Malnutrition: urgent action required

At a time when the world thinks of India as a major economic power in the making, malnutrition still is a major problem which contributes to the poor human development situation in our country. The figures are deeply disturbing: the prevalence of underweight children in India is among the highest in the world, nearly double that of Sub-Saharan Africa. The UN estimates that 2.1 million children die every year before they reach the age of five. Though India has many programs to tackle malnutrition, not much headway has been made in the fight against malnutrition.

IDENTIFYING MALNUTRITION

Malnutrition is identified into two constituents: protein-energy malnutrition (this is widely prevalent in India and other developing countries) and micronutrient deficiencies. Physical findings help in early identification of malnutrition, which is useful in early rehabilitation. Gomez classified protein-energy malnutrition (PEM) into three degrees: Grade 1 which is severe malnutrition (90-100% degree of PEM), Grade 2, moderate malnutrition (75-89% degree of PEM) and Grade 3, mild malnutrition with less than 60% degree of PEM.

Malnutrition is widely prevalent in rural areas, with tribal areas having the poorest nutritional status. We take the figures in Gondia district of Maharashtra, where there are 1, 02,692 children between the ages of zero and six. Of this, 779 are in the severe malnutrition category and 3,411 in the moderate malnutrition category. From April till July this year, 118 infants did not reach the age of one. Of the children between the ages of zero and six, 22% are underweight and roughly 3% are severely underweight. The weaker children are identified by anganwadi workers or Accredited Social Health Activists under the National Rural Health Mission and brought to the Nutritional Rehabilitation Center (NRC). Shockingly, the NRC in Gondia district opened only on August 15 this year.

The situation in nearby Gadchiroli district (with a tribal population of more than 50%) is not much different. Of a total of 93,983 children aged between zero and six, only 63% are of normal weight.

Among the various states of India, Madhya Pradesh, Jharkhand and Bihar have very high rates of under-nutrition. Even states like Mizoram, Sikkim, Manipur, Kerala, Punjab and Goa, where the numbers are lower, the rate of malnutrition is greatly higher than that of developed countries. Further, anemia is found in over 70% of individuals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, Karnataka, Haryana, and Jharkhand.

REASONS FOR HIGH RATE OF MALNUTRITION

People in the far-flung villages were reluctant to bring weak children to the NRC or even seek medical attention, she adds. Poverty was one of the main reasons and the parents mostly worked as agricultural labourers and found it difficult to stay in hospitals and look after their children. In addition to this, scattered population makes access to good health care facilities very difficult. Infants are neglected after birth and do not get proper nutritional supplements. Many villages are in inaccessible areas. Poor nutrition is also reflected at birth with 20 per cent of infants having low birth weight. Malaria and other diseases compound the health situation even more. In addition to this, many anganwadi workers (or Accredited Social Health Activists) do not turn up in many centers. Most growth retardation occurs by the age of two, and most damage is irreversible. The prevalence of underweight in rural areas 50 percent versus 38 percent in urban areas and higher among girls (48.9 percent) than among boys (45.5 percent)

PROGRAMS TO ADDRESS MALNUTRITION

The Government has introduced many programs to tackle malnutrition. The most famous among these are the Integrated Child Development Scheme (ICDS) set up in 1975 and the National Rural Health Mission (NRHM). The ICDS national development program is one of the largest in the world. It reaches more than 34 million children aged 0–6 years and 7 million pregnant and lactating mothers. NRHM, created for the years 2005-2012, seeks to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women, and children. The ICDS’ emphasis on older children has meant that infants under the age of two and pregnant women barely get covered. After the age of 2, growth retardation is irreversible. Thus, this program has failed.

Another program for tackling malnutrition is the Public Distribution System and the Mid-day meal schemes in Indian schools. The Mid-day meal scheme, set up by the Akshaya Patra Foundation, runs the world's largest NGO-run midday meal programme serving freshly cooked meals to over 1.2 million hungry school children in government and government-aided schools in India. This programme is conducted with part subsidies from the government.

Like many government programs, the challenge for all these programs and schemes is how to increase efficiency, impact and coverage. Corruption is also a huge problem.

