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Leaving aside two or three countries like Niger and Yemen, India has the highest proportion of underweight children in the world: a full 36 per cent according to the National Family Health Survey 2015-16 (NFHS-4). The corresponding proportion is much lower in other South Asian countries, including Bangladesh (22 per cent) and Nepal (27 per cent). If we focus on child stunting (low height-for-age) instead of low weight-for-age, India’s rank improves a little, but it still stands out as one of the most undernourished countries, in the company of a dozen other countries such as Ethiopia, Congo and Afghanistan. These startling facts, based on the World Bank’s World Development Indicators, are rarely discussed in India’s prolix democracy.
Early data from the National Family Health Survey 2019-20 (NFHS-5), released a few days ago by the health minister, reveals another alarming fact: Child nutrition indicators have not improved between 2015-16 and 2019-20. In fact, in seven out of 10 major states for which data has been released, the proportion of underweight children increased in that period. In six of these 10 states, stunting increased.
The proportion of undernourished children in these 10 states combined (about half of India’s population) can be estimated with reasonable precision as a population-weighted average of the state-wise figures. This comes to 36 per cent for stunting and 34 per cent for underweight — the same, in both cases, as the corresponding weighted-average for 2015-16, based on NFHS-4 data. This suggests that the progress of child nutrition in India, modest as it was earlier, has come to a standstill.
The stagnation of stunting rates is particularly alarming. Height, unlike weight, is not affected by short-term factors, so this is not a transient setback. Stunting in childhood is associated with serious impairments later in life, including lower school achievements.
Note that the NFHS-5 data pertains to the situation just before the COVID-19 crisis. One year later, chances are that child nutrition has deteriorated. Indeed, numerous household surveys point to severe food insecurity across India in 2020. In the latest survey, Hunger Watch, two-thirds of the respondents (adults from India’s poorest households) said that they were eating less nutritious food today than before the lockdown — a chilling thought. It would be surprising if this did not have an adverse impact on child growth.
For good measure, mid-day meals in schools and anganwadis were discontinued from the lockdown onwards, to this day. Many states did try to make some arrangement for distribution of cash or “take-home rations” in lieu of cooked meals, but these measures were mostly haphazard and inadequate. Children have also suffered from the massive disruption of routine health services — including immunisation — during the lockdown, evident from the official Health Management Information System. Anganwadis, for their part, have been closed for nearly a year in most of the country. The prolonged closure of anganwadis and schools possibly had other, less well-documented consequences, such as an increase in child labour and child abuse. In short, 2020 was an all-round catastrophe for Indian children.
All this calls for urgent intervention. The first step is to value child development, both for its own sake and for the future of the country. On this, the NDA government has much to answer for. In its first annual Budget, for 2015-16, there were staggering cuts in financial allocations for mid-day meals and the Integrated Child Development Services (ICDS) — way beyond what could possibly be justified on the grounds that states were getting a higher share of the tax pool. The cuts were partially reversed later in the year, but to this day, the central budget for mid-day meals (Rs 11,000 crore) is lower than what it was in 2014-15 (Rs 13,000 crore). In real terms, the central allocation for ICDS is also lower today than it was six years ago. Poshan Abhiyaan, the NDA government’s flagship programme for child nutrition, has a minuscule budget of Rs 3,700 crore.
For several years, the NDA government also failed to respect pregnant women’s right to maternity benefits — Rs 6,000 per child under the National Food Security Act 2013. When it finally launched a scheme (Pradhan Mantri Matru Vandana Yojana) for this purpose, in 2017, the benefits were illegally restricted to one child per family and Rs 5,000 per child. In many states, the NDA’s allies and associates also have a distinguished record of opposing or resisting the inclusion of eggs in mid-day meals and take-home rations — one of the best things that can be done without delay to improve child nutrition.
The forthcoming Budget, for 2021-22, is an opportunity to make up for some of these lapses. Ad hoc measures will not do, we need bold and durable initiatives. Reviving and revamping mid-day meals in schools and anganwadis would be a good start. Eggs are begging to be included as a matter of national policy (not only in mid-day meals but also in take-home rations for young children and pregnant women), with a fruit option or such for vegetarians. Extending maternity entitlements to all births, not just the first living child, is a legal obligation under NFSA, and the spirit of the Act also calls for raising their amount well above the outdated norm of Rs 6,000 per child.
The ICDS programme also needs a shot in the arm. India has an invaluable network of 14 lakh anganwadis managed by local women. Most of these anganwadi workers and helpers are capable women who can work wonders with a supportive environment. The southern states, and some other states like Himachal Pradesh and even Odisha, have amply demonstrated the possibility of turning anganwadis into vibrant child development centres at the village level. There is no better way of reaching out to the country’s young children.
These are just some examples of possible initiatives. None of this, however, is likely to happen without some introspection about policy priorities. If India’s overwhelming goal is to become a $5 trillion economy within a few years, there is no reason to pay attention to children. But if it is development in the full sense of the term, then child development is paramount.
This article first appeared in the print edition on December 17, 2020 under the title ‘Give children weight’. The author is Visiting Professor at the Department of Economics, Ranchi University