Why despite years of economic progress India continues to report high rates of child malnutrition has been a matter of endless discussion. One that has received renewed attention following the announcement that the 2015 Nobel for economics has gone to Angus Deaton.
Much of Deaton’s work has revolved around India, covering issues like nutrition, poverty and health gaps. Alongwith fellow welfare economist Jean Dreze, Deaton has analyzed the reasons why under nutrition levels in India are consistently higher than far poorer countries in sub Saharan Africa.
Nearly 39% of children in India are stunted due to poor nutrition. Two of five stunted children in the world are in India, making it the epicenter of global malnutrition. India reports a far higher figure than Burkina Faso or Haiti.
Stunting, which is the fallout of chronic malnourishment, has permanent consequences. It is accompanied by a host of problems – poor immunity, risk of disease and a greater risk of dying before the age of five. On the whole Indians are stunted compared to people in most countries, including Africa and China.
It’s not just a question of a shorter height than normal, but is a marker for an array of developmental problems, explains Dr Armida Fernandez, former dean at Lokmanya Tilak Municipal Hospital, one of Mumbai’s largest public health facilities.
“When you are short there are many things that are affected”, says Dr Fernandez. “The brain is not developed and as the child grows older, there is the risk of early onset of diseases. Children who are born small run the risk of hypertension and diabetes.”
The impact on brain development is a cause for great concern and is seen as an explanation for why stunted children drop out of school early.
There are many factors responsible like poor maternal nutrition, poor feeding practices, substandard food quality as well as frequent infections. However, nutritional interventions are only a part of the solution because stunting also occurs among well-fed children. Lack of access to adequate hygiene sanitation and clean drinking water are compelling factors as well. The WHO estimates that 50% of malnutrition is associated with repeated diarrhea or intestinal worm infections from unsafe water, poor sanitation or hygiene.
Studies have also shown that women’s roles play a strong role. The low status of women in India means poor levels of maternal nutrition. Many children are therefore malnourished in the womb itself.
“We need to look beyond just the lack of toilets”, says Dr Fernandez. “We need to look at the quality of food girls are given, women’s health, domestic violence and what a mother undergoes during pregnancy. There is no simple cause and effect factor for stunting”.