CONCLUSION

As we have seen, malnutrition is a huge problem in our country, with millions of children dying before they reach the age of six. Malnutrition amounts to a massive human development crisis, where the state is unable to provide the most basic facilities to so many of its people. It is now estimated that India will be unable to meet its Millennium Development Goals of halving malnutrition by 2015. On the contrary, disparities are growing. Even though GDP growth is impressive, malnutrition is decreasing by only a few percentage points. Malnutrition has an effect on productivity: it is estimated that physical impediments caused by malnutrition knock off 3% of GDP. One solution for the problem is fortifying food handed out by the Public Distribution System (PDS) to lower rates of anemia and decrease nutrition. A long term solution, which needs urgent emphasis, is redirecting our energies towards pregnant women and infants under the age of two. Unless we do this on a priority basis, malnutrition will continue to be a huge problem for our country. India has missed a huge window of opportunity; we cannot afford to do so any longer. The future of our children is at stake. We must act now.

FDI in retail

FDI in retail is back in the news. There are reports that the government will allow FDI in multi-brand retail from April 2012. This is a topic which has seen much controversy. Economists have been discussing the issue for years. Strangely enough, this issue also sees the BJP and the Left on the same page. An issue on which the left and the right stand together must be a special one and that certainly is the case.

Before I go into my view on the subject, some background is in order. India permits 100% FDI (Foreign Direct Investment) in certain sectors, like cash and carry, wholesale trading and 51% FDI in single brand retail (high end stores like GUCCI come into this category). FDI in retail has for long been seen as the answer to India’s inflation problem. The Economic Survey 2010-11 noted that “"Permitting FDI in retail in a phased manner beginning with metros and incentivizing the existing retail shops to modernize could help address the concerns of farmers and consumers. FDI in retail may also help bring in technical know-how to set up efficient supply chains which could act as models of development." Numerous companies involved in the sector welcome a move to have FDI in retail. So why the controversy?

India has a number of kirana shops, wholesale shops which form the backbone of the present retail industry in the country. These are generally small businesses (called mom and pop stores in the US) which might not be able to compete if the big companies enter the retail sector. There is a political angle as well: the retail sector contributes 13% of GDP and employs a huge mass of people. Can any government afford to alienate this vote bank, especially in the era of coalition politics with little scope for political ideology?

Before I go into the political angle, it is important to list the reasons why so many people see FDI in retail as a good thing. The Indian food sector is an absolute mess, with around 40% of the food being produced going waste. Thus we have the unsavoury scenes of rats eating grain when millions of our people go to bed hungry. Storage and distribution facilities are non-existent. The Food Corporation of India is unable to store the grain that is produced and leaves stacks of grain in the open, only to be destroyed by rain. Global retailers, with the technical expertise, will help us fix our supply chain and storage problems. Critical food produce will not be wasted and the poor in this country will have access to food, a basic duty of the state.

In addition to this, another benefit of having a smooth transit of produce from farms to shop floors is the elimination of middlemen. Any person with a rudimentary knowledge of Indian agriculture understands how middlemen play havoc with both the farmer and the consumer. FDI in retail will ensure contract farming, which will mean that the farmers will sell their produce directly to the retail chains. They will get the market price for their produce (which can easily be ascertained in today’s internet age) and the consumers will not have to pay through the nose for basic foodgrain.

Another advantage is that global retailers setting up operations in India will have to employ a huge mass of people. This could help address our huge unemployment numbers. It is well known that the present economic model is unsustainable: the over-dependence on services is not feasible in the long term. India needs a seismic change and FDI in retail could help contribute in a small manner to that change. Sure, at some point we will have to look towards more labour intensive sectors like manufacturing, but this can surely be an option in the short term. Furthermore, credit, the bane of every business in India (apart from corruption and red tape) will not be an issue with global retailers coming in.

But what of the wholesale traders, the kirana shops which are dead against this move? Is their survival so important that we ignore all the benefits that FDI in retail will provide? Well, no. The argument that traders need protection from the big retail chains is an argument that belongs to an age gone by. It is evident that even the biggest retailer will not be able to cater to every part of India. This is where wholesale traders come in. They can certainly help the big retailers offer their services in the rural areas of the country. As we have seen, prices will come down as a result of global retailers getting involved. These traders can come to the party, as it were, and see to it that the rural areas do not get left behind. India is looking forward, not looking back. Everybody must change with the times, and so must wholesale traders, who for long have enjoyed at the expense of the farmer and the consumer. Traders must look for innovative ways to stay competitive and there are many sectors where players have changed to remain relevant. There is no reason why retailers cannot adopt the same outlook.

