Child Malnourishment is a Preventable Pandemic, Says CRY

http://www.cry.org/mediacenter/childmalnourishmentisapreventablepandemic.html

Evidence points to large scale presence of an avertable emergency:

• 96% of the families with malnourished children do not earn basic minimum wages in UP
• 15,000 children have died between years 2006-09 in MP
• AWCs considered 'useless' by residents in Delhi

April 28, 2011, New Delhi: Shabnam, 25, and Mohammad Afzal, 30, have been living in Kali Mata Basti in New Delhi for the past six years with their two children, four-and-a-half-year-old Ruksar and one-year-old Mohammad Gisan. Both children are severely malnourished - Ruksar weighs 11kgs while her brother Mohammad weighs in at 7kgs. Mohammad Afzal, a labourer, earns Rs 2,500 a month, and money is scarce for this family of four. Shabnam is therefore forced to take her children to the local PHC, where the care and treatment leaves much to be desired. On one occasion she was asked to show the doctors and health workers her children from 'a little distance'. "When I take my children to the PHC, they don't check them properly nor do they prescribe any medication," she says.

In Uttar Pradesh's Azamgarh district, Saifuddin, a field worker with CRY partner ROSA, bribed a nurse in the District Hospital with Rs 30 to admit Suraj, who was suffering from severe malnourishment. His twin sister Guddu had recently succumbed to malnourishment, and it was critical to get Suraj admitted. Unfortunately, the child passed away within the week, as the medicines prescribed by the doctor were not available in the hospital. The hospital staff also demanded Rs 800 for a blood transfusion, which Suraj's father could not afford. In the Bibipur Gram Panchayat, Tarwa development area, 88 of the 545 children are severely malnourished, and 32 have died. These deaths could have been easily circumvented with the presence of a working anganwadi, a health centre and regular food grains from the PDS shops.

Dheeraj Kumar is one-year-and-seven months old, but weighs just 4 kgs. His mother, Sangeeta Rajak irons clothes for a living, while his father, Ramdas works as a labourer. They belong to the SC class, and both parents have to work hard to make ends meet for themselves and their three children. Despite his deteriorating health condition, Dheeraj could not be admitted in the PHC, as according to norms, only the mother is allowed to stay with the child. Sangeeta bears the responsibility of two other children at home, as well as that of putting bread on their plates.

Pappu Lal has a bulging stomach, feeble limbs, is extremely thin, keeps to himself and usually stays unnaturally quiet for periods of time-displaying both, physical and psychological signs of severe malnourishment. He is two-and-a-half years old, and lives with his parents Satyanarayan and Sayaru Devi, in Dhani, Rajmahal village, in Rajasthan's Tonk district. His father has spent a whopping Rs 10,000 - an amount he can ill afford - on Pappu's treatment in a hospital in Devli for over a year. He was forced to do this as Dhani does not have an anganwadi centre, and therefore does not have the adequate caregivers who are trained to identify and treat malnourishment.

Evidence collected by Child Rights and You-CRY and its partners points to large-scale occurrence of preventable malnourishment in India, says CRY. As a press conference in Delhi today, cases from Delhi, Uttar Pradesh, Madhya Pradesh, and Rajasthan provided factual reports on the large gaps in government's programmes such as the Integrated Child Development Scheme (ICDS).

More than 40% of children in India are underweight¹, 45% are stunted. In all, 49% of the world's malnourished children live in India². Children between 0-6 years constitute 13.12 per cent of India's total population. In 2008, the country's infant mortality rate was noted at 53 per 1000 live births³. The most damaging effects of under-nutrition occur during pregnancy and the first two years of a child's life. These damages are irreversible, and is a leading factor behind India's high infant mortality and morbidity rates

"With timely investment in terms of resources, staff and planning, these child deaths and diseases are entirely preventable," says Yogita Verma Saighal, Director, CRY. The significance of the ICDS services is evident, yet only 33% children in India have access to it⁴.

Uttar Pradesh (UP) has a child population of 29,278,235⁵, with 85% children suffering from anemia, 41.6% are underweight⁶, and infant mortality rate (IMR) is amongst the highest in India (67⁷). While the CRY and Voice of People (VoP) conducted survey of 2,841⁸ children in 8 districts in UP in 2010-11 states that 54% children surveyed are malnourished, of which 70% belong to the schedule caste (SC) while 18% belonged to other caste category (Pasi, Mushahar, Badi etc.) with other backward caste (OBC) as second highest. "Not only are they financially crippled but lack access to essential services like portable water, electricity, toilets, health services, schools, security, and sanitation. According to the survey 96% of the families with malnourished children do not earn basic minimum wages⁹," says Verma. Presently only 70%¹⁰ of anganwadi centres (AWC) are in place in comparison to the required strength. While only 50% children get any service under the ICDS¹¹.

Madhya Pradesh (MP) has the highest prevalence of malnourishment among children¹². According to the Census 2011, MP's population and the IMR is 72 out of 1,000 children born. Madhya Pradesh (MP) has a child population of 10,548,295 (Census, 2011). The share of children in the age group of 0-6 is 14.53 per cent, a decline of 3.34 per cent from 2001 Census.

