India - Malnutrition in Children Worsens : National Family Health Survey / Indian Express / Gauri Ghosh
Malnutrition in kids worsens in key states 2015-19
ByUdit Misra Nushaiba Iqbal
indianexpress.com
3 min
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Child wasting reflects acute undernutrition and refers to children having low weight for their height. India has always had a high level of child wasting but instead of reducing it, several states such as Telangana, Kerala, Bihar, and Assam as well as the UT of J&K have witnessed an increase.Child wasting reflects acute undernutrition and refers to children having low weight for their height. India has always had a high level of child wasting but instead of reducing it, several states such as Telangana, Kerala, Bihar, and Assam as well as the UT of J&K have witnessed an increase. (File)
Several states across the country have reversed course and recorded worsening levels of child malnutrition despite dramatic improvements in sanitation and better access to fuel and drinking water.
This is one of the startling revelations in the first-phase data of the National Family Health Survey (NFHS) 2019-20 — released by the Union Ministry of Health and Family Welfare on December 12 — and marks a shift since the last NFHS in 2015-16.
The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five Union Territories (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic. Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.
https://images.indianexpress.com/2020/08/1x1.png
Data from the first phase shows that several states have either witnessed meagre improvements or sustained reversals on child (under 5 years of age) malnutrition parameters such as child stunting; child wasting; share of children underweight and child mortality rate.
These four are key metrics and their data are used in several global indices such as the Global Hunger Index.
Child wasting reflects acute undernutrition and refers to children having low weight for their height. India has always had a high level of child wasting but instead of reducing it, several states such as Telangana, Kerala, Bihar, and Assam as well as the UT of J&K have witnessed an increase.
Others like Maharashtra and West Bengal have been stagnant on this.
When it comes to the proportion of underweight children, again, several big states, Gujarat, Maharashtra, West Bengal, Telangana, Assam and Kerala, have seen an increase.
But the most surprising reversals have happened in child stunting, which reflects chronic undernutrition, and refers to the percentage of children who have low height for their age.
Stunting, more than any other factor, is likely to have long-lasting adverse effects on the cognitive and physical development of a child.
Telangana, Gujarat, Kerala, Maharashtra, and West Bengal — all saw increased levels of child stunting.
According to Purnima Menon, a senior research fellow at the International Food Policy Research Institute, the reversals in child stunting are “hugely troubling”.
“One has not seen stunting increases in most of the world,” she said. “Normally, we do not see stunting levels increasing because all the things that affect child growth tend to improve as stable democracies and economies move ahead.”
Infant Mortality Rate — that is, the number of deaths per 1000 live births for children under the age of 1 — and Under 5 Mortality Rate data, too, is mostly stagnant.
Aashish Gupta, a researcher affiliated with the University of Pennsylvania, said that between NFHS-3 (2005-05) and 4 (2015-16), there was progress on mortality reduction.
“Under 5 mortality was observed to be 74 deaths per 1,000 births in NFHS-3, and 50 deaths per 1,000 births in NFHS-4, a decline of about 33% over 10 years. NFHS-5 and NFHS-4 are about five years apart, but we are seeing very little progress in many states. In Maharashtra, the under-5 mortality rate is basically the same in NFHS-4 and 5, and in Bihar, it reduced by just 3% over five years,” he said.
Menon said that over 60 per cent of child mortality is explained by poor nutrition. In other words, child malnutrition is the central problem.
The NFHS-5 data captures data during the first five years of the Modi government. Menon said that researchers would have to look at more granular data to arrive at why such reversals have happened. There are several factors at play. For instance, if income levels decline, it can worsen malnutrition.
According to the Ministry, the contents of NFHS-5 are similar to NFHS-4 to allow comparisons over time. The NFHS-5, however, includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.
Several states across the country have reversed course and recorded worsening levels of child malnutrition despite dramatic improvements in sanitation and better access to fuel and drinking water.
This is one of the startling revelations in the first-phase data of the National Family Health Survey (NFHS) 2019-20 — released by the Union Ministry of Health and Family Welfare on December 12 — and marks a shift since the last NFHS in 2015-16.
The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five Union Territories (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic. Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.
https://images.indianexpress.com/2020/08/1x1.png
Data from the first phase shows that several states have either witnessed meagre improvements or sustained reversals on child (under 5 years of age) malnutrition parameters such as child stunting; child wasting; share of children underweight and child mortality rate.
