Wednesday, July 11, 2018

Malnutrition: More than just lack of food

A joint study by Assocham and Ernst & Young showed that almost 50% of the worlds under nourished children reside in India.(1) Malnourishment has been called India’s silent emergency and the need to look into this issue has never been this urgent. The cause of alarm is the high rate of infant deaths. Pankaja Munde, Minister, Women and Child Development Department admitted that a total number of 2,161 infant deaths have been recorded in 16 districts of Maharashtra in 2017. Adding to this, in the span of only 5 months, September 2017 – January 2018, a total number of 995 infants between 0 – 6 months have died (2). The numbers are alarming.
Malnutrition at such a high level implies heavy economic costs for India, as it affects a child’s productivity, cognition, reduces participation in school and further ability to contribute to the economy (3). India is one of the fastest growing economies of the world, yet has the highest number of under nourished children. The basic right to a healthy life and to simply live is a fundamental one. The fact that this is snatched away from children and infants due to various structural and social barriers is unacceptable and requires immediate redressal. Although the battle to tackle this issue has been an uphill one with little visible progress, it has been uneven and the structural reasons causing malnourishment remain unaddressed.
A common misconception held by most people about child malnutrition is: food insecurity is the only cause for malnutrition (4), often placing the onus upon the mother or the child for not ‘eating well’. However, the reasons resulting in such high levels of malnutrition are varied and go beyond just the consumption of food. But unfortunately, most interventions are based on providing food rather than addressing other determinants.
The data from the National Family Health Survey (2015 – 16) showed three key factors of difference in districts with high and low levels of child malnutrition. These are: the status of women, diets fed to children and access to toilets (5). Lack of education, health awareness, sanitation and infrastructure form the basis of child under nourishment. It is also important to recognize that malnourishment is very much a gendered issue (6) stemming from the patriarchal set-up of society. The NFHS survey also revealed that malnutrition is higher in girls especially from rural areas and the scheduled castes and tribes are more susceptible to malnutrition.
Malnourishment affects women more than men due to specific nutrition requirements of women during adolescence, pregnancy and lactation. The nutrition deprivation in women perpetuates a cycle of deprivation in children. Under nourished girls grow up to become under nourished women who then give birth to undernourished children. The onus often lies with the woman to provide nutrition for the child, however she is not equipped to do so due to skewed power relations within the family, food distribution practices, lack of economic means and health awareness.
Integrated Child Development Services program, is the government’s flagship program to tackle child malnutrition. It has sustained for over 30 years and has been successful in many ways. However, it has been unsuccessful in reversing the adverse effects of child malnutrition due to the emphasis it lays on food supplementation and distribution.
There are gaping holes in in the implementation of the ICDS policies. There are no consistent mechanisms of identifying children with malnutrition which results in denial of special care and support to Moderately/Severely malnourished children. There is a lack of and poor distribution of appropriate and adequate supplementary nutrition. Often, adequate medical support is not provided at the right time. Moreover, cultural differences of different communities and groups are not taken into consideration by the health officials. It is important to also note the rampant under reporting of malnutrition, due to the misdirected monitoring system which puts the blame completely on the Anganwadi worker for the number of Malnutrition cases, thus absolving the family, community and the medical service providers and institutions of their role in addressing issues related to malnutrition (7).
Interventions on creating awareness around good caring behaviors for infants and children require community and familial engagement and require the training of grass root workers in order to maximize impact. Investments should be redirected towards younger children (between 0 – 3 years), the mother’s feeding and caring behaviors, improving household sanitation and strengthening access to health care. Economic growth cannot alone address these problems. Malnutrition is a social phenomenon which must be addressed by changing mind sets, scaling up of health, nutrition, education and infrastructural interventions.


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Wednesday, April 25, 2018

How long? How often? 
Some questions to assess if legal reform is enough to tackle the culture of violence against women in India

The last few weeks have been traumatic for most of us, with sordid and heart wrenching details surfacing about the Kathua and Unnao rape incidents. The brutality, depravity and brazenness of the perpetrators shook the conscience of the nation. Protest marches have been heldall over the country. After the Prime Minister was criticised from all quarters for not responding conclusively to the public’s angst, the government has briskly introduced an ordinance to award death penalty to those convicted of raping childrenbelow the age of 12.

