India Prosperity Creates Paradox; Many Children Are Fat, Even More Are Famished

SOMINI SENGUPTA
NYT, 31 December

NEW DELHI, Dec. 30 — Presenting a confounding portrait of child health in India, new research commissioned by the government finds that despite the economic advances of recent years India’s share of malnourished children remains among the worst in the world.

Paradox being pervasive in this country, the new data on child malnutrition comes even as public health officials confront what they call alarming levels of childhood obesity.

In short, while new money and new foods transform the eating habits of some of India’s youngest citizens, gnawing destitution continues to plague millions of others. Taken together, it is a picture of plenty and want, each producing its own set of afflictions.

Consider the statistics from Delhi, one of the country’s most prosperous states and the seat of the capital. A recent study conducted by the Delhi Diabetes Research Center among schoolchildren ages 10 to 16 found nearly one in five to be either overweight or clinically obese.

At the same time, preliminary figures from the latest National Family Health Survey showed one in three children under the age of 3 to be clinically underweight, the most reliable measure of malnutrition.

Most vexing, especially for the government, is that the preliminary findings of the national survey, conducted in 2005-6, suggest that India’s share of malnourished children seems to have declined only modestly since the last national survey seven years ago.

In Delhi, for instance, the share of underweight children dipped to 33 percent from 35 percent in that period. In perhaps the most damning indictment of the public health system, the share of Delhi children who were fully immunized actually fell to 63 percent from a level of 70 percent.

During that period, the Indian economy soared.

“I just want to assure you, government is very aware,” Montek Singh Ahluwalia, the deputy chairman of the Planning Commission said at a meeting of children’s rights advocates this month. “We must really judge our success in terms of these indicators, not in terms of growth.”

Amartya Sen, the Nobel Prize-winning economist, said bluntly at the same gathering, “Our failure here is very extraordinary.”

The rampant malnutrition occurs even though India has long had a surplus of food grains, and one of the largest child health and nutrition programs in the world. Public health experts say social practice and government neglect are more to blame.

Deprivation starts with mothers: poor women, who are likely to be malnourished to begin with, tend to get insufficient food and rest during pregnancy. They give birth to underweight babies and often cannot produce enough breast milk.

Millions of families, including their babies, survive on little more than rice, wheat and lentils. Poor sanitation, irregular immunization and a lack of access to primary health care can make already fragile children even more prone to falling ill and losing more weight.

The child nutrition program, which is supposed to provide food rations and health counseling to mothers and children, has a checkered record, delivering high-quality meals in some places but dogged elsewhere by charges of corruption and mismanagement.

A government panel this year recommended sweeping changes to the program, including serving cooked food to children and delivering rations at home for pregnant women and babies.

In a rare rebuke, the Supreme Court of India this month ordered the government to expand swiftly the number of nutrition programs in the country. The programs now serve around 46 million children, at least on paper.

The repercussions of child malnutrition, particularly in a country where 40 percent of the people are younger than 18, are obvious and far-reaching. It stunts mental and physical development and makes children additionally susceptible to illness.

The World Bank this year put a price on malnutrition, saying that India lost up to $2.5 billion annually because of reduced productivity.

The government has so far released data from the latest National Family Health Survey for 22 of the country’s 29 states, and it reveals, like most everything else here, a mixed picture. In India’s largest state, Uttar Pradesh in the north, 47 percent of children younger than 3 are clinically underweight. In central Madhya Pradesh, home to many of India’s indigenous tribes, the portion is a staggering 60 percent. In southern Tamil Nadu, the share has steadily dipped over the past decade to 33 percent.

Because not all state information is released, no official figure is available yet on the latest nationwide malnutrition figure.

An independent analysis by Jean Dreze, an economist and advocate for the expansion of the national child nutrition program, estimated that the national malnutrition rate was 42 percent, based on the population-weighted average of the 22 states where figures are available.

That represents a slight decline from seven years ago when nearly 47 percent of children nationwide were found to be underweight.

One morning in a destitute rural district called Barabanki about 300 miles northwest of here, a dozen small children, most of them barefoot, some of them barely clothed, lined up for help at a program known as Integrated Child Development Services.

On this morning, every child received a scoop of dry cereal, a bland mixture of wheat, sugar and soy that is called panjiri in Hindi.

Some brought a plastic bag to hold their gift. Others made a bowl with the dirty end of whatever they wore. They sat on the ground and shoveled the food into their mouths.

Mothers in this village said the dry ration cereal sometimes made their children sick. No cooked food was available at this center. The center was also supposed to dispense vitamin-fortified oil to the villagers, but they said it rarely came.

Child health workers assigned to the centers in Barabanki were infrequent visitors. One parent said she had not seen a health worker in her village in months, since the last distribution of polio vaccine.

Immunization rates in this state are among the lowest anywhere in India. Fewer than one in four children are fully immunized, according to the latest health survey.

An independent survey by Mr. Dreze and his team across six states in India concluded that, like the centers in Barabanki, most of the feeding programs had neither kitchens nor toilets. A third of them were described as being in “poor” or “very poor” shape.

The best ones, the survey found, like those in southern Tamil Nadu state, served a variety of hot, freshly cooked food. Stubborn social divides in some parts of India meant that low-caste children or those from Muslim families were not served at all.

Around the corner from one center in Barabanki, at the home of a toddler named Asma, who is almost 3, was a typical portrait of want.

Asma’s mother, Alia Bano, said she had never had enough breast milk to feed Asma, the youngest of six children. She barely had money to buy milk, and with it, she made a pot of milky tea for the family each morning.

The family’s daily meals consisted of lentils, with rice or whole wheat bread, and sometimes a vegetable. Fruit was too expensive. Asma’s mother could not recall when she last bought meat or eggs. The family lived off the earnings of Asma’s father, a day laborer. They owned no land.

Asma waddled with a distended belly, a hallmark of malnutrition. Her mother said she frequently suffered from diarrhea and fever.

A portrait of India’s afflictions of plenty is almost equally commonplace.

Here in the nation’s capital, on a Saturday afternoon several months ago a teenager named Mansi Arya sat in a nutritionist’s clinic, recalling just how much she had eaten during her last round of school examinations.

She would come home from class, persuade her mother to fry spiced bread known as parathas or open a packet of namkeen, the deep-fried spicy snacks that are the Indian equivalent of potato chips. She would plunk down with her books and study until dinner, eat and return to the books.

At school, the canteen served all manner of hot fried delicacies, all of which Mansi ate with abandon. At birthday parties, there was the usual array of junk food and cakes. That year, when she was in the 10th grade, Mansi said she had gained close to 22 pounds.

For nearly five months, with the help of nutrition counseling, Mansi dropped pounds. She gave up junk food. Her mother kept fruit on the dinner table. Her parents bought her a treadmill. The family gave up eating white bread and switched to healthful grains.

Then, a few months ago, she entered the crunch of college entrance exams, the most serious in an Indian youngster’s life.

Mansi confessed last week that her discipline had melted in the face of stress. She said she craves chocolates and spiced potato cutlets. She said she couldn’t remember when she was last on that treadmill.

“With this tight schedule and so much of stress, I don’t like all that diet food,” she said. “I feel hungry when I eat that diet food, and I can’t study when I’m hungry.”

A continuing study among Delhi teenagers by Anoop Misra, a doctor at the privately run Fortis Hospital here, found that the ranks of the obese had jumped sharply in the last two years alone, from 16 percent to nearly 29 percent.

Mansi, now 16, swears she will get back on the diet after her exams next March. She says she wants to look good when she starts college next year.