Although child-undernourishment rates have significantly declined in the past decade, India remains home to more than 40 million stunted children under five, according to the India Health Report for Nutrition Security in India, 2015, released by the Public Health Foundation of India. To present a clearer picture of child undernourishment, 38.7 percent are stunted or below normal height for the age, 19.8 percent are underweight and short, and 42.4 percent are underweight. Such numbers persist, despite significant structural changes over the past two decades and a 200 percent hike in overall spending on child health in the past decade. “The central government’s spending on health has been changing structurally over the past two decades, from providing only nutritional supplements, such as vitamins, to a more holistic approach, from maternal health to sanitation,” according to a report by IndiaSpend, a data-driven news website. The rapid spike in health expenditure over the past decade was facilitated due to an increased focus on meeting the challenges of the United Nation’s Millennium Development Goals (MDG). Unfortunately, India missed its MDG targets. According to relevant studies, India is likely to have 33 percent malnourished children by the end of 2015, while the target under the United Nations’ Millennium Development Goals (MDGs) is to bring it down to 26 percent. In addition to the Integrated Child Development Services (ICDS), which is a flagship programme of the Indian government since 1975, the Centre had launched the National Rural Health Mission in 2005, which was soon upgraded to the National Health Mission (NHM) in 2015. Under the NHM, the government is obligated to provide affordable, accessible, and quality healthcare to rural areas. Under the ambit of the NHM, the Centre started the Reproductive and Child Health programme, under which the government aims to reduce social and geographical disparities in access to, and utilisation of quality reproductive and child health services. In a reply to a query in the Lok Sabha, the Centre said that fund allocations to States for Reproductive and Child Health programme had been increased from 1699.16 crores in 2005-06 to 5700 crores in 2014-15. Coming back to the India Health Report, it is amply clear that the acceleration of local and holistic health policies, which include a greater emphasis on maternal care and sanitation, is vitally important to improve nutrition levels. Therefore, it is imperative to discern the implications of the Centre’s decision to raise the state’s share of its tax revenue from 32 percent to 42 percent. While presenting the NDA government’s first full Budget, Finance Minister Arun Jaitley had reduced spending on health by 15 percent. Despite the higher devolution of funds, states were left with lesser funds for development. Irrespective of the reduced allocation, states with a high incidence of child malnutrition, for example, Jharkhand and Uttar Pradesh, should bear greater expenditure on public healthcare and nutrition. “But how do we know that states are responsible enough to make judicious use of the additional funds?” NITI Aayog member Bibek Debroy had asked in a recent column for a leading Indian news daily.
In November, Food Minister Ram Vilas Paswan said that all Union Territories and states, except for Tamil Nadu, will implement the landmark National Food Security Act (NFSA) by March 2016. The Act provides two-thirds of India’s populace five kilogrammes of subsidised grains each month. Suffice to say, such an announcement has been long overdue. The law was passed by the Parliament in 2013 and state governments were given a year to implement it. The deadline has since been extended thrice, with the latest one ending in September, according to recent reports. Food entitlements are an absolute necessity, considering that vast sections of the Indian populace are not well-off. Stunted growth among children is a consequence of both undernourishment (not having enough to eat) and undernutrition (when caloric intake is below the minimum dietary energy requirement) in the first 1000 days of an infant’s life, which includes the gestation period. What’s worse, numerous studies have shown that ill-effects of undernourishment and undernutrition at tender ages result in irreversible health consequences. These studies have gone on to suggest that stunted children learn less in school. Consequently, they are more likely to find themselves to live in poverty and go on to have children also stunted by poor nutrition. This vicious cycle of poverty only widens the gap between the rich and poor. “You can feed up an underweight child, but with a stunted child, because of the effects on the brain, it has a permanently reduced cognitive capacity by the age of around two years old,” said Antony Lake, the Executive Director of the United Nations Children’s Fund. Suffice to say, better delivery of basic food is only one part of the solution.