Improvement Needed To Meet All Child malnutrition targets by 2022

Three decades since the adoption of Convention on the Rights of the Child (CRC) and 7 years after the implementation of National Food Security Act (NFSA), it’s imperative to examine their impact. Severe acute malnutrition continues to be the leading risk factor for disease burden in India. In 2019, India’s ranking in the Global Health Index fell to 102 out of 117 nations, the lowest among South Asian countries, far behind other BRICS nations.

Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%), while 21% of children under five years are wasted, as per National Family Health Survey (NFHS-4), 2015-16. Although the burden of child malnutrition has declined in India since 1990, it remains the predominant risk factor for health loss among children below 5 years of age.

A child’s right to adequate food and freedom from hunger is intrinsically and indivisibly related to his right to clean water, health and adequate standard of living. The child is dependent on his caregiver to realize the right, who in turn depends on several financial, physical, socio-cultural factors and their own level of awareness and education about child nutrition. This right must be guaranteed and implemented efficiently at ground level as an entitlement, not as charity.

                              (Image Source: Akshaya Patra Foundation)

The realisation of children’s right to food calls for urgent attention of all stakeholders to adopt a holistic child-centric approach. Identifying high-burden pockets for implementing effective nutrition promotion programs and addressing all social determinants including women empowerment in underserved and marginalized communities must be integrated into the intervention package. Given the magnitude of the issue, the judiciary’s guidelines and proactive role is vital along with creation of Human Rights Courts, a more proactive National Human Rights Commission, and civil society vigilance.

International human rights instruments place a binding obligation on nations to respect, protect and fulfill the right to food; observe policies of non-discrimination; and progressively realize children’s right to adequate food. The International Covenant on Economic, Social, and Cultural Rights similarly recognizes “the fundamental right of everyone to be free from hunger” (Article 11) holding countries responsible to ensure that everyone, including children, has access to food to meet their basic nutritional needs. Convention on the Rights of the Child, 1989 (Article 24, CRC) specifically requires states to recognize children’s right to enjoy “the highest attainable standard of health” and to undertake appropriate measures “to combat disease and malnutrition” to provide adequate nutritious foods, clean drinking water, and health care.

Justiciability of the right to food at national level largely depends on a robust judiciary. In Keshavananda Bharati–versus–State of Kerala, the Supreme Court (SC) declared freedom from hunger as a fundamental right. Right to Food is a part of the right to life guaranteed under Article 21 of the Constitution. It is enforceable and is a part of the basic structure (State of Maharashtra–versus–Chandrabhan). State is also duty bound to raise the level of nutrition and the standard of living and to improve public health, under Article 47, Directive Principles of State Policy of the Constitution.

Addressing the urgent need to transform the government’s food policy choices into enforceable rights for the citizens, SC has directed implementation of various schemes to intervene and protect vulnerable groups from starvation. It has passed several orders including for ensuring good health of lactating mothers and street children and appointed Commissioners to investigate and report violations of interim orders. The case ended 17 years later with the NFSA coming into force, without explicitly stating that access to food is a fundamental right.

The NFSA provides for subsidized food and nutritional security, with a human lifecycle approach, guaranteeing access to adequate quantity and quality of affordable food to lead a life with dignity. It targets to provide subsided food grains to approximately two-thirds of India’s population, addressing nutritional needs of children at various stages, i.e. breastfeeding promotion (up to 6 months), Anganwadis (for 6 months to 6 year old children) and age appropriate mid-day meals (for 6 year to 14 year olds). A monitoring and evaluation, grievance redressal mechanism, penalties, reforms, and central funding for public distribution system (PDS), are also included.

Though the NFSA is a step in the right direction, it defines food standards generally, without specifying details of the nutritional levels to be reached. The Act also omits specific criteria for the identification of households eligible for the Public Distribution System (PDS) entitlements. NFSA programs need to be developed based on state-wise indicators, beneficiaries should be selected carefully and allow some state-level innovations in implementation.

Other policy initiatives include the Mid-Day Meal Scheme for school children, National Nutrition Mission (NNM) i.e. POSHAN Abhiyaan, and National Nutrition Strategy (NNS). POSHAN sets ambitious targets to combat malnutrition, with the overarching goal to reduce child and maternal malnutrition and NNS further commits to ensure that every child, adolescent girl and woman attains optimal nutritional status - especially those from vulnerable communities. Going by current trends, substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Vision 2022 Kupohoshan Mukt Bharat target.

                                                     (Image source: Wikipedia)

At national policy level, there is a need to effectively address the broader determinants of undernutrition including supplementary nutrition component of Integrated Child Development Scheme, Maternity Benefit Programme, Mid-Day Meal Scheme, dietary diversification to improve iron and folic acid intake (especially for teenage girls), engaging private sector in food fortification efforts and emphasizing on broader social determinants of nutrition like clean water, sanitation and psychosocial health care integrated into the programs.

Policy makers must also be mindful of the new challenges the world faces today - the irony of coexisting child under nutrition and growing prevalence of obesity especially over the last decade, impact of dramatic climate change, environmental degradation effecting soil, water and livestock, which can further widen the existing inequalities and inadequacies in realization of children’s right to adequate food and freedom from hunger.

( Purva Singh, Advocate, has done LLM from University of London, and Dr Sitanshi Sharma is MD (Pediatrics), Research Scientist, Centre for Health Research and Development, New Delhi)