These four are key metrics and their data are used in several global indices such as the Global Hunger Index.
Child wasting reflects acute undernutrition and refers to children having low weight for their height. India has always had a high level of child wasting but instead of reducing it, several states such as Telangana, Kerala, Bihar, and Assam as well as the UT of J&K have witnessed an increase.
Others like Maharashtra and West Bengal have been stagnant on this.
When it comes to the proportion of underweight children, again, several big states, Gujarat, Maharashtra, West Bengal, Telangana, Assam and Kerala, have seen an increase.
But the most surprising reversals have happened in child stunting, which reflects chronic undernutrition, and refers to the percentage of children who have low height for their age.
Stunting, more than any other factor, is likely to have long-lasting adverse effects on the cognitive and physical development of a child.
Telangana, Gujarat, Kerala, Maharashtra, and West Bengal — all saw increased levels of child stunting.
According to Purnima Menon, a senior research fellow at the International Food Policy Research Institute, the reversals in child stunting are “hugely troubling”.
“One has not seen stunting increases in most of the world,” she said. “Normally, we do not see stunting levels increasing because all the things that affect child growth tend to improve as stable democracies and economies move ahead.”
Infant Mortality Rate — that is, the number of deaths per 1000 live births for children under the age of 1 — and Under 5 Mortality Rate data, too, is mostly stagnant.
Aashish Gupta, a researcher affiliated with the University of Pennsylvania, said that between NFHS-3 (2005-05) and 4 (2015-16), there was progress on mortality reduction.
“Under 5 mortality was observed to be 74 deaths per 1,000 births in NFHS-3, and 50 deaths per 1,000 births in NFHS-4, a decline of about 33% over 10 years. NFHS-5 and NFHS-4 are about five years apart, but we are seeing very little progress in many states. In Maharashtra, the under-5 mortality rate is basically the same in NFHS-4 and 5, and in Bihar, it reduced by just 3% over five years,” he said.
Menon said that over 60 per cent of child mortality is explained by poor nutrition. In other words, child malnutrition is the central problem.
The NFHS-5 data captures data during the first five years of the Modi government. Menon said that researchers would have to look at more granular data to arrive at why such reversals have happened. There are several factors at play. For instance, if income levels decline, it can worsen malnutrition.
According to the Ministry, the contents of NFHS-5 are similar to NFHS-4 to allow comparisons over time. The NFHS-5, however, includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.
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ReplyDeleteFrom Agop Kayayan
ReplyDeleteSteve,
I studied agriculture for my first university degree. The main reason: I wanted, at 18, to produce food for the poor people of India. I had read about famines in India.
I graduated from the school of agriculture and never practiced.
I am glad you are bringing up thr issue of UNICEF India not being well aware of the situation. Someone has to bring up these issues. I am glad you are. I hope they hear your voice.
Best regards, Agop Kayayan
Sent from Mail for Windows 10
Agop Kayayan
From Steve Umemoto
DeleteI wonder, what is the perspective among those of the x-unicef community with india experience ... of UNICEF's current role in the country. I personally have a feeling that the organization in its largest programme country, has over the years and decades swung between high relevance and marginal relevance; between active and assertive advocacy and a rather diplomatic "don't ruffle any feathers" posture; and between creative programming including support of innovation among civil society groups (NGOs) and comfortable supporting whatever the GOI seems to want. However, I must admit that these feelings on my part are based at best on very fragmentary information, and nothing in the way of real research and fact based analysis. Steve
UNICEF India does not yet seem to have internalized these findings. The website says on the subject of child nutrition:
ReplyDelete"India is making good progress but there is a need for national leadership to accelerate already successful efforts to end stunting and other forms of undernutrition across India."
Thanks Stephen for drawing attention to UNICEF's website.
DeleteNot only this, but in an article published by UNICEF just last week in mainstream media, it goes all out to rejoice the 'progress on nutrition' that India has made and regales on the success of the nutrition scheme (POSHAN Abhiyan) that was launched by the country's current prime minister in 2017. I am wondering if UNICEF is aware that only 30 percent of the 1.2 billion USD that was allocated for 3 years to the programme (50% is a loan from WB), have been spent (as per a report published in 2019).