Finally, we come to the political argument. Like I mentioned, on this issue, the left and the right find each other on the same platform. While such a scenario would certainly be desirable if these parties are working for the good of the country, that is not the case here. Narrow political considerations are at play. It is a downright disgrace that our politicians put their interests before that of the nation. The left’s opposition is not unexpected, what with the comrades refusing to come out of their 19^th century dogma, but the BJP’s opposition is surprising. Even more ridiculous is the reasons cited for opposition. The argument that FDI in retail will not bring inflation down defies common sense. Yashwant Sinha, probably the worst Finance Minister this country has had the misfortune of suffering, makes a ridiculous parallel between FDI in India and FDI in Mexico. If one were to make arguments based on how liberal policies did not work in a particular country, we’d have to be back to the bad old days of socialism and perpetual bondage. On second thought, it is not surprising that the BJP, which came to power on the back of lies on our heritage, culture and history, chooses to extend its habit of dishonesty and immoral conduct to economic policy.

Competition is a good thing. There is no better example for this than the telecom sector. The government has an obligation to provide every citizen of this country three square meals a day. Foodgrains rotting outside warehouses, rats and dogs eating grain while millions go to bed hungry, and the middle class having to pay exorbitant prices for foodgrains is a disaster for any elected government. The government has to choice between succumbing to the pressure of an oligarchy and leading us all to ruin and fulfilling its obligation to the Indian people. One hopes that the government makes the right choice.

Binayak Sen: a pawn in a larger game

What is it about Binayak Sen? Unfortunately, in India, we have many more cases of individuals being wrongly treated by the state. Why, then, do Nobel laureates not sign petitions, so-called liberals with dubious credentials not blast the state, and the media not use such shrill tones and cover the issue in any of the other cases?



The obvious answer would be the man's story. Here is a person who could have made a lot of money by doing what so many of his colleagues do. But he chose to serve the poor and make a difference to the lives of the less fortunate. However, there is more to this than that. Sure, the man's story does play a part, but there are people with equally inspiring stories who don't get the same "print-space". The truth is that Dr Sen is a perfect fit for those who take a lot of pleasure in throwing mud at India. They take up his cause because the story of a Doctor who fought for the poor is more "sexy" than the story of, say, an illiterate villager who fights the power despite bearing its full brunt time and again.




Over the last few months, I have been exposed to a mafia of haters whose only job is to throw mud at India. I do not know why they do it, but their modus operandi is simple. Highlight the negatives and make it larger than they are and deny the positives. I don't want to take names, but a knowledgeable person will know whom I am talking about. To them, India has to be criticised, our failures highlighted, more so than any other country. If their criticism was based on a desire to be constructive, to contribute to making towards a better India, I would have been grateful. But that is not the case. To them, Dr Sen's case is manna from heaven, especially when India is seeking an enhanced role in the international community. They do not have an iota of knowledge on the case; nor do they even read the judgement. To them, what matters is that India gets bad press. The same facts which they claim are sacred are irrelevant.



The left-liberal reporting of the case is a perfect case study in hypocrisy. Here is a band of hypocrites who wax eulogies on a judgement if they agree with it, and blast another which does not agree with their ideology. To be fair, this would have been acceptable and indeed, along expected lines if it were not for a propensity to play around with words like "mockery of justice", laws which fall short of "standards for criminal prosecution", and a trial which apparently is unfair. How is it that laws which are perfectly fine in one case fall short of standards on another; how is it that the same system they praise to the skies in one case is unfair in another? They refuse to read the judgement, to understand what the judge said when he mentioned that he would have taken a lenient view if it were not for the Maoists. To me, it seems that the left-libs take themselves far too seriously; they believe to the bigger than the idea of India, they believe their story is bigger than the institutions which make India a democracy, no matter however flawed.




If you disagree with a judgement (as I do in this case), argue on the basis of the case alone. Certainly, have a media campaign demanding his release along with compensation, have public debates on the issue, but implanting motives on the judiciary, which for all its faults is independent, is not on. However, left-liberals have a tendency to exaggerate, and it is this attitude the haters feed on.



I firmly believe Dr Sen is being played with. One the one hand is the police, who use an environment of anti-Maoism to serve their needs, and an unholy alliance of haters and so-called liberals who use him to stoke their ego, or to feed their Indophobia. This is very unfortunate.