HEALTH: LET’S START FROM OUR CHILDREN
Human resources of a nation are its biggest capital and when we talk of human resources, we have to lay greater emphasis on moulding our young human resources, children. No nation can progress on any front by neglecting its children. Children are the nation’s future. A sizeable percentage of our population is children and we cannot afford to neglect them at any cost. Women and children constitute the most vulnerable sections of our society and they need the special care of the state. The health and nutrition of children is invariably linked to poverty; in other words, poverty deprives poor children of their right to survival, right to food and nutrition and proper medical care.
Maharashtra is a comparatively progress State and around 160 km from India’s proud financial capital, Mumbai, is Thane district, a predominantly tribal belt with hilly terrain, poor soil, lack of irrigation and rampant unemployment, an ideal home of hundreds of severely malnourished children. As many as 1,100 children in the age-group 0-6 died in Thane district between April 2005 and March 2006. Government denies it, but the region has witnessed chronic malnutrition.
The greatest disease of the region is poverty that spawns anemic mothers-to-be who give birth to underweight children. Many of these children suffer from an irreversible disorder caused by protein deficiency, kwashiorkor. They have no appetite and have to be force-fed. Low-birth weight babies find it difficult to survive. The law age of marriage among tribal women is another cause of concern. The area is covered by India’s ambitious ICDS (Integrated Child Development Scheme), a scheme that looks after both the mother and the child. How can you tackle the malnourished child and its anemic mother, when they don’t have the minimum health to allow medical care to work out in these mere bags of skin and bones? Is just like asking: “if you don’t have bread eat cake!” If you don’t have the means to eat, what kind of medicines will work to save you?
And according to the global report of the United Nations Children’s Fund (UNICEF) released on May 3, 2006, India accounts for 57 million of the world’s 146 million malnourished children. The pity of it is mat India has the same rate of malnutrition as Ethiopia (47 percent) and Nepal and Bangladesh (48 percent). Juxtapose the India picture with that of China and one is appalled at the remarkable headway China has made in tackling malnutrition. The figures for China are a mere 8 percent, Thailand 18 percent and even Afghanistan 39 percent.
At the current rate of progress, the millennium development goal to halve child hunger by 2015 will not be reached.
The proportion of underweight children in developing countries has declined only slightly in the last 15 years, falling just 5 percentage points since 1990. One in children under five in developing countries in underweight (27 percent of 146 million). Nearly half of them live in India, Bangladesh and Pakistan, accounting for the death of 5.6 million children under five every year.
UNICEF says that each 6,00,000 under-5 child death could be averted in India if simple health interventions along with correct feeding practices are universally applied. One out of every three adult women is underweight and therefore at risk of giving birth too low-weight babies. This is simple logic. If the state does not take adequate care of expectant and nursing mothers, the ultimate sufferers would be both the mothers and their children. This shows that rural medical care is still a dream as far as our poor citizens are concerned. There is no purchasing power among the poor village and tribal households. Child ill health and malnutrition can be tackled only through enhanced awareness generation and periodic monitoring of the health and nutritional status of all-members of the household, more particularly the adolescent girls, mothers and children. That this is not happening is reflected in the rising incidence of infant mortality child morbidity and mortality, child malnutrition, maternal malnutrition and maternal mortality.
The entire spectrum of child health and child malnutrition must be viewed from the angle of the total poverty of the entire rural household. And the poor access of millions below the poverty line to nutrition, basic healthcare, nutritious food, cleans, drinking water, sanitation and decent housing. The child cannot be seen in isolation. In other words, child’s health is closely intertwined with our basic antipoverty programmes.
Every August, we celebrate Breast Feeding Weeks educating the community on the various aspects of breast feeding that could save children from mortality and several diseases children are prone to. But if the mother’s health itself is poor, how can we go about propagating the fundamentals of breastfeeding? The health of the mother has a great impact on the infant growth. While most infants in India are initially breastfed, only 37 percent children are exclusively breastfed for four months.
In a country where female feticide and infanticide is still resorted to illegally and where girls are treated as a liability, there is no wonder that severe malnutrition is more frequent among girls (19.1 percent) than boys (16.9 percent).
Malnutrition rates among children of 0-3 years vary considerably across States: Madhya Pradesh (55.10), Bihar (54.4), Orissa (54.4), Uttar Pradesh (51.7), Rajasthan (50.6), Goa (28.6), Manipur (27%) and Kerala (26.9).
Some of the State Governments like Madhya Pradesh have taken various steps in tackling malnutrition. The State has launched Bal Shakti Yojana for treatment and nutritional rehabilitation of severely malnourished children in the State. According to the report of the seventh Bal Sanji vani Abhiyan, conducted from October 15 to November 14, 2005, malnutrition has affected 33.4 lakhs children in 0-5 year age group in the State. The number constitutes 50 percent of the total children in the State, more or less approximate to the percentage given by UNICEF.
About 10,913 children among them come under grade-4 malnutrition category, while 67,352 children come under grade-3. Majority of them come from poor and weaker sections. The scheme, to be jointly implemented by the Public Health Department and the women and Child Development Department, aims at bringing down the number of children with grade-4 and grade-3 malnutrition to one percent. The scheme would provide necessary medical services to children identified as afflicted by grade-4 and grade-3 malnutrition during the Bal Sanjivani Abhiyan conducted by the Women and Child Development Department.
“Families of such children would be educated about importance of nutrition and trained in preparing nutrition-rich food,” say the Government functionaries. But what every State Government is aware of the exploitative conditions of mothers who work daylong at construction sites and elsewhere and who cannot feed themselves or their children? Recently, a private news channel showed a mother of six children working for a mere Rs. 30 as daily wages. Can you lecture to them on nutrition? And such exploited women can be found in several backward States in India.
UNICEF report suggests that half of all children in India under-3 are underweight, a quarter of all children are born with low weight, and three-quarters of under-3 children and half of adult women are anemic. Malnutrition is not only about hunger, but also because of early marriage and consequently of early motherhood and also lack of sanitation. Poor food quality and women’s low social status also contribute to the child’s malnutrition.
How do we come up with this dismal picture of the Indian children? UNICEF suggests improvement in the prenatal and postnatal care, the need to give colostrums, breastfeeding for six months in a row and adequate complementary foods three to five times a day after mat. Besides, children should be brought to health centers for immunization and micronutrient supplementation.
We could go a step further. In that, massive intervention by the state is a must to help families come out of chronic poverty. Poverty means illiteracy, poor food intake, no education, no access to pure water and lack of sanitation, but a large number of children. When poverty stalks, who on earth will think of nutrition? The United Progressive Alliance (UPA) Government has launched several schemes towards providing rural employment and rural health. Are these schemes delivering?