Even before the pandemic struck, malnutrition was a silent epidemic in India, particularly among children. But an abrupt lockdown with little preparation, triggered by Covid-19 is threatening a body-blow to decades of slow progress in lowering malnutrition. As routine health outreach services stand disrupted, food-supplies struggle to keep from breaking and income losses loom, the effect on children’s health and their already fragile nutrition status is likely to be devastating.
In pre-pandemic times, the Global Nutrition Report 2020 found that 37.9 per cent of India’s children under five years are stunted, and 20.8 per cent are wasted, a form of malnutrition where children are too thin for their height. These numbers are much higher than in other developing countries, where on an average 25 per cent of children suffer stunting and 8.9 per cent are victims of wasting. These statistics also corroborate an embarrassment India faced last year when it slipped on the Global Hunger Index to occupy rank 102 out of the 117 countries rated. These claims are not completely out of sync with our own National Family Health Surveys that show how between 2005 and 2015, child wasting soared to affect 21 per cent of children under five years from 19.8 per cent and severe wasting (another name for severe acute malnutrition), increased to 7.5 per cent from 6.4 per cent.
Considering these forms of malnutrition have been shown to impede physical and mental growth of children, predisposing them to high risk of acquiring diseases, they should have been cause for great national concern. The Covid crisis may have damaged children’s health for years to come.
What worked in Assam
Our experience of working with district administrations and NGOs in my constituency in Assam shows that simple but innovative solutions go a long way to address nutrition concerns. We helped set up 2,000 school nutrition gardens, where local vegetables are grown, and we worked with communities to create homestead gardens. These gardens with local vegetables can sustain nutritional security of low-income households. Children and teachers were taught the importance of nutrition through customised learning tool kits.
We realised that such small steps to involve children and teachers at schools and families at home helped our communities — including tea-garden workers and the tribal population, who have traditionally been victims of under-nutrition. But sadly, neither has the Narendra Modi government put any mechanism for one state to learn from the other’s experience, nor has it given malnourished children the attention they deserve, leaving a nutrition-insecure issue in the middle of a raging pandemic. And even as coronavirus-led containment measures were announced, the risks of plunging millions of children deeper into severe malnutrition were not weighed.
Now, early warning signs of a looming hunger hazard are here.
Vulnerable children at risk
Based on the analysis of a recent Lancet study, UNICEF is predicting that 3 lakh children could die in India over the next six months as health outreach services are reduced and child wasting increases during the pandemic. Because the nutrition-risk profile of the Indian population was already very fragile, it doesn’t come as a huge shock that the country could end up facing one of the harshest burdens in terms of numbers.
The stresses of the pandemic are weakening an already weak health system. The virus containment measures announced by the Modi government ended up disrupting food security programmes and nutrition delivery for women and children. As schools shut, so did mid-day meal programmes, which remain the primary source of nutrition for millions of children in India. In pockets, where dry ration was distributed, it couldn’t have fully compensated the needs of a child when the entire family was struggling for food. As our health workers — the ASHAs and Anganwadi workers — were given additional responsibilities related to COVID-19, their focus on the nutritional status of children suffered.
Constrained access to clinics, social workers, water, and sanitation under the current situation will adversely impact children. These shocks can push borderline cases into the malnutrition bucket. If that happens, many severely malnourished children could face near-death situation and those suffering from moderate malnutrition could slip into severe malnutrition.
Can’t cut corners for children
As economic activities dwindle, job losses, pay cuts loom, families on the margin are finding themselves short of the financial capacity to source their own food. It is now clear that the virus does not treat us equally. The elderly and men have shown higher susceptibility to Covid-19, so have the socially deprived, and those with co-morbidities. It is now emerging that the aftermath of virus, will be equally discriminating. Vulnerable populations facing socio-economic disadvantage, particularly women and children, are likely to bear the maximum brunt of the repercussion of pandemic-triggered decisions. The UNICEF warns, if urgent action is not taken, a health crisis will snowball into a child-rights crisis.
It’s true a pandemic accelerates decision-making without little thinking for the future. How such decisions pan out was recently visible in the plight of stranded workers, who overnight lost rights and means to go back to their homes. But the health of children is not a space where we can cut corners.
Time is running out
In the post-Covid world, the Modi government should consider our Assam model for wider use. But for now, monitoring India’s changing nutrition risk profile in fast-shifting global reality is essential. Health services to women who are pregnant, lactating, and children have to be prioritised. Coverage of dry-ration distribution should expand because more and more people are likely to need safety-nets. Strengthening our frontline workers by deepening their engagement in communities should be prioritised. Anticipating a rise in severe malnutrition, and other forms of malnutrition, and even hunger in places, preemptive steps should be taken.
From where we stand, return to health will not be easy. But if we fail to act now, raising a fractured and unhealthy generation ahead, will be even more painful and expensive for this young country. All of us should not become part of a grand tragedy that is preventable today but will be irreversible tomorrow.
The author is the Congress Lok Sabha MP from Kaliabor, Assam. Views are personal.