For those who feel that this is the rightful consummation of public anger, we ask the following questions: The criminal law was amended in 2013 post the Nirbhaya case, again partly owing to public pressure, expanding the understanding of rape and doling out tougher punishment to perpetrators. What is happening with the implementation of these amendments? Why is it that we as citizens have to repeatedly come out onto the streets to question how the systems work; to demand that the cases are filed, the arrests are made? Why can’t the systems run on auto pilot? Both Kathua and Unnao incidents give some insights into why the systems dont work, despite legal reforms. It isbecause they are subservient to those who have influence and clout. When the high and mighty are the perpetrators, the systems are manipulated to deny justice.Even seemingly independent institutions such as the National Commission for Women and the Human Rights Commission maintained a deafening silence on the cases for a long time. This is unnerving considering both these bodies are vested with the power to intervene. Is it because of mere ineptitude or the large scale politicization of these bodies?

Another set of questions to ask isregarding the innumerable cases that are reported in the papers almost on a daily basis, equally heinous and barbaric, that go unnoticed. There may be many more that are not registered or reported for fear of stigma or fear of the system. How many of the cases registered actually go through the complete judicial process? How many cases are withdrawn?How many cases result in acquittals because of lack of evidence or witnesses turning hostile? Although the National Crime Records Bureau (NCRB) reports compilethe statistics, there is no detailed reporting on the same. The conviction rate of rape cases in 2016 according to the NCRB reportwas just 25.5% in 2016. Why was this so? Who is supposed to monitor charge-sheeting and acquittals due to lack of evidence? How do we build accountability of the prosecution and judicial system? These are the questions that we need to ask ourselves.While tougher laws and greater punishment might act as deterrents, its more important to work towards sympathetic responsive systems and effective convictions to address the issue holistically.

Moreover, while it is necessary to raise our voice when an unjust incident happens, it should also serve as apivot for introspection about why it is happening and where we as a country are heading. The Kathua case epitomises the use of rape as a means of violence to terrorise a community into silence for political and economic gains. The main accused Sanji Ram proudly declared the same.We need to highlight and address the issue of aggression against womens bodies as a tool to make political points or, as in the Kathua case, to stress communal superiority or right over land. It is also important to seek solutions to tackle the rape culture in the nation, which exposes even infants to sexual violence, hitting at the more basic mindset and behavioural aspects as well as the patriarchal roots of the issue. What is it that makes a young man rush to a crime site to plead to rape a bruised, battered and drugged 8 year old?

Further, in addition to the gendered aspects of the issue, anothercrucial collectiveintrospection needs to take place regarding why it is becoming so easy to use fear and terror to address social issues in general.Juvenileperpetrators were involved in both the Kathua and Nirbhaya cases (alongwith many other cases of violence including themob lynching incidents over the past few years). What is it that is making our youth so vulnerable to radicalisation, whether right wing or left wing? Why is there such a dearth of conversations, dialogue and critical thinking among the youth? Why are they not developing a sense of respect and empathy?

A lot of the responsibility for the increasing violence and aggression among the youth, and their vulnerability to indoctrination lies with our education system which is now referred to as theeducation business. This factory-model of education is reinforcing unquestioning allegiance to authority, wiping out compassion and integrity. In an education system which workssolely for better results in examinations and material acquisition, which makes children slaves to rote learning, which deprives children of opportunities to play and bond with others, which ignores instilling the right values and ethics, which does not provide space for healthy disagreements and negotiations, we cannot hope to have children who can resist indoctrination. All through their lives they are being indoctrinated - to be mere followers and not leaders.The disintegrating networks of physical neighbourhoods and communities on the one hand, and the increasing influence of reactionary and compartmentalizing social media on the other further compound the problem.

We also need to look at government programmes such as Skill India more critically. The question is: are we creating an environment wherein youth can contribute productively and creatively to society or are we merely facilitating corporates and multinationals to create a vast pool of semi-skilled cheap workforce? While the number of people being skilled is important, the quality, content and long term career development aspects of skilling is much more crucial. Whether it is a shop floor assistant or delivery staff of a major retailer, what opportunities do they have to fulfil their long-term growth needs?How do they deal with the conflict between their rising aspirations and the ground realities?It is time we work towards inclusive  and holistic development programs rather than target based initiatives.

All-in all, public pressure may lead to piecemeal government responses to specific publicized cases. But till the time we ponder about some of the deeper questions as a society, we may continue to go out onto the streets once in a while and get back to our comfort zones; oblivious of the world we are creating - making the vulnerable more vulnerable and the powerful more brazen.

Dr. A. L. Sharada, Director Population First
 Ms. Maggie Paul, Senior Manager, Gender Trainings and Research