Tragic picture

Published : Jun 02, 2006 00:00 IST

A UNICEF report says that South Asia has the largest number of underweight children below the age of five.

EVEN as much of the world claims to be marching towards the 21st century goals of economic growth and development, most of sub-Saharan Africa and large parts of Asia continue to grapple with the problem of undernourishment among children below the age of five. The United Nations Children's Fund (UNICEF) estimates that of the 146 million children under five who are underweight in the developing world, 106 million (73 per cent) live in just 10 countries. South Asia has the largest number of underweight children below five. India accounts for 57 million of them.

Although the situation has improved in the developing world since the 1990s, the rate of improvement has not been adequate to halve undernutrition rates by 2015. It is worth noting that the lowest prevalence of the problem is seen in Central and Eastern Europe, the Commonwealth of Independent States (CIS), Latin America and the Caribbean. Within Asia, the number of underweight children declined in East Asia, particularly China, where the prevalence of the problem went down by more than half. The improvement in the region, states the "Progress for Children", UNICEF's report card on nutrition, was primarily driven by the gains made in China, which accounts for 59 per cent of the region's under-five population. Without China's gains, it would not be possible for the East Asian and Pacific regions to reach the millennium development goals (MDGs).

The report says that given the lack of progress (in combating malnutrition) and the population growth, the number of underweight children actually increased in sub-Saharan Africa. A more balanced argument would have understood sub-Saharan Africa's plight in a historical context of colonial and post-colonial depredation and civil strife and as an outcome of competitive politics and global politics in a unipolar world.

Of equal concern is that the situation in West Asia and North Africa has deteriorated and the countries that have contributed to this are Iraq, Sudan and Yemen. Although there is high prevalence of morbidity, mortality and undernutrition among Iraqi children, it is disconcerting that the report card does not dwell much on their state. There is some mention, however, but without any explanation of the contemporary situation of an external aggression on the country. For instance, the section on West Asia and North Africa states: "Iraq has been dominated by conflict. Following the 1991 war, mushrooming rates of undernutrition and child mortality reached a peak in mid decade, then dropped." There is no explanation as to how it dropped, considering that Iraq was still reeling under U.N. sanctions and the United States-led military onslaught. Secondly, the report card cites some preliminary figures from a UNICEF-supported survey of child nutrition in Iraq, carried out in 2002, to show that wasting and being underweight were at less than half the levels of 1996, while stunting had fallen by nearly 30 per cent during the same period. But it is also stated that the proportion of underweight children in Iraq was still substantially higher than in 1990, as was the overall mortality rate for under-five children. And breast-feeding practices, which had been the norm earlier, were actually disrupted by the provision of free formula feed under the Oil for Food programme. This, concurs the report, has left a "legacy of poor feeding practices that will be difficult to reverse". Iraqi babies were therefore made to face the wrath of sanctions, of U.S.- sponsored aggression, and formula feed which were most likely to be manufactured by leading multinational baby food manufacturers.

In Latin America, though generally the problem is not very serious, disaggregated data indicate widening gaps between the rich and the poor. It is estimated that children living in the poorest households are 3.6 times more likely to be underweight than children in the richest households. But the worst levels of "underweightness" are prevalent in India, Bangladesh and Pakistan, which account for half the world's underweight children. In the U.S., only 2 per cent of the children are underweight, 1 per cent are stunted and 6 per cent are wasted. Nearly 40 per cent of all babies with low birth weight in the developing world are found in India. In China, the incidence of low birthweight is comparable with the industrialised countries.

In industrialised countries, the problem is obesity rather than undernutrition. The lowest incidence of low birthweight is found mainly in the Scandinavian countries and CIS member-states such as Estonia and Lithuania. Here maternal nutrition is also good, thus resulting in good child nutritional status.

The worrying note is that the percentage of infants with low birthweight has increased in industrialised countries in recent years. The causes have less to do with poverty: they include increasing numbers of multiple births owing to the use of fertility drugs, late child bearing and improved medical technology that allows pre-term babies to survive. But this is not to say that there is no poverty-induced undernutrition in the developed world. There are disparities within and between countries and social inequalities are on the rise, especially in some countries of Eastern Europe. Among ethnic groups in the United States, the indigenous communities of Australia and the lower socio-economic categories and single mothers, low birth-weight is common. Strangely, even as affluent sections have reverted to a healthy lifestyle, the economically lower groups have taken to eating the cheaper high-calorie and high-carbohydrate fast foods resulting in high obesity levels.

There is a correlation between low-birthweight and socio-economic status. Poor maternal nutrition too is an outcome of poverty and gender-based discrimination. Such discrimination gets accentuated in conditions of acute economic distress. What is more worrying is that if unchecked this would set in motion what the UNICEF report card calls a "generational cycle of undernutrition". There have been various interventions suggested, including exclusive breastfeeding, iodised salt consumption and Vitamin A and iron supplementation. However, these interventions should be bolstered by stable food security programmes, which seem to be non-existent in most of the developing nations. Even those that were in place have been dismantled or converted into targeted programmes, often resulting in the exclusion of people who need them most.

Undernutrition leads to high morbidity and mortality levels. The UNICEF attributes 50 per cent of all childhood deaths in India to malnutrition. The data have been culled from the latest National Family Health Survey data. There was a mild improvement in the situation between 1992 and 1998; malnutrition recorded an annual decline of only 0.8 per cent. This is disconcerting as this was the period of economic reforms, cuts in social expenditure and the launch of the Targeted Public Distribution System (TPDS) as compared to the universal PDS that existed prior to the 1990s.

Despite this dismal picture, India also has one of the most unique systems of addressing child nutrition - the Integrated Child Development Services (ICDS) programme. This programme is conducted by village-level volunteers called anganwadi workers and helpers who cater to pregnant women, lactating mothers and children in the age group of zero to six. They counsel mothers on health and nutritional education, provide pre-school education to children and recommend supplementary nutrition. In addition to these, they do other duties assigned by their supervisors or the Child Development Project Officer (CDPO).

UNICEF believes that anganwadi workers lack knowledge on what information to communicate and may not have the necessary skills to provide effective counselling to mothers and care-givers. Some of them were themselves not convinced that breastfeeding alone for the first six months was crucial in the development of a well-nourished child.

Even if this assessment is partly true, nothing prevents the state and other agencies from improving the skills of the anganwadi worker and helper. It was also the government's responsibility to ensure that anganwadi workers were convinced about the beneficial effects of breastfeeding.

Currently, ICDS needs to be universalised. Addressing the needs of anganwadi workers is also essential. They continue to be "volunteers" and receive a meagre honorarium. It is ironical that while the grassroot worker is a "volunteer" , everybody else in the ICDS - the supervisor, the CDPO, the top bureaucrats, are government employees.

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