Child malnutrition: Myths and solutions  

  Hunger
  Vol II : issue 6

  Amartya Sen
  Peter Svedberg
  M.S. Swaminathan
  Swadesh Deepak
  
Jayanta Mahapatra
  A.K. Shiva Kumar

  Only in Print

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A.K. Shiva Kumar

One of the most neglected forms of human deprivation is malnutrition, particularly among children. Scientific evidence suggests that compared with the risks facing a well-nourished child, the risk of death from common childhood diseases is doubled for a mildly malnourished child, tripled for a moderately malnourished child, and may be even as high as eight times for a severely malnourished child. How well nourished are India’s children?[1] Many myths surround discussions on child malnutrition.

Myth # 1

Indian children are far better nourished than most African children.

Fact: Not true.

8 Some 47 per cent of India’s children below the age of three years are malnourished (underweight). In Sub-Saharan Africa, the proportion is, on an average, 30 per cent.

8 Thirty out of 37 countries in Sub-Saharan Africa report lower levels of child malnutrition than India.

8 Bihar (54 per cent), Orissa (54 per cent) and Madhya Pradesh (55 per cent) report child malnutrition rates higher than the maximum reported in Sub-Saharan Africa by Angola (51 per cent).

INDIA PHOTOWALLA

Myth #2

India’s low per capita income is a major underlying cause of child malnutrition.

Fact: Not true.

Worldwide, levels of per capita income are not correlated to child malnutrition in any predictable manner.

8 Twenty-eight out of 37 Sub-Saharan African countries have a lower per capita income than India –– and most of them report lower rates of child malnutrition.

8 Outside Sub-Saharan Africa as well, there are countries such as Vietnam, Mongolia and Haiti that report lower levels of income as well as lower levels of child malnutrition than India.

Within India itself:

8 Manipur reported a per capita income of Rs 8,114 (in 1997-98) and a child malnutrition rate of 28 per cent. Gujarat, on the other hand, reported a per capita income of Rs 16,251 and a child malnutrition rate of 45 per cent.

8 Orissa (50 per cent) and Maharashtra (51 per cent) report similar levels of malnutrition, but Maharashtra’s per capita income is almost three times higher than that of Orissa.

8 Kerala and Karnataka report similar levels of per capita income. Yet 27 per cent of children under the age of three are malnourished in Kerala. The figure is 44 per cent in Karnataka.

Myth #3

More than the level of income, it is inequality in the distribution of income that explains the prevalence of high malnutrition rates.

Fact: Not true.

Child malnutrition rates are lower than India’s among many countries that report similar levels of income inequality. Income inequality in Botswana, Mozambique and Cote d’Ivoire in Sub-Saharan Africa, for instance, is similar to India’s (measured by the gini index[2] of income distribution). Yet child malnutrition in these three countries ranges between 24 and 29 per cent, as against 47 per cent in India.

Also, compared to India, child malnutrition is lower among many countries in Sub-Saharan Africa with not only greater income inequality but also lower per capita incomes. Gambia, Mali, Nigeria and Guinea Bissau, for example, report both lower levels of income and greater income inequality, and yet levels of child malnutrition in these countries are lower than in India.

Myth #4

Income poverty is a major underlying cause of malnutrition.

Fact: Not entirely true.

At a national level, the linkages between income poverty and child malnutrition are not obvious. Most countries of Sub-Saharan Africa report higher levels of income poverty than India even though levels of child malnutrition in India are significantly higher than in Sub-Saharan Africa.

Within India, too, the link between poverty levels and child malnutrition is not obvious.

8 In 1993-94, Tamil Nadu and West Bengal reported similar levels of income poverty (35-36 per cent living below the poverty line), and yet in 1998-99, only 37 per cent of Tamil Nadu’s children below three years were malnourished as against 49 per cent in West Bengal.

8 Haryana (35 per cent) and Assam (36 per cent) reported similar levels of child malnutrition despite the fact that in 1993-94, only 25 per cent of Haryana’s population lived below the poverty line as against 41 per cent in Assam.

Myth #5

The use of international growth standards to assess malnutrition is what explains India’s high levels of child malnutrition.

Fact: Not true.

It was argued that biologically and genetically, Indian children do not normally grow as fast or as large as children in other countries. This is simply not true. Extensive studies by the Nutrition Foundation of India have established that global standards of height and weight apply to all Indian children as well. And the growth patterns of Indian children who are well-fed and well looked after are similar to those of adequately nourished children in other parts of the world, no matter where they are born –– in New York, New Delhi or New Zealand.

Myth #6

High levels of malnutrition can be attributed to the non-availability of food.

Fact: Not true.

There is no predictable relationship between levels of malnutrition and food production within a country. India, for instance, has witnessed an impressive expansion in food production over the years, and it has built up a large buffer stock of foodgrains. Yet child malnutrition remains high. The critical element is the way households establish command over food, and how this food is distributed among members within a household.

Myth #7

Indian children are malnourished because families are too poor to feed their children.

Fact: Not true.

At a very young age, between 6-18 months, when most infants begin to experience growth faltering, food availability within the household is usually not the critical factor causing malnutrition. It is very often inadequate knowledge about feeding practices that are in the best interest of the child. The denial of as little as 200-300 calories in a young child’s daily diet is what makes the difference between normal growth and the faltering that starts the descent towards illness and death. We are talking of half a chapati dipped in dal. Equally critical for preventing malnutrition during early infancy is the quality of care and attention that young infants receive when being fed. Infants do not eat by themselves, and feeding them takes time –– a luxury few rural women can afford, and a chore that older siblings can perform satisfactorily.


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A.K. Shiva Kumar, a development economist, is a consultant with UNICEF. He lives in Delhi