Cures for malnourishment

The ranking of India at 107 out of 121 countries on the Global Hunger Index (GHI) should make us introspect on what we have been doing wrong and how to set the system right. The solution for malnourishment lies in taking deep systemic and institutional measures already prescribed by policy, such as the National Nutrition Policy, laws, such as the National Food Security Act, SC directives on universalisation of ICDS, Law Commission recommendation on making ECCD a fundamental right; expert group recommendations on converting Anganwadis to full day-care centres, infrastructure, manpower, and budget enhancements for ICDS, etc.

But two other issues too need special attention to curb malnourishment: girls dropping out of school and child marriage. Girl dropouts who undergo child marriage are the ones who mostly give birth to underweight babies who are most likely to die before their fifth birthday due to malnourishment. But paradoxically, these under-aged mothers are the ones denied all government benefits—the Rs 5,000 under the Pradhan Mantri Matru Vandhana Yojana, the Rs 1,000 under the Janani Suraksha Yojana, etc.—since they were married before the legal age for marriage. If we do not help these under-aged mothers giving birth to low-weight babies, how will we improve the child’s level of malnutrition?

The whole problem appears to be that we are taking a ‘curative’ and not a ‘preventive’ approach to child marriage. Though hundreds of officials have been designated as Child Marriage Prohibition Officers (CMPOs), they can prevent a marriage only if the child, or someone on her behalf, informs them that she is about to be married. If CMPOs are not notified and her parents proceed with the marriage, the onus of preventing child marriages has been placed on citizens. The wedding invitation printer, the kalyana mantap manager, the priest, the caterer, the photographer, and even the guests are supposed to make sure that the couple is over the legal age for marriage.

How can these people tell if the couple’s age certificates are genuine? Many of these citizens are now “punishable with rigorous imprisonment of not less than one year” for allowing a child marriage. How can the State’s responsibility to enforce a law be imposed on ordinary citizens?

Compulsory licencing of marriage: Compulsory registration of marriage is being put forward as a solution for child marriages. But this does not prevent the marriage. Rather than this, should not the preventive approach be “compulsory licensing” of the marriage by the state before the marriage takes place?

Surprisingly, if an organisation wishes to conduct mass marriages in Karnataka, tahsildars are required to verify the age proofs of the couples and only then accord permission for conducting mass marriages. Why is this procedure of tahsildars issuing licences not extended to cover all marriages? This will be the best “preventive” measure for child marriage.

Preventing drop-outs: Education of the girl child is the cure for malnourishment, as it has been proven that an educated mother’s child is better nourished. But we have no statutory means at the national level of preventing dropouts at the elementary level. At least 50% of the almost 5.5 crore children of compulsory school age who are out of school are girl dropouts. A further hurdle is that the RTE Act makes education only up to age 14 compulsory. If children are allowed to drop out or discontinue their education at 14, it is likely that parents will marry off their girl children before they turn 18 as they fear for the safety of the girl child at home when both parents go to work.

A pioneering initiative of Karnataka, through a suo motu PIL, is the “preventive protocol” introduced into its RTE Rules for retaining children at the compulsory education level. This needs to be upscaled to the entire country. It is also necessary to raise the compulsory schooling age to 18 years in order to keep children, particularly girls, in school while also ensuring their safety.

False focus on technology: But rather than the above structural measures, the main focus of the much-publicised POSHAN Abhiyan, initiated in 2018, is on none of these things but on technological upgradation, the digitisation of data, and the uploading of activities on centralised dashboards.

Anganwadi workers are not even getting minimum wages, and their honoraria are often not released for months, but a lot of money has been spent on buying 11.03 lakh smart phones for them and on apps.

While Anganwadi workers are already overburdened, additional work has been imposed on them to daily collect, collate, and upload data on the smart phones.

Decreased budgets: According to a study by the Accountability Initiative, total allocations for the restructured ICDS, renamed Saksham Anganwadi and POSHAN 2.0, for 2021–22 were lower than the 2020–21 budget estimates for ICDS at Rs 20,532 crore. In 2020–21, required budgets for the Supplementary Nutrition Programme (SNP) at full coverage of the target population were only 41% of the required costs. Per-person SNP costs have not increased since 2017. Only 53% of the allocations made had been released by GoI till 2020- 21 for POSHAN Abhiyaan. Between 2016 and 2021, the number of beneficiaries receiving SNP and Pre-School Education (PSE) has actually fallen by 19%. Stunting and wasting among children under the age of five have increased in at least 12 states and Union Territories (UTs) between NFHS-4 and NFHS-5.

Poor outcomes: In terms of outcomes between NFHS-4 and NFHS-5, stunting, wasting, and underweight prevalence have reduced by not more than 1% per year. At this rate, India may meet the SDG target of reducing stunting in children under the age of five by 50% by 2030 (from 41% in 2012 to 20.5%), but this would still be a high percentage. But India is not on track to meet the SDG target of reducing the number of children under five years with wasting to less than 3% by 2030, according to UNICEF. So, how will we lessen malnourishment without addressing the systemic issues?

(The writer is Executive Trustee of CIVIC-Bangalore and an associate of the Right to Food Campaign.)