Need to rethink approaches to infant & maternal healthcare

The figures reporting the decline in infant deaths in India is something to celebrate. Data for 2015 shows that 27 babies died for every 1,000 births, which is two better than the government’s own projected figures.

That is a drop of 53%, which is still far short of 67%, which is what India had promised to achieve under the MDGs. But it is promising in that it shows government programs to reduce baby deaths like incentivizing institutional deliveries, providing supplements to pregnant women, etc., is having some impact.

Data from states like Goa, Manipur and Punjab, which have reported a drop of over 60% in IMR is especially promising. However, compare this to the high rates in Uttarakhand and Madhya Pradesh and one gets a picture of just how patchy and uneven the quality of healthcare services remains.

This is a critical lack and needs to be addressed, as high IMR is a report card of the health of the country and an indicator of the future growth potential. Clearly policies aimed towards maternal and infant health need a rethink given the huge gaps that exist.

While widespread illiteracy, poor nutrition and sanitation, and lack of awareness are key factors that explain the high rates, the poor healthcare infrastructure on the ground is evident in the high number of deaths reported from states like Odisha, which witnessed the deaths of over 50 children in just two weeks in a state-run children’s hospital. 151 deaths were reported across hospitals in Kendrapara in Odisha in just 4 months.

There is a need to address the system on the ground and look at what the shortfalls are. Maternal and child health policies cannot work in isolation. There are important connections between these groups and there is a need to strengthen the continuum of care to ensure that an unbroken curve spans the home, community, health center, and hospital. This would help manage the maternal-newborn-child health scale of care in a more unified way.


Need for new approaches to end stunting

The start you get in life determines the future course not just for an individual but for a country.

Just how critical that is, is brought home in a series of research papers published in the medical journal Lancet earlier this month.

The research says that children who lose out on that early start, that is, they are deprived of the required nutrition and care, go on to earn 26% less on average than others. This applies to 250 million children across the world, over 40% of them under the age of five years. This is because stunting and acute poverty will act as a barrier in the way of them realizing their full potential.

Just how critical the need to invest in the first two years of a child’s life has been shown time and again in many studies. The nutrition children get in these years determines not just physical, but also mental growth. Addressing those shortfalls at a later stage is not possible, especially when it comes to cognitive or reasoning abilities. The human brain develops faster at conception and through the first 2-3 years of life.

In terms of numbers, we are looking at 250 million adults unable to realize their full potential. Economically, this translates into income loss and low productivity.

India needs to act quickly if it wants to halt this social and economic loss. The cost of not taking steps to reduce stunting in children, is said to be 8.3% of India’s GDP. We are looking at this lack of action affecting future generations.

A change in approach is called for. Perhaps there is a need to look at programs followed in countries like Peru where under a World Bank-supported program, conditional cash transfers were given to mothers of stunted children. They were also educated about the importance of giving nutritious foods to their kids. Incentives were given to health clinics to support them. The monthly payments depended on how the children progressed.

There is a need for a relook at early childhood and maternal care programs because clearly they are not doing a good enough job of reaching thousands of mothers and babies, especially in large parts of rural India.


Tacking malnutrition in Mumbai

The latest data put out by the Integrated Child Development Services highlights what a tough challenge tackling child malnutrition in Mumbai’s slums remains.

The latest data says that the slums have over 50,000 moderately underweight and over 3,000 severely underweight children. Undernourished children account for a massive 17% of the total children weighed in anganwadis across Mumbai until March 2016.

All this shows how tough challenge malnutrition remains despite the various interventions, both by the government as well as NGOs.

Between 2015-16, eight children, who were suffering from malnutrition, died. Five were infants below the age of one year, while the rest were between three to six years.

Experts say that the figures highlight the challenges of dealing with a migrant population.

“The slums that have reported such high numbers are home to a migrant population, people who come from different castes and religions”, says Dr Yogesh Nandanwar, Head, Gynecology, at Lokmanya Tilak Municipal Hospital. “The mothers are anemic and undernourished and they are in no condition to have health babies. “

Dr Nandanwar calls anemia the nucleus of all problems. “Because of anemia, worm infestation becomes an issue. Low hemoglobin is another major issue.”

Given that migrants account for one-third of Mumbai’s population, the numbers are enormous. And the fact that this is a floating population makes the challenge even bigger, underlining the need to have a specific policy to look at nutrition issues among the city’s migrant population.

No Country for Children

It’s been a damning week for India.

A series of reports from different parts of the country brings home just how poorly our children are doing when it comes to access to basic nutrition, sanitation and health.

First Odisha, where according to official figures, 15 children have died of malnutrition-related illnesses in the tribal Nagada village since January. Village authorities say the actual figure is much higher. The news finally made it to the headlines only when five children died in a span of 20 days.

The children in Nagada and nearby villages all show signs of severe malnutrition. The bad roads’ leading to these villages has meant lack of access to basic health care and clean drinking water. It took several newspaper TV reports for authorities to organize a kitchen and a health camp.

The fact that so many deaths have taken place in a mineral rich region of the state has exposed just hollow Odisha’s development claims are. The several flagship schemes for children of vulnerable tribal groups remain on paper and don’t seem to reach those who most need it.

And then this week we also had the results of a combined study by experts from the Johns Hopkins Bloomberg School of Public Health in the US and School for Applied Studies, Delhi, found that diarrhea kills nine children under the age of five in Uttar Pradesh every hour, which 71, 000 deaths in a year.

The study found that just over 15% of private doctors in UP prescribe zinc, which strengthens the ORS. Even the most basic treatment of childhood diarrhoea is a problem across large parts of the state. This explains the huge numbers as since most families opt for private over public health care.

Again, diarrhea is easily preventable with safe drinking water, sanitation, nutrition, to mention just a few.

Finally this week, we have the most recent WaterAid study that says India has the largest number of stunted children in the world, ranking higher than smaller economies and conflict-ridden countries like Pakistan and Nigeria.

Two in every five children under the age of five years in India are stunted, a condition that affects not just physical growth but emotional and cognitive development.

The report points to sanitation as a major cause, citing the practice of open defecation, which is widespread in India.

A country cannot lay claim to be a global economic superpower when it’s children are dying for lack of access to basic amenities; amenities linked to basic rights enshrined in the Constitution, but remain a mirage nearly 70 years after Independence.


Strong case for a nationwide “fat tax”

For the first time in India, the Kerala government plans to impose a “fat tax” of 14.5% on branded food chains and restaurants selling food like pizzas, burgers etc.

The announcement has evoked strong reactions.

Some have dismissed it a meaningless move that will not help achieve the stated goal of reducing the consumption of junk food and cutting down obesity-related illnesses. Others have called it yet another excuse to tax the middle and high-income groups.

The argument in favour of such a tax in Kerala is compelling. National Family Health Survey figures show that after Punjab, Kerala has the second highest number of people suffering from obesity.

How far the fat tax will change this scenario, only time will tell. There is no denying, however, that the move has helped focus attention to the growing epidemic of obesity and lifestyle diseases in India.

As the 2016 Global Nutrition Report highlights, the number of overweight or obese people is rising everywhere, leading to a spike in diabetes and other lifestyle-related diseases. One in 12 people worldwide have diabetes while nearly two million are obese or overweight.

Some health experts in Karnataka are calling for the state government to follow Kerala’s move and impose a fat tax as well. But they are asking for the tax to be extended to Indian snacks and foods like puris, bhajiyas and namkeen as well. Experts also say that while the tax can change behaviour by pushing people towards healthier options, tacking obesity calls for a larger behaviour change that can only be achieved through greater awareness of nutrition and healthy routines.