Millennium Post

Those old hunger games

Those old hunger games
With a new prime minister who claims to hail from a marginalised caste, the timing couldn’t be better. A study supported the Global Alliance for Improved Nutrition has examined the status of under-nutrition and its determinants among the dalits. Also under scanner were the policies, programmes and legislation meant for dalits (scheduled castes, or SCs) and improving their nutrition status.

Why nutrition? Well, because it is a composite tip-of-the-iceberg indicator for many things working well, like healthcare, food security, education, water sanitation and social protection, as the Lancet journal pointed out in its special nutrition issue in June 2013. Also because, India, the second fastest growing economy not so long ago, has been stuck with seabed level under-nutrition figures at 46per cent – almost double the burden of sub-Saharan Africa.

Dalit under-nutrition cannot be decoupled from the story of caste-based discrimination and marginalisation and the increasing political resurgence of dalits in recent past. The performance of the marginalised constituencies, dalits, adivasis (scheduled tribes, or STs), Muslims and others, is an apt litmus test of the government’s sincerity towards the most vulnerable groups and effectiveness of its programmes and policies for them.

A long away from catching up

An exercise of the National Family Health Survey (NFHS) reanalysis suggests that 53.6per cent of dalit children are malnourished (moderate and severe acute malnutrition) compared to the general category children at 39.2per cent and the all-India average of 48.4per cent as per NFHS 3. While the decrease in severe acute malnourished is at 3per cent, the moderately malnourished amongst the dalit children has increased by 3.4per cent, negating the overall improvement since NFHS 2. As per NFHS 2, while the total malnourished children among dalits were at 53.5per cent, the figure has worsened marginally to 53.6per cent by NFHS 3.

Forty-eight percent dalit children are stunted compared to the average of 35.6per cent for general category children and 43per cent for the all-India average. The 13per cent additional stunting prevalence among dalit children and similar figures among adivasi children worsens the all-India average, and hence require specific action.

Only 13.89per cent dalit households have piped water supply in their residence, plot or yard, compared to 27.51per cent among the general category. There was a limitation in NFHS 3 that it did not provide data for hand-pump into residence, plot or yard and it seems that it was merged with ‘public tap/hand-pump’. So, performance and trend vis-à-vis NFHS 2 is difficult to state. In this case it would be more significant to say that 86per cent of dalit households were not getting piped water supply as per NFHS 3. This is a major concern considering most habitat-level discriminations as well as hygiene and pollution factors play out via water (access, inaccess and restricted access to it). As a counter, increasingly confident and affirmative dalit youths are also affirming their dignity via water access, reversing practices of purity and pollution.

One-fifth of dalit mothers of underweight children can decide on their own how to spend money, which is 7per cent less than the general category mothers with children who were underweight. Between NFHS 2 and NFHS 3, autonomy in terms of decision-making for spending money and seeking health care has shifted heavily from solely the partner’s domain to ‘jointly with partner’, which is a good development. Though dalit women have more economic engagement than general category women, almost 60per cent of women were not allowed to have money for her own use, which means brahminical patriarchy was also rearing its head among dalit households.

It is clearly evident that a majority of children at the time of birth have average or larger than average size, and deprivation-based growth differences kicks in much later than in mother’s womb. It is the socio-political adversities which make them underweight, wasted or stunted during their initial years of life. The state’s role needs to be questioned here, both in service provisioning and political will.

Coupled with the fact that the WHO’s global growth monitoring anthropometric standards were set up through an elaborate six-country exercise, where India was also a case study, means Indian children’s anthropometric failures have more to do with public policy and social challenges than genetic programming.

During NFHS 2 it became evident that family planning workers were not visiting households across all sections of society. And the visits were not significantly different between households with normal children vis-à-vis households with underweight children. However, this question has changed in NHFS 3 to ‘visits by auxiliary nurse midwife/lady health volunteer and anganwadi worker’, so they cannot be compared with NFHS 2.  But it is important to note that for underweight children the anganwadi workers are paying fewer visits to the households of all categories, including dalits. Home visit figures are extremely low and that is a matter of concern. Visit (or lack of it) to the pregnant women or child-bearing households is also where discrimination by frontline staff can and does easily play out.

Common sense says that prevalence of underweight children in poor households is higher. However, the conflation of poverty (low standard of living) and underweight children is considerably higher among dalits at 49.1per cent, which goes much higher to 56.8per cent for adivasis. For the general category it is much less at 25.8per cent and the all-India average is 37.5per cent. Again, this is a statistic made considerably worse at the national level because of the adverse performance among the dalits and adivasi poor households and under-nutrition prevalence, which clearly points to the necessity of state intervention.

In summary, a rigorous reanalysis shows that while the performance of nutrition indicators among dalits is improving, it is nowhere near the catch-up pace. It is lower than the general category performance. Under-performance of nutrition indicators among the marginalised population categories is a double whammy: on one hand it is pulling down the all-India averages and on the other, till catch-up happens, the anthropometric inequalities and its consequent impact on learning and earning will also persist.

Resources, legislations, allocations

The state response has been predictable. It denied the harsh reality, and even shot the messenger by discontinuing the NFHS exercise because the survey findings brought bad news. The NFHS 3 concluded in 2005 and the next NFHS is only now, over 2014-15, after much lobbying and advocacy.

But many progressive legislations and programmes for reaching the unreached among dalits and adivasis cannot be denied either, especially the ones authored by the father of our constitution and the subsequent improvements via legislations.

Key constitutional provisions have been nothing short of inspirational, from Article 14 on equality, Article 16 on equality of opportunities, Article 17 on abolition of untouchability, Article 21 on right to life, Article 46 on promotion of educational and economic interests, and Article 47 on nutrition to a host of provisions on adequate representation of the dalits and Article 271(1) on additional special central assistance via special component plan (SCP).

By arrangement with GovernanceNow

Biraj Swain & Ranvir Singh

Biraj Swain & Ranvir Singh

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