India’s gnawing pain
Sitting in the basket of a hanging scale, 20-month-old Deep Kumar epitomizes the silent but monumental crisis gripping this country: The needle stops at 14 pounds.
A healthy child his age ought to weigh nearly twice as much. But very little about Deep is healthy. Whereas a normal toddler would run around, the boy seems to struggle to keep his stunted frame sitting upright. His limbs are pitifully thin, the bones within as fragile as glass.
These are classic signs of severe malnutrition, and they are branded on the wasted bodies of millions of youngsters across India.
Astonishingly, an estimated 40% of all the world’s severely malnourished children younger than 5 live in this country, a dark stain on the record of a nation that touts its high rate of economic growth and fancies itself a rising power.
Soaring food prices and ineffectual government threaten to push that figure even higher. Officials are beginning to wake up to the magnitude of the emergency, as experts warn of grave consequences for the future of India’s economic boom if the state fails to improve the well-being of its youngest citizens.
Already, the proportion of malnourished children is several times greater than in China, Asia’s other developing giant, and double the rate found in most countries of sub-Saharan Africa.
“This is a stunning fact,” said Abhijit Banerjee, a professor of economics at the Massachusetts Institute of Technology who has studied the problem.
To its credit, India has in the last several decades succeeded in warding off the specter of famine that regularly haunted the subcontinent well into the 20th century. As a result of better farming techniques and food-security policies, mass starvation is no longer the dread concern it once was.
But that achievement, as well as the recent euphoria over India’s rapid economic expansion, has obscured the government’s failure to help provide its people, particularly the young, with the nutrients needed to build healthy, productive lives.
Many officials were shocked when a 2005-06 government study revealed hardly any progress in reducing child malnutrition over the last decade and a half -- exactly when the Indian economy was exploding and attracting international attention.
“This has not been a policy priority for this country for the last 40 years,” said Victor M. Aguayo, chief of child nutrition and development at the United Nations Children’s Fund office in New Delhi. “There was an underlying assumption that as soon as economic growth takes place, this will vanish. So let’s focus on economic growth; let’s focus on getting rich.”
Instead, India’s performance in combating child malnutrition has been worse than that of other countries with similar economic conditions. Close to half of all young children in India -- or a staggering 60 million -- are malnourished. Only Bangladesh and Nepal have a higher percentage of underweight children.
In a speech last year, Indian Prime Minister Manmohan Singh acknowledged the gravity of the situation, calling it a “national shame.”
“We cannot deny that it is a crisis,” said Loveleen Kacker, a senior official at the central Ministry for Women and Child Development. “Maybe we didn’t treat it like a crisis earlier, which we should have. Then we would have taken corrective steps much earlier than now. And what we’re thinking of doing now we should’ve started 10 years back.”
The World Bank estimates that malnutrition and its negative effects on health and productivity cost India as much as 3% of GDP a year. Beyond the economic fallout is the damage to India’s image and credibility as it tries to assert itself as an important player on the world stage.
“It’s not nice to want to have an international role and then find that you’re having to defend such an indefensible position,” Kacker said.
Just why malnutrition remains such a stubborn problem here is due to a constellation of causes that tend to reinforce and aggravate each other, creating “the perfect storm of risk factors,” as Aguayo put it.
At root is the abject poverty so pervasive in India, where one-third of the population of 1.1 billion squeaks by on less than $1 a day. Another third makes do with $2 a day.
That deprivation can stack the cards against a child before he or she is even born. Too many women here are underweight and undernourished themselves, the major reason why 30% of Indian babies enter the world weighing less than 5 1/2 pounds. Afterward, in the crucial first two years of life, many children are fed sugary water, animal milk, rice and other foods lacking the fat, protein and vitamins necessary for proper physical and mental growth.
“Women too thin and anemic, giving birth to tiny babies, who are poorly fed in the first two years of life: That’s the synopsis of the tragedy,” Aguayo said. “India needs to break this intergenerational cycle of malnutrition.”
That cycle is plainly evident with 20-month-old Deep and his mother, Bachiya Devi, here in the dirt-poor eastern state of Bihar, where the proportion of malnourished children younger than 3 has actually risen, not dropped, in recent years, from 54% to 58%.
Like her son’s, Devi’s arms are stick-thin, the bangles adorning them sliding up and down with no resistance. The sinews of her neck protrude, while her chest seems lost far below the folds of her canary-yellow sari. Her careworn face suggests an age much older than her 45 years.
With a blind husband who is unable to work, Devi depends on her parents to help out with buying food. She reckons that 100 rupees a day would be enough to guarantee two square meals for her husband, herself and the three of their five children who live at home. But from her modest vegetable stall she earns an average of 30 rupees a day, the equivalent of 70 cents.
“There are four or five days a month when the pot doesn’t boil and we go hungry,” Devi said. At home, little Deep, her youngest child and only son, eats one roti, or piece of flatbread, a day, plus some rice and occasionally some vegetables.
“I’m a poor woman,” Devi said.
“What more can I afford?”
As she spoke, her sleeping son twitched fitfully on a bed in a “nutrition rehabilitation center” here in Saraiya sponsored by UNICEF, which in effect provides triage for the worst-hit.
The ward is a study in cheated childhood. Mumta, at 22 months, looks less than half her age; her rib cage can be easily felt beneath her clothes. Muskan, 1 1/2 , lies still under her mother’s watchful gaze, a blue hand towel covering nearly her entire body. Vikas, almost 4 and suffering from cerebral palsy, can barely sit up without help from his gaunt mother, who is 45 and pregnant with her fifth child.
There are flickers of hope. After 10 days of eating nutrient-laden eggs and other foods not available at home, Deep has gained almost a pound and a bit more energy. Other children in the ward also exhibit small signs of improvement.
All the youngsters are so chronically malnourished that they belong to a category known as “severely wasted.” India is home to 8 million such cases needing immediate therapeutic feeding and treatment.
However, the government accepts no foreign food aid and has not imported any of the high-energy, ready-to-eat food packets on the market that can be administered to badly malnourished youngsters to jump-start their recovery, Aguayo said. None of the country’s biotechnology firms -- among the most advanced in the world -- manufactures them, though the cost would probably be only about a dollar a pound.
These triage packets would help the worst-off cases. But if India fails to cut its overall rate of child malnutrition, experts warn, it faces a future dragged down by an underproductive workforce and ballooning numbers of malnourished youngsters.
As Farhat Saiyed, a nutritionist here in Bihar state, put it: “We are entering a dangerous world.”
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Underfed in India
Despite a booming economy, India is one of the nations whose children have low weights for their age:
East Timor: 46%
Note: Data for the period 1996-2005; numbers apply to most recent year available in the period.
Source: World Development Indicators, 2007
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