Hard to swallow

At an anganwadi at Yeragera village in Raichur district. Children find the packaged dried food that has replaced freshly cooked meals in anganwadis very unappetising.-K. GOPINATHAN

The ready-to-eat food given in anganwadis is one of the reasons for the dismal nutritional status of children in northern Karnataka.

OVER the months, Renuka, a young anganwadi teacher in Marakamdinni village in Deodurg taluk of Raichur district, has resigned herself to some harsh facts: One of them is that there is no guarantee that the food meant for the children at her anganwadi will be supplied regularly. Another is that even if that happens, the children may not eat the packaged, instant food supplied. As a result, only a third of the children enrolled (30 out of 89) attend the anganwadi, whose primary role is to address child nutrition and health. But there is one statistic she cannot come to terms with. Running her finger down the register in which she records health indicators of the children, she does a quick calculation to confirm what she already knows. Five of these children are malnourished, she announces. That is a fifth of the total number of children under her care.

It has been a year and a half since packaged food, made up of roughly pounded rice, wheat, pulses and spices, has replaced freshly cooked food in the anganwadis in Karnataka. Anganwadi teachers across the State describe the dried food at best as unappetising and at worst as unfit even for cattle.

Raichur is among the most impoverished districts of the State, which are concentrated in the north Karnataka region and figure at the bottom of the list in terms of all human development indices. It was with this in mind that the flagship Integrated Child Development Services (ICDS) was implemented with the mandate to provide nutrition and health care through a network of anganwadis. But fundamental flaws in the implementation of the project in the State, despite crores of rupees being pumped into it, have condemned districts like Raichur into a spiral of deprivation.

According to data available with the Department of Women and Child Development for April 2010, as many as 78,366 children are malnourished in Raichur. Of them, 599 suffer from the most severe forms (Grade III and IV) of malnutrition. Raichur only features third in the malnutrition roster. Koppal district has the dubious distinction of having the worst record in child malnutrition: 0.7 per cent of the children up to six years there are severely malnourished, which is more than double the State average. Close behind is Bagalkot (0.6). Raichur and Bellary tie at the third place (0.5).

In the backdrop of the expensive public relations campaign of the Bharatiya Janata Party government in the State to establish Karnataka, and Bangalore in particular, as the first choice of global investors, such human development figures are a discomfiting reality. Even though Karnataka fares slightly better than the national average in terms of the percentage of children suffering from the most severe form of malnutrition, it compares poorly with all other southern States. As against 0.3 per cent in Karnataka, Tamil Nadu has 0.02, Kerala has 0.06 and Andhra Pradesh has 0.09 per cent of its children suffering from Grade III and IV malnutrition, according to ICDS figures as on December 31, 2009. The national average is 0.4 per cent.

The National Family Health Survey-3 also demonstrates that Karnataka performs poorly in comparison with its neighbours on several indices that reflect child nutrition. For instance, 84 per cent of Karnataka's children (below 35 months) are anaemic as against 80 per cent in Andhra Pradesh, 72 per cent in Tamil Nadu and 56 per cent in Kerala. Karnataka comes first again with 33 per cent underweight children below three years, followed by Andhra Pradesh with 30 per cent, Tamil Nadu with 26 per cent and Kerala with 22 per cent.

In spite of this acute deprivation, packaged food supplied to anganwadis is being thrown away in Koppal district. The children are refusing to eat it, said an anganwadi worker from Gangavathi taluk. She said the packaged food was often spoilt even though it was supplied before the printed expiry date on the packet and wondered whether the contents, which were only blended at the taluk level, were procured long before the date of packaging.

In the adjacent Bellary district, Nagarathna K., an anganwadi worker in Hospet taluk, said that children sometimes ended up having indigestion when they ate the food. She said higher officials did not entertain complaints about the food lest they should bring disrepute to the department. Anganwadi workers have been threatened with transfers over the issue.

Supporting factors

But packaged food is only one of the many contributors to malnutrition, a condition that is inextricably linked to several other developmental indicators. As the economist Prof. K. Nagaraj pointed out, the absorption of nutrients depended upon several supporting factors such as drinking water supply, sanitation, access to health care and literacy levels of mothers. Putting in place an infant feeding programme alone will not ensure better levels of nutrition, he said.

For instance, the Karnataka Human Development Report for 2005 shows that Raichur district has the lowest female literacy rate, at 58.50 per cent as against the State average of 74.87 per cent. Raichur is followed by Koppal at 59.18 per cent, Bagalkot at 60.82 per cent and Gulbarga at 61.70 per cent. The gap between female and male literacy rates is also very stark in these districts.

