Nearly a third of all children in India are stunted and despite the host of social welfare schemes launched in the last few decades to tackle malnourishment, it still remains as a primary health concern in India.

A report on malnourishment published by the Centre for Budget and Governance Accountability (CBGA) reveals that 29 percent of all children in India are stunted. The report also makes some important observations.
The report, while stressing on the fact that the recent changes in the federal fiscal architecture and the policy landscape over the last year have a number of implications on financing for nutrition, states that since, “under-nutrition requires a multi-sector approach, adequate public investment for nutrition across a range of sectors is crucial."

Dwelling into the problems in tackling the issue of malnourishment, the report adds that “there has been a disconnect to some extent between the discourse on nutrition and that on budgets in the country.”

What the report reveals

In India, the prevalence of stunting in children of less than five years of age is 39 percent, according to the latest 2013-14 national survey of the Ministry of Women and Child Development (2015). This represents a decline of 19.4 percent since the previous survey in 2005-06.

However, the annual rate of decline, of 2.4 percent, is not rapid enough to achieve the global target.
With nearly 47 million children under the age of five suffering from stunting in 2015, India is the epicentre of the global crisis.

According to the latest global estimates, India has a higher proportion of stunted children than Africa (32 percent), a number that is almost three times more than Latin America and the Caribbean (11.7 percent).

Dwelling into what has been achieved and what remains to be done by India to tackle the problem of malnourishment, Arti Ahuja, commissioner-cum-secretary, department of health and family welfare, government of Odisha, states that the success of India in reduction of malnutrition finds honourable mention in GNR 2015. She says, "to a man with a hammer, everything looks like a nail. So might a nutrition champion appear to the uninitiated, viewing most activities from the nutrition lens."

"The fact remains however that malnutrition, encompassing both under and over nutrition, is impacted by many factors- nutrition sensitive and specific. A host of inputs such as drinking water, immunisation, food diversity, open defecation, mother’s age and education, apart from food intake and dietary diversity, impact the nutritional status,” Ahuja said.

The recently released Rapid Survey on Children (RSOC) data of 2014, on being compared with the last such nationwide survey, the National Family Health Survey (NFHS-3), showed a fall in stunting from 48 percent to 39 percent, a decline in wasting rates, and an increase in exclusive breast feeding rates.

However, as is the case with almost all social indicators, there are regional disparities. The rate of decline varies among states and in some cases, there is reason to worry about the reversal of wasting rates.
Ahuja adds that while the news from India is indeed heartening, it does not fare too well in global comparisons.

India fares much worse than its alphabetic neighbours in the GNR 2015. Placed between Guyana, Haiti, and Honduras on one side and Indonesia, Iran and Iraq on the other, India statistics for anaemia (48 percent in 2011) is worse than all these countries.

For stunting and wasting also (NFHS 2006), it fares worse than these alphabetic neighbours. In comparison with geographical neighbours, the situation is by and large the same. Thus, while the pace of reduction is indeed good news, it needs to be accelerated.

The report demonstrates that there are clear pathways for reduction of malnutrition, and with clearly articulated will and the capacity to walk the talk, countries can, and indeed have conquered this bastion of inequality and inequity.

Dr NC Saxena, Supreme Court commissioner on right to food and former secretary of planning commission, while discussing the problems of undernourishment among children belonging to scheduled tribes (ST), states that Human Rights groups working on the right to food have reported some cases in which tribal children cannot access facilities provided by the anganwadi centre under ICDS, and the chances of survival of a tribal child are low, with many of the tribal children being malnourished and anaemic.

Saxena adds, “Over 70% of adivasis reside in the central region of India, which though resource rich, is home to the poorest people who have not benefited from social and economic development to the same extent as people in other regions have. In some cases, they may have actually suffered due to the anti-tribal, market oriented forest policies (as they depleted the gatherable biomass), or resulted in displacement from their ancestral lands."
"The lack of accountability of government personnel in these remote and sometimes inaccessible regions has also resulted in poor delivery of all government programmes, contributing to the utter neglect of adivasis,” Saxena said.

The study also revealed that a mere 10 percent of malnourished children figure in government records. Under-reporting is facilitated by collusion between field staff and their supervisors, who are thus able to evade responsibility for improving nutritional outcomes.

Talking in this context, Saxena observes that “there are cases to show that the tribes are denied their right to food. Children of the Birhor tribal community in Madhya Pradesh do not have access to the right to education and right to a mid-day meal at the school, as the teachers fear that the Birhor children will pollute the utensils. The chances of survival of a tribal child are low, with 71.4% of tribal children being malnourished and 82.5% anaemic.”
While the report highlights many case studies and data to show that a lot has been done to tackle the issue of malnourishment among children, a lot still needs to be done which requires an integrated effort on part of the policy makers responsible for implementing the schemes reduce and eventually eliminate malnourishment among children in India.