Khaali is a word often heard when women of Koppal, Raichur and Ballari districts talk about their children. The word, which translates to ‘nothingness’ or ‘empty’ in Kannada, is used to describe an abortion or the death of an infant. A majority of women in this region have lived through this situation. They don’t forget to mention the deceased child even during a casual talk about their maternal life, though it is invariably a conversation devoid of emotion.
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At the heart of most of these cases of abortion, maternal mortality or infant death is Karnataka’s dark secret: In some parts of the state, malnutrition is worse than in sub-Saharan Africa.
While 45% of pregnant women in the state are anaemic, the numbers are still high in the Hyderabad-Karnataka region, with Raichur topping the list at 73%. Pregnant women with haemoglobin levels below 11 g/dl are considered anaemic. Naturally, their children are born undernourished.
Karnataka scores the worst in South India on various parameters related to nutrition, shows National Family Health Survey 2016.
A 2018 report by the Centre for Policy Research, New Delhi, which compiled country-wide data, shows that 26% of Integrated Child Development Services (ICDS) beneficiaries in the state are malnourished. Despite higher spending between 2015 and 2017, the state ranks fourth in malnutrition levels, only behind Maharashtra, Bihar and Assam, and is at par with Uttar Pradesh. ICDS, a central government programme launched in 1975, aims to address the nutritional and early-learning needs of children under six years, and pregnant and lactating women.
A visit to the state’s rural areas clearly shows that the nutrition interventions for women and children under the ICDS have failed to make a positive impact. Even worse, the state government is yet to utilise the funds released in the last two years under the Union government’s nutrition scheme, Poshan Abhiyaan.
No trust in schemes
“We have lost trust in government schemes. Every other year, a new programme is introduced and a huge amount is allocated for the purpose. Why are we leading a miserable life despite so many nutrition programmes? Why do we have to spend sleepless nights worrying about the high possibility of stillbirth, or giving birth to an undernourished baby?” asked Muttamma, a social worker in Hospet taluk of Ballari.
She was married at 18. “I was five months pregnant when I came to know about my pregnancy,” she said. Like many other women in the locality, she was anaemic with a haemoglobin count of 7 in the first trimester. A few months after the first child birth, she was pregnant again.
“My kid was underweight and I knew I couldn’t tolerate a difficult pregnancy again. We opted for abortion. I wouldn’t have had to endure this situation had I known about the reproductive cycle and if I had access to good food as a teenager,” she said. She still struggles to improve the health of her two-and-a-half-year-old kid while dealing with her health complications.
On an average, the haemoglobin levels of pregnant women in North Karnataka districts range from 6 to 9 g/dl, according to ASHA (Accredited Social Health Activist) workers.
Perpetual poverty has made earning a single meal a day a challenge for many families; children, like elders, resort to snuffing tobacco powder to satiate their hunger.
While the poor in Hyderabad-Karnataka districts fight malnutrition due to the lack of access to the right food, the first findings of a pilot study by Azim Premji University in Anekal taluk in Bengaluru Urban district indicates that in urban areas, nutritional transition and lifestyle changes have an adverse impact. As per government data, Bengaluru Urban ranks fifth in the category of children with stunting and ninth in the category of wasting.
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Eight years after the state witnessed the death of children due to malnourishment in Raichur district, which eventually led to the formation of Justice N K Patil
committee, the situation has not changed much.
“The high levels of malnutrition that persist in North Karnataka reflect the administrative apathy towards the situation,” said Justice N K Patil, who headed the committee that submitted an exhaustive list of recommendations to the government in 2012, to end malnutrition.
The State Department of Women and Child Welfare report prepared in April 2019 shows that Bidar is at the bottom of the nutrition chart with 30 out of 100 children suffering from malnourishment, and Koppal follows closely with a malnutrition rate of 29.71%. The number could be much more as this data considered only ICDS beneficiaries.
Developmental delay
Koppal is also among the districts with high numbers of specially-abled people. “If we don’t address malnourishment immediately and effectively, it leads to developmental delay, which in turn results in disabilities,” said B Hampanna, assistant director of Samhuha, a nonprofit organisation that works with specially-abled children.
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Most of the government programmes may be noble in their intent but have a faulty design and poor implementation. Senior bureaucrats, who wished to remain anonymous, said that malnutrition is often misunderstood as hunger, even by lawmakers. While satiating hunger is a short-term goal, meeting the nutrition needs will go a long way in shaping a healthy and prosperous future for children.
