The malnutrition flashpoint

In about four months, India will enter the 40th year of one of its most unique programmes, the world’s largest, on early childhood development. The Integrated Child Development Services (ICDS) Scheme, the foremost symbol of the country’s commitment to its children, requires serious introspection and review especially in the light of a just-released study.

The word ‘development’ has become synonymous with material resources development, with governments, economists and the political class showing little concern for or emphasis on child development. The resultant 

statistics are appalling. 

As the country struggles to tackle the severe problem of child malnutrition, a just-released study causes more concern as it places India on the top of the list of new-born (neonatal) deaths every year in the world. Of the nearly 27 million babies born every year in the country, around 7,80,000 babies die, many within 24 hours of birth, according to the findings of the research on newborn survival, carried out by a team of experts led by Joy Lawn of the London School of Hygiene & Tropical Medicine, a public research 

university in London.

Each year, globally, 2.9 million newborn babies die from largely preventable causes and 2.6 million babies are stillborn (half of which occur during labour). These 5.5 million are born and die without birth or death certificates, says the study Every Newborn Series 

published in the British medical journal The Lancet.

The leading causes of death among children aged less than five years include pneumonia, prematurity, birth asphyxia, diarrhoea and malaria. Worldwide, about 45 percent of under-five deaths are linked to undernutrition (outcome of insufficient food intake and repeated infectious diseases) – with the highest (22 per cent) being in India, according to the World Health Organisation. The newborn are particularly at high risk. ‘Care for mother and baby in the first 24 hours of any child’s life is critical for the health and wellbeing of both,’ says Margaret Chan, Director-General, WHO. ‘Up to half of all newborn deaths occur within the first day.’ Most of these babies could be saved if they had access to some basic health-care services. These include skilled care during and after childbirth; inexpensive medicines such as antibiotics; and practices such as skin-to-skin contact between mothers and their newborn babies and exclusive breastfeeding for the first six months of life.

The ICDS Scheme, launched on 2 October 1975, suffers from proper implementation. Aimed at enhancing survival and development of children from vulnerable sections of society, the world’s largest outreach agenda targets infants and children below six years of age, expectant and nursing mothers. This primary policy response to malnutrition covers almost all development blocks in the country and offers a wide range of health, nutrition and education services to children, women and adolescent girls. Though well-conceived and well-placed to address the major causes of child under nutrition, the scheme requires significant changes to address the current malnutrition crisis. A World Bank report says more attention has been given to increasing coverage than to improving the quality of service delivery and to distributing food rather than changing family-based feeding and caring behaviour. This has resulted in limited impact and a mismatch between the programme’s intentions and its actual implementation. 

Moreover, inequalities in under nutrition between demographic, socioeconomic and geographic groups increased during the 1990s. Malnutrition is concentrated in a relatively small number of five states and 50 per cent of villages, which account for 80 per cent of the cases and thus a large share of the burden. 

To a great extent, the ICDS scheme is dependent on the profile of the key multi-tasking functionary, the community-based voluntary frontline Anganwadi Worker (AWW) – such as her qualification, experience, skills, attitude and training. Studies have shown that they are overburdened and their honorarium is not conducive to their pivotal role and responsibilities.

‘There is an urgent unmet need to provide timely, high-quality care for both mother and baby around the time of birth,’ says Joy Lawn. Most newborn deaths are preventable. The experts recommend, in resource-poor environments, techniques like promoting of breastfeeding, keeping babies safe from infection and training in resuscitation techniques to tackle asphyxia, a common cause of death. These interventions would require a mere Rs 67 per person annually, the report estimates.

To save lives, India should invest in high impact and quality care during the time just before and immediately before and after birth. Small and sick newborns should be provided special care in government-run hospitals – especially in villages where doctors shudder to be engaged. Additionally, family planning services and meeting the unmet need for family planning would be synergistic by reducing the annual number of births and, therefore, deaths by about half.

The situation is dire. The new dispensation at the Centre must immediately review the path trod so far and recalibrate – as children’s development is the mainstay of material development. The country would require more, and better, investments in child and maternal health care to reach the nutrition Millennium Development Goals. Mere economic growth will not be enough.