`Health awareness must be stepped up'

Maharashtra has been experiencing the problem of malnutrition-related deaths across the State for many years. Vandana Krishna, Secretary, Women and Child Welfare, spoke to Anupama Katakam about the problem and the efforts taken by the government to solve it. Excerpts from the interview:

The Maharashtra government admitted in the High Court recently to a high rate of malnutrition-related deaths. Could you comment on this alarming situation?

Every year this issue [of malnutrition deaths] comes up. The media decide to blow it up. The fact is, the problem is an ongoing one and the government is aware of it. The figures put out by the media are often inflated or are quoted out of context. When you say there are one lakh malnutrition deaths, you have to give it along with a ratio, within a time period in a geographical area. Neither of which the media bother to provide. For instance, how many deaths per 1,000 children within a certain age group in a particular region is the more accurate way of giving a number. Actually, in Maharashtra the infant mortality rate has dropped from 48 to 42 [per 1,000 live births], marginal but nevertheless significant.

The numbers may be high, but in many cases it may be a malnutrition-related death or death for some other reason such as pneumonia, malaria or diarrhoea. But because the child is also malnourished, the death is classified as malnutrition death. I am not sure of these numbers because many cases of death are never reported, as people do not see it as important.

Is it rampant in the State?

There are two ways of looking at this problem. If you equate it with other major issues such as poverty, unemployment and sex-based discrimination, then malnutrition is rampant. But if you ask if there is a sudden increase, then, no. The problem runs deep and is linked to many issues such as basic child care, women's health, unemployment and livelihood problems, illiteracy, failure of agriculture, water and sanitation and social attitudes in communities where there is a high incidence of deaths.

What is the State government doing about it? Could you name some specific programmes evolved to combat this?

To begin with, we have been placing a lot of emphasis on reporting deaths. The government machinery can act on it if there is information that there has been an increase in deaths in an area.

Our teams, including anganwadi workers, have been asked to step up the process of surveying and registering newborn children. We are constantly tracking their weight so that it does not fall below the normal limit. Also, several government departments are working together to protect people from disease. For example, bleaching powder is supplied to the villages to prevent water contamination.

A disease like polio is being combated in an organized way. Even if malnourishment is not a disease why can't it be handled more aggressively?

In the case of polio, it is a one-time intervention campaign. In the case of malnourishment, it is a scattered form of intervention. There are so many more issues to tackle. It cannot be solved with just medication.

In spite of these schemes and the ICDS programme, malnutrition deaths among children are quite high. What is the reason for this and how do you tackle the problem?

First, the government must not be blamed entirely for the problem. There are several reasons why epidemics, diseases or such problems as malnourishment among children occur. For instance, the government may provide chlorine tablets to decontaminate water but the tanks are not kept clean. So when water contamination takes place, the government is blamed for not taking preventive measures.

If you look at malnourished children, most often the mothers have no idea about correct child-feeding practices. The mothers themselves are underfed. In one area, we came across a practice where the women are told not to eat well during pregnancy because a small baby is easier to deliver. In spite of an aggressive campaign for breast-feeding, people still give infants water, which often leads to health problems. The first year is crucial for the child's growth.

Alcoholism is a huge problem, which must not be underestimated. The money earned is spent on drinking. And whatever money is saved is spent on weddings or other functions, not on medical treatment. Social customs are often responsible for children suffering from various maladies.

Through the anganwadi, the children get one meal, but in several cases this turns out to be their only meal of the day. This would link us to the larger story of livelihood, which is a major factor in determining the health of children. The loss of income has a direct effect on children.

Is there a solution?

The government will have to continue its efforts to provide better health care and step up its health awareness campaigns. There are suggestions that the Kerala literacy way works. Once people are educated, such problem will become less. We must step up the literacy efforts, particularly among women, so that there is better awareness.

One area that can be tackled better by non-governmental organisations is in removing harmful social customs and superstitions. Also, attitudes have to change in rural areas for better health care. But, as I stated earlier, it is inter-linked: livelihood issues or unemployment will be related to a larger problem, perhaps, drought. Children are always the first to be affected in these adverse circumstances. It is a complex issue, which will require the intervention of national-level policies.