A significant portion of the WB funds were to be used for monitoring, tracking and recording the delivery of services to children and mothers across all the central govt run early childhood centres (anganwadis, AWs) touted as the world's biggest nutrition system for pregnant mothers and children. With support from the Bill and Melinda Gates Foundation, a massive nutrition monitoring portal had been developed - the ICDS-CAS, an innovative web and mobile phone based application to ensure swift tracking, effective implementation and smart programme management. It had uploaded data of all the 700,000 AWs of the country. No guesses who the Indian service provider is, a mobile and media technology company that enjoys a privileged position in the country and has grown in leaps and bounds in the last 3-4 years.
The server was being hosted by the BMGF and its US collaborator. Once the ICDS-CAS got off to a great start, the Indian govt insisted that the portal be transferred to India, to an Indian service provider. In principle this sounds like a sensible step - towards transfer of technology and management of the portal nationally. However, eversince the transfer, there have been endless snags that developed and the portal has been down now for sometime!
At a time when the need to intensify efforts to identify mothers and children in need of nutritional interventions is greatest, not only because of the ongoing high rates of stunting and malnutrition in the country but due to the COVID related aggravation of poverty and hunger, the collapse of the ICDS-CAS, the mainstay of POSHAN Abhiyan, has been a huge setback as real time monitoring of the situation is not possible any more. The delivery of nutrition services to all children as also targeted nutritional supplies for the most needy have been brought to a halt or slowed down hugely, due to the lack of the online data based on which the food supplies are released.
Little wonder that the situation of nutrition is so dire in the country today. There are at least 2-3 articles published every month in mainstream media drawing attention to the worsening situation.
Editor's note: As we cannot include attachments on a comment, this comment will be added with attachment as a separate article on our website.
ReplyDeleteDear all,
Reading with surprise the increases in stunting in some Indian states despite real advances in decreasing Open Defecation. Surprise, becasue it has been theorized that children growing up in Open Defecation Free communities have a much better chance of not being stunted (26% according to a 2015 study in Mali)- https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00144-8/fulltext, and environmental enteropathies, casued by fecal contamination, have always been seen as one of the main causes of long-term malnutrition and therefore stunting...oh, oh, we might have to revise our theories.
I am attaching a presentation which has often been used to demonstrate the importance of sanitation, making emphasis on its impact on malnutrition...we need to dig further into this, I think. Slide 4 below is of special importance:
Inline image
Season's Greetings to all of you,
Susana Sandoz
ex WASH officer, manager and chief.
"Remember that when you leave this earth, you can take with you nothing that you have received - only what you have given."
Dear Susana,
DeleteThe comments of Anjana and you are very valuable . When the great sanitation programme was launched as Swachch Bharat by the current PM , I kept on insisting on the priority of Hygiene education and implement ion of the hardware as per the created demand but they juggernauted the programme with a WB person as the head ! Then I tried to advise them on the impact evaluation and there was none . No involvement of grassroot NGOs as the current government does not trust them . So we have a clear case where the country is claiming a huge success in stopping open defamation but it is not the case. Besides mere stopping open defamation if not a total sanitation achievement unless hygiene Knowledge and practice is improved . Without the complete WASH you will not get the end result .
In India the programmes spend more on publicity than in its substance and UNICEF India is a conniving party to this approach. UNICEF and their staff are kowtowing the lines of government and stopped doing independent analysis .
The entire Clean India movement isn’t a big hoax and implemented to provide contracts to petty as well as big suppliers and contractors only .
Gujarat is a state which is trumpeting it’s development model but where steadily the malnutrition is increasing since the current Indian Prime Minister was the Chief Minister there . I personally pointed the same to him long before he became the PM but with no result excepting in organising industrial jumbories like Garvi Gujarat !
Gourisankar Ghosh
Dear Gourisankar,
DeleteIn your statement "The entire Clean India movement isn’t a big hoax and implemented to provide contracts to petty as well as big suppliers and contractors only", I think you actually meant "The entire Clean India movement is a big hoax...." You also said " the programmes spend more on publicity than in its substance and UNICEF India is a conniving party to this approach. UNICEF and their staff are kowtowing the lines of government.." and I fully agree with you (having worked in UNICEF India country office from 1983-1990). I hope that the present UNICEF ICO Rep and especially the WASH staff are listening to you.
Best regards and greeting to all for the festive season. Stay safe everyone.
