Episode 2: Malnutrition: India's legacy of neglect
New numbers show a spike in undernutrition among children
Hi Everyone,
A very happy Monday to you and a Merry Christmas in advance.
This week, in the second episode of Capital Calculus 2.0, I examine a very disconcerting trend: a spike in undernutrition among children in India.
Something which severely undermines the health of children, reduces their longevity and jeopardises the demographic dividend that India so dearly wants to harvest. Worse it drives inequality as malnutrition perpetuates the cycle of poverty and ill-health. Yet it is something that has rarely been a public policy priority; at least not with the earnestness it deserves.
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Read on.
India’s health emergency: malnutrition
Last week the union government released the first tranche of the National Family Health Survey (NFHS-5) conducted in 2019. The data covering 17 states and five union territories (UTs) reveals a very disconcerting fact: the decline in malnutrition, observed in NFHS-4 released in 2015, among children under five years has been reversed in several states.
Before we take a quick dive into these new numbers it may be worth realising that things haven’t come to such a sorry pass overnight. It is the tragic outcome of seven decades of neglect; a legacy India needs to rectify ASAP. To use a cliché, the chickens are now coming home to roost.
Broadly, the results of NFHS-5 reveal that in 16 out of the 22 states and UTs:
There was an increase in the incidence of severe acute malnutrition;
The proportion of children under five who are underweight has increased.
Further, in 13 of the 22 states there was an increase in childhood stunting—a classic symptom of malnutrition. Most worrying is that this trend has not spared even Kerala, the poster child of good health metrics in the country. The proportion of children under 5 years with stunting in the state increased to 23.4% in NFHS-5 compared to 19.7% in NFHS-4.
Another matter of concern is that the national or state average mask the regional variations—both inter and intra-states—in under-nutrition. The variations between districts in a state are known to be staggering.
It is pretty logical to believe that covid-19 which devastated livelihoods, especially among those at the bottom of the pyramid, would have only worsened this trend. (A more detailed examination of the new numbers can be accessed in an insightful piece by Dipa Sinha in The Hindu.)
Equally worrying is that the other aspect of malnutrition caused by inadequate vitamins, overweight, obesity—all of which result in diet-related non-communicable diseases—is also on the rise. In that sense the NFHS-5 numbers are a double whammy.
Before we explore the consequences, it may help knowing that NFHS is a large-scale survey conducted over multiple rounds among a representative sample of households throughout India. The union health ministry has designated the Mumbai-based International Institute for the Population Sciences as the nodal agency to carry out the internationally funded survey. Bear in mind that this is a survey and not a Census—hence the findings are best used to ascertain trends.
In this instance there is no confusion about the trend: the decline has been reversed. But this is indeed baffling. In 2015-16 the decline in malnutrition was welcomed and seen as an outcome of the progressive improvement in the overall well-being of the populace—through the expansion in the social safety net and decline in poverty levels. Since then nutrition, health, drinking water and sanitation have only gained in importance in the government’s priorities. And yet we see a spike in undernutrition. Clearly a puzzle for policy planners to resolve.
Some may ask as to why worry about malnutrition? The answer is pretty straight forward: under-nutrition leads to wasting and stunting, both of which pose serious risks to the afflicted individuals as well as the health fabric of India. The nature of the affliction—a patient in the initial stages is not bed ridden—is such that it is often ignored or knocked down in the list of health priorities. Eventually, when there is an intervention, it is often too late. In short malnutrition is a silent assassin, which like an incoming tide, is very difficult to ascertain visually. Exactly why it is so dangerous and should be feared.
The cohorts most vulnerable to malnutrition are obviously the poor and the socially disenfranchised segment of women and children. As the World Health Organisation (WHO) puts it: poverty amplifies the risks of and from malnutrition. “Also, malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health,” the WHO said in a fact-sheet it put out earlier this year on the subject.
Drawing from the above it is obvious that one consequence of undernutrition is that the poor will become poorer. Keep in mind that covid-19 pandemic has only swelled the ranks of the poor. There is no empirical evidence on hand, but it is logical to conclude that inequality in India must only have worsened in this period.
So whichever way you look the spurt in malnutrition, especially among children, is a serious policy challenge. India has to make good for its past errors of omission and commission. Ignoring the problem can only worsen the health risks and attendant impact on the economy.
Remember covid-19 started out as a once in a century health challenge. But nine months later we see it more as something which caused an unprecedented economic crisis.
Scary that State like Kerala has shown increase in the number of children suffering from malnutrition.
Covid Pandemic may have worsened such problems in not only making poor as poorer but in also policy diversion to seemingly more pressing medical issues and use of scarce resources to combat these pressing issues .
Pray Your article may help bring such policy correctives !
Thanks for bringing such matters to fore !
Anil, very interesting and well written as always !!!