghanistan and among others.
Surprisingly, the Road Scholarz twitter handle, which had tweeted about the report’s adverse findings, was suspended by the social media platform.
According to IndiaSpend, if the all-India rates of child stunting were to rise, as the phase-I data (of NHFS-5) indicate, this would represent the first increase in child stunting since 1998-99. However, it’s important to note here while making any comparisons that the data covered in NHFS 1, 2 and 3 on child nutrition were for children aged three years and below, while the data for the NHFS 4 and 5 covers children under five years and below. Therefore, making a direct comparison with this year can be difficult. As per previous data, the rates of child stunting for children below the age of three declined from 1998-99 to 2005-06.
Purnima Menon, senior research fellow at the International Food Policy Research Institute, told IndiaSpend, “I think what we are seeing right now is the impact of the economic slowdown of the last few years and some of those economic shocks that were experienced.”
“The increase in child stunting is ‘extremely worrying’,” said Menon, adding that there are parts of India where we really do not know how people have been living and how they have experienced the impacts of the last few years. She told IndiaSpend that NHFS-5 data was collected in 2019, and would not account for the food insecurity experienced in 2020 following the lockdown, urging the need for large sample surveys to understand the food insecurity situation in India.
There are three key indicators used to measure child under-nutrition: stunting, wasting, and underweight. Stunting, or low height-for-age, is considered an indicator of cumulative nutritional deficiencies from conception, and of the long-term health of the child. Child wasting, or low weight-for-height, and being underweight, or low weight-for-age, reflect more short-term nutritional deficiencies.
According to a World Bank 2019 report, India has the second highest number of stunted children in South Asia (at 38%), after Afghanistan (41%). Wasting is highest in India at 21%, followed by Sri Lanka at 15% and Bangladesh at 14%, the report said.
On the positive side, there has been an increase in the rates of child vaccination, showed the report. Seventy percent of the children under the age of two are fully vaccinated across seventeen states and UTs. This is important as the government is looking vaccinate its 1.3 billion population against COVID-19.
The report highlighted a decline in marital violence over the years; however sexual assaults against children have increased since 2015-16. In nine of the 22 states and UTs, more young women said they have experienced sexual violence as children than in 2015-16.
The trends are in line with the indications of rising rural poverty and food insecurity that emerged in the National Sample Survey Organisation’s 2017-’18 survey on consumer expenditure, which has now been buried. The data in the survey showed a fall in real food expenditure in rural areas between 2011-’12 and 2017-’18 – a trend seen for the first time in 40 years. During this period, the real wages of regular wage or salaried workers declined and that of rural workers remained stagnant.
Other findings released earlier also point towards a decline in the country’s nutritional status due to economic slowdown. In a report titled ‘Pauses and Reversals of Infant Mortality Decline in India in 2017 and 2018’, released last month, demonetisation and economic slowdown were cited as the main causes for increase in overall infant mortality rate in the country.
Hunger and malnutrition continue to be acute problems even months after the lockdown ended. Hunger Watch, a survey of over 4,000 people from vulnerable and marginalised communities across 11 states conducted by the Right to Food campaign, found that about 27% of the respondents sometimes went to bed without eating in September-October. Moreover, 71% reported that the nutritional quality of their food had worsened from what it had been before the lockdown.
The data for the National Family Health Survey were collected before the pandemic hit India. The pandemic and ensuing the lockdown created a serious humanitarian crisis as cash, food and work grew scarce. The Central government launched the Pradhan Mantri Garib Kalyan Anna Yojana soon after the lockdown was declared in March. Under this scheme, beneficiaries of the public distribution system were entitled to an additional 5 kg of foodgrain. The scheme was extended till November but then discontinued, even though the crisis of food insecurity is far from over.
The most humane and effective response would be to continue with additional food support through a universal and improved public distribution system that includes pulses, coarse grains and edible oils.
Strengthen public distribution
While the allocation of additional foodgrain under the Pradhan Mantri Garib Kalyan Anna Yojana was a welcome initiative, Jean Drèze, Reetika Khera and Meghana Mungikar have pointed out that millions are excluded from the public distribution system, which is based on outdated Census figures.
Up to 67% of the population is to be covered under the National Food Security Act. Using the population projection for 2020 – over 1,371 million – the number of people covered under Act should have been around 919 million. However, only 804 million people were identified under Pradhan Mantri Garib Kalyan Anna Yojana for additional foodgrain allocation from July to November. That is, around 115 million people who could have been covered under the National Food Security Act were excluded. Even among the identified beneficiaries, there are reports of exclusion errors because of biometric identification or other administrative reasons.
According to the latest available consumer expenditure survey data (2011-12), exclusion errors, or poor households excluded from subsidised rations, are lower in states that expanded the coverage of the public distribution system. Providing 10 kg of foodgrain per person per month to 80% of the population, or 1,097 million people, through the public distribution system would require 11 million tonnes of foodgrains. This is only around one-third of the excess foodgrain, over and above the buffer norms, available in the central pool in October 2020.
There is evidence that in states where the public distribution system works well, there have been nutritional gains for children as well as potential catch-up growth through the mid-day meals scheme. Nutrition deficiencies in children could be reversed with school meals that include eggs. In several states, eggs are currently not on the mid-day meal menu.
The pandemic has underlined the importance of the public distribution system, the midday meal scheme and India’s current food policy set-up. We need to strengthen them further to counter rising hunger and undernutrition. The required resources are readily available.
(Compiled by us from: “Child Nutrition Levels in India Worsened Over Last Five Years, Finds NHFS Survey”, by The Wire Staff; and “India’s Children are not Getting the Nutrition They Need. Here Is a Measure That Could Help”, by Anjana Thampi & Ishan Anand, courtesy: Scroll.in.)