Despite this, only 186 Nutrition Rehabilitation Centers (NRCs) are operational in MP, a highly insufficient number. "Although the National Nutrition Mission is high on the MP government agenda this year, with an allocation of Rs 90 crore, but the total budget for children has seen a decline from 21.7% to 17.56% in the context of child health¹³," says Verma. CRY fellows Javed and Upasana found 49% children malnourished and 20% severely malnourished in a random sample survey of 255 children in 11 settlements¹⁴ of Bhopal. There is shortfall of 47% anganwadi centres under the ICDS in MP. In the case of Bhopal as well, only 3 settlements (Shyam Nagar, Rajiv Nagar and Balvir Nagar) had operational AWCs, while Rahul Nagar and Gautam Nagar had either no anganwadi or one situated at a distance of 1km. While CRY partner Vikas Samvad Samiti reports¹⁵ that 83% children in 8 villages of Rewa district are malnourished. The alarming fact is that severely malnourished children are turned away from NRCs and advised to wait for their turn as since the inception of the NRC in the Community Health Centre in Jawa, it has had a capacity to accommodate only 10 children (10 beds). In Rewa district, 15,000 children have died between years 2006-09.

Delhi is considered the melting pot for people migrating to the city for better opportunities. The capital's migrant population comprises of almost 20% of the total, and 64% live in resettlements and slums. In Delhi 66% children (under age 6) living in slums are malnourished¹⁶.

According to a baseline survey conducted by CRY partner Alliance for People's Rights (APR) in the 7 districts of Delhi that CRY has presence in, there are approximately 7,500 children between ages 0-6. According to NFHS-3, 30% children are born under-weight, 63% anemic and there is a glaring gap in the under five mortality between the urban poor (73. 6 per 1000 births) and the urban rich (41.8 per 1000 births). The AWCs in these project area communities are considered 'useless' by residents as internal problems plague the centers, including low wages, a lack of infrastructure, unavailability of space for children to play and educational facilities are also missing. "For informal sector workers who have irregular incomes at level that fall below minimum wages, a working Anganwadi can be a lifesaver," says Verma. "The large pockets of poverty that India's Capital houses needs its entitlements, the same as everyone else."

CRY recommends that the government considers this compelling evidence from the ground in designing a robust, holistic food security Act. Schemes such as the ICDS, which, incidentally, is among the world's largest child development schemes, must be universalised and a transparent system instituted to fix accountability. The same goes for employment guarantee schemes, increased investment and political will is needed to stop the continuous slide into poverty and destitution that a large number of agriculture and other informal sector workers are facing in India today. The Public Distribution system too must be universalized and take care of both food grain needs as well as other nutrition needs.

India has made a commitment to reducing under-5 mortality by two-thirds by 2015 (MDGs). While the National Rural Health Mission (NRHM) has made some headway in tackling child mortality in rural areas, the need for a similar programme such as the National Urban Health Mission (now shelved) for the urban poor is immediate.

Spokespersons:

1. Yogita Verma: Director, CRY
2. R.B. Pal: CRY fellow and a founding member of Voice of People (UP Alliance), which is spread out in 58 blocks and 18 districts.
3. Shruti Nagvanshi: founder member of CRY partner, People's Vigilance Committee on Human Rights (PVCHR) in UP. Earlier, she has held the position of District General Secretary of the Bachpan Bachao Andolan.
4. Ram Kumar: President of CRY project Ahesas, and member of Alliance for People's Rights. He has worked at the grassroot level for 15 years, working on issues such as Child Rights, Female feticide, Women empowerment, Child sexual abuse, etc.
5. Prashant Dubey: is associated with CRY partner Vikas Samvad in MP and has been working on right to food campaign since 2002. He is also a freelance journalist and has won the National RTI Award in 2009.

Note to the Editor:

CRY - Child Rights and You earlier known as Child Relief and You - is India's leading advocate for child rights. Over 30 years CRY has partnered with NGOs, communities, government, the media and is dedicated to mobilising all sections of society to eliminate the root causes of deprivation, exclusion, exploitation and abuse. For more information please visit us at http://www.cry.org/.

For Further information, please contact: Child Rights and You (CRY) purvi.malhotra@crymail.org (9810039283)

Sources:

1. National Family Health Survey-3 (NFHS-3)
2. WHO, 2010
3. SRS 2008. The SRS (Sample Registration System) is a large-scale demographic survey for providing reliable annual estimates of birth rate, death rate and other fertility & mortality indicators at the national and sub-national levels.
4. Status of Children in India Inc: HAQ and Centre for Child Rights and FOCUS Report
5. Census 2011
6. National Family Health Survey-3 (NFHS-3)
7. SRS 2008
8. CRY and VoP picked 10% of the 2,841 children as a sample survey to analyse and understand the linkages between the socio-economic conditions and malnourishment.
9. The basic minimum wage in UP is Rs 120 per day.
10. Only 33 percent of children below 6 years receive any kind of service from an anganwadi centre. Use of services is greater where AWCs have been in operation for 6 or more years.
11. CRY and VoP ICDS survey conducted in 17 UP districts, covering 421 ICDS centres 2010, found 38% ICDS workers belong to General and OBC categories, 16% to SC and 5% Muslims. Nutrition is the highest focus of ICDS centres (87% Centres) and referral is the least (34%). Only 49% centres said that they operate ECDC (pre-school) in their centres. 75% respondents said that bringing children to the centre is very tough and they need to put in lot of efforts. 38% workers agreed that they needed to put in their own funds to operate the centres.
12. National Rural Health Mission (NRHM) report 2010, and Sample Registration carried out by the Family & Health Welfare Dept. of the Government of India.
13. In 2011-12 out of total child budget that is Rs 30456 Crore government has decided to give only Rs 5347.80 Crore for child health.
14. 1. Shyam Nagar, 2. Gautam Nagar, 3. Rajeev Nagar, 4. Rahul Nagar Pampapur, 5. Balbir Nagar, 6. Jhagriya, 7. New Ambedkar Nagar, 8. Shankar Nagar, 9. Patrapul, 10. Milan Basti, and 11. New Aarif Nagar
15. Cyclone of Malnutrition, 2009
16. Situational Analysis of Young Children in Delhi report, 2010