“The nutrition schemes, be it the food served at the anganwadis or meals to pregnant and lactating mothers under the Mathru Poorna scheme, offer a uniform diet and lack variety. A person in Kalaburagi would prefer to have jowar instead of rice. Policymakers should develop a personalised nutrition chart factoring in that particular region’s food habits,” reasoned Dr Asha Benakappa, former director, Indira Gandhi Institute of Child Health in Bengaluru.
She also expressed concern about various programmes not reaching the needy due to poor planning, implementation and monitoring. “Our early-intervention programmes begin too late,” she said.
Multiple challenges
Malnourishment is not a linear issue. While it has several consequences, various factors contribute to malnourishment, Dr Padmini, a Bengaluru-based nutrition expert, told DH. She explained how the right nutrition during the first thousand days of the child – from the day of conception to the child’s second birthday – are crucial for the child to grow healthier. She also stressed on the need for capacity building of teenagers by creating awareness about reproductive cycle and by providing nutritious food, proper counselling and skill development.
However, teenagers in the Hyderabad-Karnataka region feel that they are a neglected lot. “A year ago, the government used to distribute provisions to us. All of a sudden it was stopped. We were told that a certain amount will be credited to our account but nothing has come through,” said sisters Sunitha and Anitha in Ballari district. “And what does the government have for children like us who are forced to work as migrant labourers in sugar cane fields?” they ask.
Raghavendra Bhat, regional coordinator, GOK-UNICEF Child Protection Project, Koppal feels that migration, early marriage and the shift from subsistence farming to market-driven cultivation have aggravated the situation.
Poor sanitation, lack of hygiene and unsafe drinking water are important but neglected aspects while tackling malnutrition. North Karnataka districts fare badly in these parameters. Take the example of P K Halli in Ballari district. Only 20 families of the over 200 families in village’s Dalit colony have access to toilets.
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Water supplied to the village is visibly contaminated. “We filter thrice using cloth before using it for drinking and cooking purposes,” said Rudramma, a resident.
Brownish sediment had formed at the bottom of the vessel in which this ‘filtered’ water was collected. She knows that this is a clear cause for the recurring diarrhoea among children in the village.
And 10 of the 11 anganwadis DH visited in this region didn’t have toilet facilities. Infrastructure facilities including learning aids were absent in most of these anganwadis.
According to the department sources, more than 45% of the anganwadis in the state don’t have their own buildings.
Hemalatha P, secretary, Department of Women and Child Development, said, “We intend to construct buildings for anganwadis and improve hygiene conditions in convergence with other departments. The scheme for adolescent girls, which addresses nutrition needs and skill development of the girls, will soon be implemented in full vigour, in a meaningful way.”
The department also intends to strengthen the village bal vikas samiti and sanitation & nutrition committee to enable them to monitor the nutrition and sanitation programmes and to ensure no malpractice.
“There have been special efforts to improve the nutrition levels in the Hyderabad-Karnataka region. And the Comprehensive National Nutrition Survey data released recently has shown that we have improved when compared with the NHFS-4 data,” she said.
Chronic hunger
Nutrition expert and activist Dr Maya Mascarenhas, who was a member of the Justice NK Patil committee, feels that now the focus is on collecting data and not on action. She adds, “In our efforts to improve the condition of severely malnourished children, we are neglecting moderately malnourished kids who in turn slip into the danger zone. Appropriate care for both these groups is required to achieve the nutrition goal,” she said.
“You need to see the chronic hunger in these parts of the state to believe it,” said Bhagya a social worker from Hospet who specialises in women empowerment.
“If people have access to a variety of grains and pulses through the public distribution system, even if it comes at an affordable cost, that would help improve nutrition. They now get only polished rice and a kg of tur dal,” Sharada Gopal, who works in the villages of Dharwad and Belagavi districts, said.
In a positive move, some of the organisations are promoting the concept of kitchen garden as a way to improve the nutrition levels of the families. “While it’s important we give special attention to the most vulnerable, we won’t be able to break the cycle of malnutrition unless we address the issue holistically,” said Bhagya.
Nutrition is central to achieving sustainable development goals (SDG), and it’s rightly mentioned in SDG2, which aims to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture.”
“Nutrition plays a transformational role in our country in improving health and ending poverty. Teach people fishing instead of giving them fish,” said B L Patil, an advocate and social activist in Belagavi.
He is still waiting for the final verdict on the writ petition he had filed in the High Court in 2012 on nutrition, based on which Justice N K Patil committee was formed.
A holistic approach that facilitates formulation of region-specific, community-centred and tailor-made intervention will help families, not just individuals, achieve nutrition sufficiency.