Raichur and Bellary have the lowest number of mothers who have received at least one anti-tetanus injection (less than 65 per cent), according to the District Level Household and Facility Survey for 2007-08. Koppal has less than 30 per cent institutional deliveries, while Gulbarga, Raichur, Bellary, Gadag and Bagalkot have less than 50 per cent. Fewer than 60 per cent of the children aged between 12 and 23 months get vaccinated in the districts of Bijapur, Bagalkot and Raichur. The same survey shows that in nine of the 12 northern districts the percentage of women who marry before they turn 18 is higher than the State average of 22.06. In Raichur, by the District Health Officer's own admission, half of the 46 primary health centres (PHCs) have no doctors. In Koppal, 23 of 55 PHCs have only supervisory staff.

These numbers in the government records translate into life-and-death questions for people like Giriyamma of Marakamdinni village. The PHC nearest to her village is eight kilometres away. As a result, Giriyamma, an agricultural labourer, gets little advice on how to care for her malnourished two-year-old daughter Bhavana. A private doctor has told me to massage Bhavana's legs with oil, she said, pointing to the child's reed-thin limbs. In the adjacent Yeragera village, five-year-old Ugra Narasimha's mother, Lakshmi, has been advised, again by a private doctor, to give her acutely malnourished son Junior Horlicks, a bottle of which costs more than a tenth of her monthly income. Diabetes has complicated the condition of 15-year-old Nagaraj.

As alarming as the official figures for malnutrition in Karnataka is the fact that they are a gross underestimation. For instance, Bhavana and Ugra Narasimha represent children who are missing in the official records on malnutrition as neither of them attends an anganwadi. Also, diseases congenital and communicable that often accompany their condition mask the underlying malaise, as with Nagaraj.

The infant mortality rate in the north Karnataka districts is higher than the State average of 55: Bidar (66), Bijapur (67), Dharwad (69), Gadag (66), Gulbarga (67), Haveri (66) and Koppal (65). Again, the district with the highest number of out-of-school children, according to the Sarva Shiksha Abhiyan survey done in January 2010, is Raichur, followed by Bijapur, Bidar, Yadgir, Gulbarga and Koppal. In this scenario, it does not help that the food supplied to anganwadis, aimed as a crucial intervention in children's health and survival, is mired in controversy.

Unlike in the neighbouring States of Tamil Nadu, Kerala and Andhra Pradesh, where fresh food is cooked at anganwadis, Karnataka supplies ready-to-eat packaged food, which needs only to be put in boiling water. Though the process might sound simple, it is a recipe for trouble, say activists and nutritionists.

Even though the ingredients are blended at the local level, they are procured from a single company based in Tamil Nadu, which has a contract with the Department of Women and Child Development for capacity building of the Mahila Supplementary Nutrition Production Centres (MSNPC) throughout the State. Many activists believe that the entire process is being controlled by the agency in the guise of capacity building.

A Supreme Court judgment in 2004 said that contractors should not be used for the supply of food to anganwadis and that ICDS funds should be spent through the village community, self-help groups and mahila mandals to buy grain and prepare meals.

A case filed by Mathews Philip, Executive Director, South India Cell for Human Rights Education and Monitoring, against the introduction of packaged food is pending before the Karnataka Lokayukta. The petition says that food items currently supplied are being rejected by children and women, and this will contribute to the increasing rate of malnutrition in the State. Notices have been served to top officials of the Department of Women and Child Development in Karnataka.

The nutritional value of this particular variety of packed foods, which come in five variants comprising largely rice and wheat, is debatable. What is beyond dispute, however, is that the children find it unpalatable and this system does not keep in mind the regional variations in food habits.

As Anura Kurpad, Dean of St. John's Research Institute and Professor of Physiology, St. John's Medical College, Bangalore, put it, serious consideration must be given to the acceptability of the food, keeping in mind how difficult it is to feed children in the age group of three to six years. Factors such as the consistency (how pasty or gummy it is) and taste can play a crucial role. It is critical to have a nuanced approach and to understand cultural backdrops against which products are made, he said.

In what could be seen as an admission of the inadequacies in the system, Karnataka's Ministry for Women and Child Development has now instituted a study to assess the food given to children in anganwadi centres. If we detect problems in the food, we will take a decision on changing it by the end of August, said P.M. Narendra Swamy, Minister for Women and Child Development. The department will also study the practices in the neighbouring States for a comparative evaluation.