Children's Day: India's Malnutrition Data An Indicator Of Social Inequality In Children's Healthcare

Children's Day is a day to spread awareness about the welfare, education and rights of children in India. It is also a day to reflect on the progress the country has made in the last 75 years in terms of safeguarding children and adolescents who are the future of the nation. Some of the first metrics to be considered include child health, nutrition and mortality. 

9.2 lakh SAM children

The World Health Organisation (WHO) defines severe acute malnutrition' (SAM) by very low weight-for-height or a mid-upper arm circumference less than 115 mm, or by the presence of nutritional oedema. Children suffering from SAM have very low weight for their height, and are nine times more likely to die in case of diseases due to their weakened immune system.

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The Covid-19 pandemic left 9.2 lakh children in India severely impacted by acute malnourishment. Uttar Pradesh topped the list with the highest cases while Bihar came second. The government data which was revealed last year in response to an RTI query underscored concerns that the Covid pandemic could exacerbate the health and nutrition crisis among the poorest of the poor. 

The data had been collected by the Women and Child Development Ministry which had in 2020 asked all states and union territories to identify SAM children for their early referral to hospitals. 

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But even before the Covid-19 pandemic, The Global Nutrition Index 2018 revealed that India has one-third of world's stunted children. 

Acute Malnutrition: Stunting, Wasting

While data is not updated year on year, NFHS-4 (National Family Health Survey) in 2015-16 showed prevalence of severe acute malnutrition among 7.4 per cent of children from 601,509 households, 699,686 women, and 112,122 men. The survey was based on Information from 265,653 children below age 5 had been collected in the survey.

The subsequent NFHS-5 which was conducted acrossd 6.1 lakh sample households and gave figures for 22 states and UTs, also presented a grim scenario. It said malnutrition increased among children in 2019-20 from 2015-16 in 22 states and UTs. While the malnutrition data had improved from NFHS-4, the new reports found that at least 35.5 per cent of India's children were stunted.

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Around 13 states and UTs out of the 22 surveyed recorded a rise in percentage of children under five years who are stunted in comparison to 2015-16; 12 states and UTs recorded a rise in percentage of children under five years who are wasted; 16 states and UTs recorded a rise in the percentage of children under five years who are severely wasted and underweight in 2019-20. 

Wasting refers to low weight in children in proportion to their height and is an indicator of acute undernutrition. It is a strong predictor of mortality among children under five years of age.

Govt initiatives

India already scores low on the Global Hunger Index, ranking just above 13 countries out of a total of 107, including North Korea, Haiti, Afghanistan and others. 

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The NFHS-5 data is concerning as it reflects how several states like Kerala, Maharashtra, Goa, Gujarat and Himachal Pradesh which in the previous decade had managed to lower their rates of stunting saw a reversal of the trend.  

To tackle high persistence of malnutrition in the country, the Centre launched the Poshan Abhiyan programme in 2018 to reduce low birth weight, stunting, undernutrition and anaemia among children, adolescent girls and women.

NFHS 6, which is set to be conducted in the next year, would evaluate the impact and outcomes of the health schemes implemented by the BJP government such as Ayushman Bharat and Poshan Abhiyan on this population. It might be interesting to know how much impact these schemes have had on the health and nutrition of children.

Indicators of inequality 

Seven years since India's independence, indicators of child and maternal health have improved drastically. With mortality now reduced to 30 per 1,000 live births. The infant mortality rate (IMR) was 145.6/1000 live births in 1947. 

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However, inequitable resource distribution and benefits of the government's healthcare policies have led to discrepancies and social gaps. Social and economic inequality overlap with health and nutritional metrics, meaning the most malnourished or undernourished children belong to socially or economically backward sections of the population. 

In 2019, UNICEF noted that globally about 165 million children under the age of 5 years were stunted (low height for age), 101 million were underweight (low weight for age), and 52 million children were wasted. Further, from the estimates from United Nations (UN), about 6.3 million under age-five mortality occurred in India, of which 45 per cent died due to malnutrition.

A 2019 study on socioeconomic inequality found an inverse relationship between a district’s economic development with childhood stunting and underweight, meaning that economically developed districts have a lower prevalence of childhood malnutrition than less developed districts.

Socially depressed sections such as children belonging to Scheduled Castes (SC), Schedules Tribes (ST), and Other Backward Classes (OBC) households report higher levels of malnutrition indicators. 

NFHS-4 found 43.8 percent of ST children under the age of five were stunted, 27.4 were wasted and 45.3 are underweight. This is the highest percentage share among all the three categories. Among children belonging to the SC category, 42.8 percent are stunted, 21.2 percent are wasted and 39.1 percent are underweight. The prevalence of Anaemia was also higher among children belonging to SC and ST categories. 

A 2019 study titled Pathways to Inequalities In Child Health highlighted how disadvantaged SECs suffer from worse health than their more advantaged peers as the pathways through which SECs influence children’s health are complex and interrelated. In general, they are "driven by differences in the distribution of power and resources that determine the economic, material and psychosocial conditions in which children grow up", the authors of the study noted.

UNICEF's World Children's Day 2022 theme was "Inclusion: For Every Child". The theme reflected the need to commit to striving for a more inclusive healthcare policy. This holds especially true for developing nations battling economic and social inequalities like India where social stigma and discrimination are key impediments to healthcare access. 

India is one of the 193 countries that are signatories to the United Nations Convention on the Rights of the Child (UNCRC), which includes promoting healthy lives (addressing survival, nutrition, health care services, etc.) as its first goal.

Any interventions in child healthcare, however, can only succeed in an inclusive sense by creating pathways to cross-sectional development in healthcare infrastructure and access that benefits the weakest section of India's population.

(With inputs from PTI)