Yes Peter ! Thanks for correcting the typo ! I may share a fact . The sanitation programme was launched first time in India by the then PM Sri Rajiv Gandhi in 1985 . Then UNICEF India did an independent evaluation after I took over that programme in 1986 in the government and found that 70% of the constructed toilets were not in use or used for something else ! There were also corruption in the approach of construction by contractors ! I presented the findings to the then PM and with his approval was able to stop the implementation and reevaluate the programme . No ego was involved .
DeleteAfter that successful model was established by UNICEF in Midnapur District in West Bengal particularly by Benoy Das of UNICEF Calcutta . Ramakrishna Mission Rural Development programme was involved as NGO and linked the hygiene education as part of literacy campaign . Ladies and youth clubs were partners . It was a success with more than 2 million people having access to knowledge of sanitation within four years and the impact was visible . The model was successfully used in other districts of Bengal.
The difference of the then UNICEF and of today’s one is clearly visible !
We have number of India UNICEF stalwarts in this group which includes Tom ,Steve , Alan among others who honestly but diplomatically could tell the government when things went wrong . Today we have cheque writers !
Wish you and friends a very joyous festive session !
Gouri
India is not making any progress in getting rid of malnutrition. This is the usual UNICEF rhetoric in not annoying the government by speaking anything against it or its orogrammes. I did it for 20 odd years in UNICEF. Doing the doable and handholding the government at all stages.
ReplyDeleteI have been working in the slums of Govindpuri for the last four under a hare brained scheme of the AAP government. The scheme is a non starter but I have been working with a total free hand because they don't really care about the scheme!
What I have seen is listed in an article which I hope will get published. But let me give a few examples.
1. The nutrition for children in Delhi Anganwadis comes from a cooked meal and a snack delivered to the AW every morning.
2. There are take away dry panjiri ration for PW and lactating mothers.
3. The mother's can collect food for under 3's from the AW.
4. The cooking is outsourced to an NGO which delivers food according to a set menu. The food comes at 9 a.m. and the children are fed at 12 noon. By then the food has congealed into a hard mass.
5. The snack on most days is a dry chana snack.
6. The Anganwadis do not have running water facility. No attached toilets.
7. They have no plates and katoris, spoons.
8. They have no new daris for the last 6 years. There is no place for any furniture.
9. There are no weighing scales to measure weight. Out of the 29 Anganwadis, 5 of them had some old weighing scales.
10. Yet they all report everything.
11. So what is the use of any monitoring system when what is needed is improvement at literally the dari level?
12. The AAP government gave smart phones to all workers to report data. They were writing false data. Now they punch in false data.
13. The Anganwadis don't have anything. No toys, no books, no colouring materials, no playthings, no daris, no plates and spoons , no nothing. Then what are they monitoring?
Let's look at rural Anganwadis. I went to Rajasthan on some other work and insisted on seeing Anganwadis. The food they get was so shockingly little that each child will get a half katori of rice and dal. Thats all. When I asked them how is this enough, they said we get so little money. We can't do any better than this.
There are many more things about the Delhi urban Anganwadis. I think we get the general picture that malnutrition is not going anywhere, when it is do happily ensconced in India.
The moment we say this they will come up with some 70 good examples. 70 against 700,000. What a travesty.
GEETA JI,
DeleteYou said it all there is or was to say. Factually put, excellently.
Mentally and " action wise " nutrition related programmes are the hardest
to monitor and maintain. My learning of that comes from 21 months in the field in Goalpara district of Assam in 1975-'76. That was the Special Child Relief
programme with Unicef staff and money thrown-in, in a very big way.
Daly, weekly and monthly monitoring with a driver and a jeep
kept one in the field was a great help. Leave it without supervision it goes
literally "down the drain". IF what you say goes on in the capital city, one can well imagine what goes on in the far off States concerned.
Evaluation ?
We need better human beings who feel for their own ....
Is there any other way ?
i will find out in my next life, please!
Stay safe with warm regards and in Peace dev c in gurugram
Thanks, Gouri for this update -pessimistic as it is. The sentence which forms the third para states that the Clean India movement isn’t a big hoax. I presume you meant to say it IS a big hoax. Please confirm and perhaps elaborate a bit more, if there is anything to elaborate.
