Child Malnourishment is a Preventable Pandemic,

Says CRY
Evidence points to large scale presence of an avertable emergency:
• 96% of the families with malnourished children do not earn basic
minimum wages in UP
• 15,000 children have died between years 2006-09 in MP
• 7 AWCs in Kali Mata Basti considered ‘useless’ by residents in Delhi

April 28, 2011, New Delhi: Shabnam, 25, and Mohammad Afzal, 30, have been living in Kali
Mata Basti in New Delhi for the past six years with their two children, four-and-a-half-year-
old Ruksar and one-year-old Mohammad Gisan. Both children are severely malnourished -
Ruksar weighs 11kgs while her brother Mohammad weighs in at 7kgs. Mohammad Afzal, a
labourer, earns Rs 2,500 a month, and money is scarce for this family of four. Shabnam is
therefore forced to take her children to the local PHC, where the care and treatment leaves
much to be desired. On one occasion she was asked to show the doctors and health workers
her children from ‘a little distance’. “When I take my children to the PHC, they don’t check
them properly nor do they prescribe any medication,” she says.

In Uttar Pradesh’s Azamgarh district, Saifuddin, a field worker with CRY partner ROSA, bribed
a nurse in the District Hospital with Rs 30 to admit Suraj, who was suffering from severe
malnourishment. His twin sister Guddu had recently succumbed to malnourishment, and it was
critical to get Suraj admitted. Unfortunately, the child passed away within the week, as the
medicines prescribed by the doctor were not available in the hospital. The hospital staff also
demanded Rs 800 for a blood transfusion, which Suraj’s father could not afford. In the Bibipur
Gram Panchayat, Tarwa development area, 88 of the 545 children are severely malnourished,
and 32 have died. These deaths could have been easily circumvented with the presence of a
working anganwadi, a health centre and regular food grains from the PDS shops.

Dheeraj Kumar is one-year-and-seven months old, but weighs just 4 kgs. His mother, Sangeeta
Rajak irons clothes for a living, while his father, Ramdas works as a labourer. They belong to
the SC class, and both parents have to work hard to make ends meet for themselves and their
three children. Despite his deteriorating health condition, Dheeraj could not be admitted in
the PHC, as according to norms, only the mother is allowed to stay with the child. Sangeeta
bears the responsibility of two other children at home, as well as that of putting bread on
their plates.

Pappu Lal has a bulging stomach, feeble limbs, is extremely thin, keeps to himself and usually
stays unnaturally quiet for periods of time—displaying both, physical and psychological signs
of severe malnourishment. He is two-and-a-half years old, and lives with his parents
Satyanarayan and Sayaru Devi, in Dhani, Rajmahal village, in Rajasthan’s Tonk district. His
father has spent a whopping Rs 10,000 – an amount he can ill afford - on Pappu’s treatment in
a hospital in Devli for over a year. He was forced to do this as Dhani does not have an
anganwadi centre, and therefore does not have the adequate caregivers who are trained to
identify and treat malnourishment.

Evidence collected by CRY and its partners points to large-scale occurrence of preventable
malnourishment in India, says CRY. As a press conference in Delhi today, cases from Delhi,
Uttar Pradesh, Madhya Pradesh, and Rajasthan provided factual reports on the large gaps in
government’s programmes such as the Integrated Child Development Scheme (ICDS).
More than 40% of children in India are underweight1, 45% are stunted. In all, 49% of the
world’s malnourished children live in India2. Children between 0-6 years constitute 13.12
per cent of India’s total population. In 2008, the country’s infant mortality rate was noted
at 53 per 1000 live births3.The most damaging effects of under-nutrition occur during
pregnancy and the first two years of a child’s life. These damages are irreversible, and is a
leading factor behind India’s high infant mortality and morbidity rates

“With timely investment in terms of resources, staff and planning, these child deaths and
diseases are entirely preventable,” says Yogita Verma Saighal, Director, CRY. The significance
of the ICDS services is evident, yet only 33% children in India have access to it4.

Uttar Pradesh (UP) has a child population of 29,278,2355, with 85% children suffering from
anemia, 41.6% are underweight6, and infant mortality rate (IMR) is amongst the highest in India
(677). While the CRY and Voice of People (VoP) conducted survey of 2,841 8 children in 8
districts in UP in 2010-11 states that 54% children surveyed are malnourished, of which 70%
belong to the schedule caste (SC) while 18% belonged to other caste category (Pasi, Mushahar,
Badi etc.) with other backward caste (OBC) as second highest. “Not only are they financially
crippled but lack access to essential services like portable water, electricity, toilets, health
services, schools, security, and sanitation. According to the survey 96% of the families with
malnourished children do not earn basic minimum wages9,” says Verma. Presently only 70%10
of anganwadi centres (AWC) are in place in comparison to the required strength. While only
50% children get any service under the ICDS11.

Madhya Pradesh (MP) has the highest prevalence of malnourishment among children12 and the
IMR is 72 out of 1,000 children born.

