A grim picture

Hunger and malnutrition is the index by which one knows the real level of development, the government may claim whatsoever. The result released for the first phase of the fifth round of National Family Health Survey (NFHS-5) with the reference year 2019-20 shows the decline, especially when compared with NFHS-4 with the reference year 2015-16. The country has the largest number of stunted children in the world. The substantial progress between NFHS-3 (2005-06) and NFHS-4 has been lost.

The NFHS-5 was disrupted by the general lockdown of the country in March, and therefore the results are available for only 22 states and UTs. The Survey was resumed last month and the results for the rest of the states and UTs will be available by mid-2021, but the reference year will remain the same as the first phase. It means we will not have the realtime data after the pandemic. However, one of the estimates referred by UNICEF tells us that over 6,000 children could die a day globally due to Covid related secondary impact out of which 1,600 will be Indian children.

With the disruption of income flowing to the households due to policy experimentation of the Government, the crisis has been worsening. The health, nutrition, immunisation, education, mental health, and physical safety of our children have further been impacted due to the pandemic. Everything was disrupted during the lockdown. Anganwadis catering to children under five, under ICDS were closed. Mid-day meals were not available to school going children because schools were shut down. Without a great intervention and investment, the growth and development of these wasting, stunting, and malnourished children will be severely impacted and thus may have no future.

The latest survey NFHS-5 phase I has revealed that child undernutrition had been on the rise even before the pandemic. The trend is most likely to continue in the second phase of the survey, and if it happens, it would be the first increase in child stunting in the last two decades. More infants had received immunisation in the reference year, but the lockdown had also disrupted the immunisation.

There are three key indicators to measure child under-nutrition which are — stunting, wasting, and underweight. A stunted child has a lower than expected height for age, a wasting one has lower than expected weight for height, and the one who is underweight has lower than expected weight for age. The share of stunted, wasted and underweight children has grown in the majority of the states surveyed in the first phase. A surprising element of the survey result is that the rate of stunting has risen even in the rich states such Kerala, Gujarat, Maharashtra, Goa, and Himachal Pradesh in the last five years, though they had lowered their rates of stunting between 2005-6 and 2015-16. It may be related to the overall economic downturn that had increased even the level of unemployment to a 45-year high.

In 18 of 22 states and UTs surveyed, over a quarter of children under five were stunted. The minimum level of stunting was recorded in Sikkim which was 22.3 per cent, which is not a low level of stunting. It rose up to 46.5 per cent in Meghalaya, a percentage that speaks loudly about the highest level of neglect of children compared to any of the states and UTs in the country. Bihar followed Meghalaya with 42.9 per cent. Gujarat, Karnataka, Assam, Maharashtra, and Dadra & Nagar Haveli had stunting between 35 and 40 per cent. In the range of 30-35 per cent were West Bengal, Telangana, Nagaland, Tripura, Lakshadweep, Andhra Pradesh, Himachal Pradesh, and Ladakh. Stunting between 22 and 30 per cent were recorded in Mizoram, Jammu & Kashmir, Goa, Kerala, Manipur, Andaman & Nicobar, and Sikkim.

The percentage of wasting is less severe than stunting, but it is also unacceptably high for all the states and UTs surveyed. It ranges from around 9.8 per cent in Mizoram to 25.6 per cent in Maharashtra. Barring Mizoram having a wasting rate of 9.9 per cent, no state and UT has a wasting rate less than 12.1 per cent (Meghalaya). Six states and UTs have over 20, and 18 have over 15 per cent.

Children being underweight presents a sad picture, indicating that a very large number of children were not even getting food. Underweight children in Bihar were highest at 41 per cent followed by Gujarat 39.7, Dadra 38.7 and Maharashtra at 36.1 per cent. Except for Mizoram (12.7), Sikkim (13.1), and Manipur (13.3), all the states have around 20 per cent and above in terms of underweight children. Ten states and UTs were in the range of having 25-35 per cent of underweight children.

How is it that the children have not been getting sufficient food and nutrition? It was decidedly due to bad policy decisions that disrupted their flow to the households, be it demonetisation, unemployment, market-oriented policies, or budgetary support. We can take the example of the last Union Budget that did not address the financial and resourced shortages affecting nutrition. Allocation to overall nutrition-sensitive schemes fell by 19 per cent though several of them received marginal increases. Service delivery mechanisms never get sufficient funding. The most critical food subsidy scheme under the National Food Security Act was allocated 37 per cent less. It adversely impacted 67 per cent of the population, 75 per cent in rural and 50 per cent in urban areas, whom the scheme was serving.

There are at least 14 schemes sensitive to nutrition, most of which are getting insufficient funding. The financial burden on states has been on the increase due to several reasons, including curtailment of their right to collect taxes and not payment of their share in time from the Central revenue such as GST. Many of the Central schemes are being run on a cost-sharing basis which most of the fund starved states were not able to meet. It all had impacted our children. Only in one year in 2018, an estimated 883,000 children under five died. Due to the impact of the pandemic, additional deaths, stunting, wasting, and instances of underweight children are estimated to increase up to 50 per cent in the worst scenario and 10 per cent in the best, which must be addressed in the coming budget 2021-22.

Views expressed are personal