ReplyDeleteBest wishes, Richard
I fully agree with the comments and sentiments of Vinod .
ReplyDeleteIt was a bold step by the PM Modi of India when he started the “Swachh Barat or Clean India” program". He is the first PM to address the nation on independence day, bringing in the construction and use of a toilet, avoiding open defecation or open urination at public places, and observing cleanliness. He even included saving girl child, promoting girls education, etc., in his speech from the Red fort. Promoting cleanliness at the highest level is one of the best examples of advocacy and good communication for behaviour change to a large audience like India.
Not using all NGOs is a deliberate move to avoid NGOs with vested interests, and some are sponsored by the international powers to exert a negative influence. We have seen these NGOs in our working environment in various countries while at the field level, especially during the humanitarian crisis.
I think over criticism and declaring the government, and UNICEF India efforts as hoax will not help.
Narinder Sharma
Vice President
Canadian Association of Former International Civil Servants (CAFICS)
I will add my memorable learning. In my work on emergency preparedness and response, I had the privilege of numerous contacts with senior level government officials in India, including being a guest of the India government to review the national and state efforts in a major drought. In one discussion after a major flood, I explored their perception of UNICEF relief assistance and was told -- yes, your water purification tablets and other relief items are useful, but such support is not strategic, and while you contribution is often tens of thousands of dollars, the national relief budget was then 500 million (if my memory serves me correctly), plus state budgets. They told me, you should do in emergency response what UNICEF did in water. I asked what that was. They laid out the facts about the vast expenditure the gov had allocated for water since independence, but acknowledged that many of the efforts were not effective. UNICEF, I was told, brought in a real professional in the field, worked with them in a review of what was not working and helped develop a revision of the national strategy, recognized as a massive and far-reaching contribution. I still view the combination of support for practical local actions as essential but UNICEF's most substantive contributions have often been less visible, more strategic, with substantial humanitarian consequences.
ReplyDeleteEverett Ressler
Dear Gouri,
DeleteThank you for these reflections on sanitation in India.
From 2013 to 2016 I worked as head of the child protection section in Delhi. During that time, the UNICEF WASH section shifted towards tackling open defecation as a deep-rooted social norm that could not be ‘fixed’ with engineering solutions. I was stunned by the complexities of the challenge to end open defecation and inspired by the innovative solutions the WASH and Communications sections developed together with media-savvy agencies and in partnership with a wide range of civil society organizations. https://www.youtube.com/watch?v=3JIkgW4pz_g
Here is an excellent book on the topic of sanitation in India. Diane Coffey and Dean Spears: Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste.
Best regards,
Joachim
Thanks Padmini for highlighting other critical factors leading to the worrying state of malnutrition in India.
ReplyDeleteFor friends who may want to inform themselves on hard facts, putting aside emotions and political bias, the latest Global Hunger Index 2020 ranks India 94 among 107 countries and puts it in the 'serious' hunger category. It is shameful that India features behind Nepal, Pakistan, Bangladesh, Indonesia among others. One would have never imagined that India would one day join with the ranks of countries such as Rwanda, Nigeria, Afghanistan, Liberia, Mozambique, Chad among others. Perhaps some consolation may be drawn from the fact that India is at least just ahead of these countries!!
The link of an article below, highlights how that huge investment in developing a data platform under the POSHAN Abhiyan national nutrition programme is actually now contributing to severe deprivation in terms of food to women and children from the poorest families and how some state governments are trying to undo that. It raises critical questions on the choices being made by the central govt - of grand investments (technology in this case) vis-a-vis intentions to follow-up on implementation, or urgently address snags or the sensitivity to issues on the ground.
https://epaper.thehindu.com/Home/ShareArticle?OrgId=GJC81JA15.1
The article below by researchers at the Swaminathan Foundation highlights how, not technology but convergence and coordination between nutrition and agriculture is the need of the hour, and calls for the need to recognize that nutrition is not just about food but is integral to gender perspectives, health, water and sanitation and above all, social norms.
http://www.zuccess.in/uploads/news/FEBRUARY-2020/1581560850930.pdf
best,
Dear Steve and others,
ReplyDeleteOf course, I follow your discussion with great interest, nutrition and sanitation being issues close to my heart. But I don’t think it is fair to involve the whole xUNICEF group in what is essentially an India discussion. So suggest not copying the mails to the entire group.
Eimi