Despite this, only 186 Nutrition Rehabilitation Centers (NRCs) are operational in MP, a highly
insufficient number. “Although the National Nutrition Mission is high on the MP government
agenda this year, with an allocation of Rs 90 crore, but the total budget for children has seen a
decline from 21.7% to 17.56% in the context of child health 13,” says Verma. CRY fellows Javed
and Upasana found 49% children malnourished and 20% severely malnourished in a random
sample survey of 255 children in 11 settlements14 of Bhopal. There is shortfall of 47% anganwadi
centres under the ICDS in MP. In the case of Bhopal as well, only 3 settlements (Shyam Nagar,
1
National Family Health Survey -3 (NFHS-3)
2
WHO, 2010
3
SRS 2008. The SRS (Sample Registration System) is a large-scale demographic survey for providing reliable annual
estimates of birth rate, death rate and other fertility & mortality indicators at the national and sub-national levels.
4
Status of Children in India Inc: HAQ and Centre for Child Rights and FOCUS Report
5
Census 2011
6
National Family Health Survey -3 (NFHS-3)
7
SRS 2008
8
CRY and VoP picked 10% of the 2,841 children as a sample survey to analyse and understand the linkages between the
socio-economic conditions and malnourishment.
9
The basic minimum wage in UP is Rs 120 per day.
10
Only 33 percent of children below 6 years receive any kind of service from an anganwadi centre. Use of services is
greater where AWCs have been in operation for 6 or more years.
11
CRY and VoP ICDS survey conducted in 17 UP districts, covering 421 ICDS centres 2010, found 38% ICDS workers
belong to General and OBC categories, 16% to SC and 5% Muslims. Nutrition is the highest focus of ICDS centres (87%
Centres) and referral is the least (34%). Only 49% centres said that they operate ECDC (pre-school) in their centres. 75%
respondents said that bringing children to the centre is very tough and they need to put in lot of efforts. 38% workers
agreed that they needed to put in their own funds to operate the centres.
12
National Rural Health Mission (NRHM) report 2010, and Sample Registration carried out by the Family & Health
Welfare Dept. of the Government of India.
13
In 2011-12 out of total child budget that is Rs 30456 Crore government has decided to give only Rs 5347.80 Crore for
child health.
14
1. Shyam Nagar, 2. Gautam Nagar, 3. Rajeev Nagar, 4. Rahul Nagar Pampapur, 5. Balbir Nagar, 6. Jhagriya, 7. New
Ambedkar Nagar, 8. Shankar Nagar, 9. Patrapul, 10. Milan Basti, and 11. New Aarif Nagar
Rajiv Nagar and Balvir Nagar) had operational AWCs, while Rahul Nagar and Gautam Nagar had
either no anganwadi or one situated at a distance of 1km. While CRY partner Vikas Samvad
Samiti reports15 that 83% children in 8 villages of Rewa district are malnourished. The alarming
fact is that severely malnourished children are turned away from NRCs and advised to wait for
their turn as since the inception of the NRC in the Community Health Centre in Jawa, it has had
a capacity to accommodate only 10 children (10 beds). In Rewa district, 15,000 children
have died between years 2006-09.

Delhi is considered the melting pot for people migrating to the city for better opportunities.
The capital’s migrant population comprises of almost 20% of the total, and 64% live in
resettlements and slums. In Delhi 33% children are malnourished, 30% are born under-weight,
while 63% are anemic16.

On the basis of a random sample survey held in Kali Mata Basti community in the capital by
CRY’s partner Ahesas, a preliminary observation of the 514 children (under age 6) in the
community found 48 cases of malnourishment and 9 cases of severe malnourishment. The
community comprises of 795 families, primarily migrants from UP, Bihar, Rajasthan, Bengal and
Maharashtra, working as laboureres, construction workers, rickshaw puller, household help,
and ragpickers. The 7 Anganwadis in the community are considered ‘useless’ by residents.
Internal problems plague the centers, including low wages, a lack of infrastructure,
unavailability of space for children to play and educational facilities are missing. “For informal
sector workers who have irregular incomes at level that fall below minimum wages, a working
Anganwadi can be a lifesaver,” says Verma. “The large pockets of poverty that India’s Capital
houses needs its entitlements, the same as everyone else.”

CRY recommends that the government considers this compelling evidence from the ground in
designing a robust, holistic food security Act. Schemes such as the ICDS, which, incidentally, is
among the world's largest child development schemes, must be universalised and a transparent
system instituted to fix accountability. The same goes for employment guarantee schemes,
increased investment and political will is needed to stop the continuous slide into poverty and
destitution that a large number of agriculture and other informal sector workers are facing in
India today. The Public Distribution system too must be universalized and take care of both
food grain needs as well as other nutrition needs.

Delhi is a critical case in point of why the Government must revive the now shelved National
Urban Health Mission. India has made a commitment to reducing under five mortality by two-
thirds by 2015. While the National Rural Health Mission (NRHM) has made some headway in
tackling child mortality in rural areas, the need for a similar programme for the urban poor is
immediate.

15
Cyclone of Malnutrition, 2009
16
NFHS-3