India targeted to reduce the proportion of underweight children by half over the period 1992-2015 under the United Nations Millennium Development Goal (MDG). The Ministry of Statistics and Program Implementation has published the 'Final Country Report-Millennium Development Goals' in November 2017 for India which noted that India has failed to achieve the MDG target. However, the MDG Final Report did not explain the nutritional status of children from socially marginalised groups like Scheduled Castes (SC) and Scheduled Tribes (ST) with respect to the MDG target.
Children being underweight is an outcome of under-nutrition which is a result of insufficient food intake and lack of necessary nutrients in the food consumed. Children who are undernourished have lowered resistance to infection and are more likely to die from common childhood ailments like diarrheal diseases and respiratory infections. Under-nutrition includes being underweight for one's age, too short for one's age (stunted) and dangerously thin (wasted). According to UNICEF, being underweight for one's age and stunted are the chronic forms of under-nutrition.
Progress Of SCs/STs On MDG Target Of Reducing Underweight Children
The data for underweight children (age group 0-59 months) is collected through National Family Health Survey (NFHS) in India. The data under NFHS is available for the year 1992-93 (NFHS 1) and 2015-16 (NFHS 4). The data from NFHS 1 is used as the base year for MDG and the data from NFHS 4 is used as the target year of MDG for comparison in this article.
The percentage of underweight children in India was 53.4% in 1992-93 which should have been reduced to 26.7% in 2015 to achieve the MDG target. However, according to the latest data from NFHS 4, the percentage of underweight children in India is 35.7%. Similarly, the percentage of SC children who were under-weight in 1992-93 was 57.5% which should have been reduced to 28.75% to achieve the MDG target in 2015. However, according to NFHS 4, 39.1% of the SC children are still under-weight. The percentage of under-weight ST children was 56.8% in 1992-93 which should have been reduced to 28.4% to achieve the MDG target in 2015. But as per NFHS 4, 45.3% of the ST children are still under-weight.
% Under-weight Children in India, 1992-93 to 2015-16
India has clearly missed the target of reducing the proportion of underweight children into half in the period between 1992 and 2015.
Stunted Children In India
According to UNICEF, child stunting (too short for one's age) is potentially the biggest threat to children's growth and development. Stunted children have stunted bodies, stunted brains and stunted lives. Stunted children are more likely to fall ill, fall behind in class and when they start work, do not perform as well and earn less than their non-stunted peers.
The percentage of total stunted children in India has increased from 19.8% in 2005-06 to 21% in 2015-16. Similarly, in the same period, the percentage of SC stunted children has increased from 21% to 21.2%. The percentage of ST stunted children has very marginally reduced from 27.6% in 2005-06 to 27.4% in 2015-16.
% Stunted Children in India, 2005-06 to 2015-16
In the last one decade (2005-06 to 2015-16), there has been almost no reduction in the percentage of stunted children in India.
Severe stunting is the worst form of stunting. The percentage of total children who suffer from severe stunting has increased from 6.4% in 2005-06 to 7.4% in 2015-16. Similarly, in the same period, the percentage of SC children with severe stunting increased from 6.6% to 7.5% while the percentage of ST children with severe stunting increased from 9.3% to 10.3% in the period to 2005-06 to 2015-16.
% Severely Stunted Children, 2005-06 to 2015-16
In the last one decade (2005-06 to 2015-16), the percentage of children with severe stunting has increased by almost 15% for all the social groups.
The 'Minimum Acceptable Diet'
According to NFHS 3 and 4 collected data on "children in the age group 6-23 months who consume a Minimum Acceptable Diet" an acceptable diet consists of breast-milk, other milk or milk products and also depends on meal frequency.
The percentage of total children who took a minimum acceptable diet was 20.7% in 2005-06 which has reduced to just 9.6% in 2015-16. Similarly, the proportion of SC children who took minimum acceptable diet has reduced from 18.8% in 2005-06 to just 9.4% in 2015-16. The percentage of ST children who took minimum acceptable diet was 14% in 2005-06 which has reduced to mere 8.7% in 2015-16.
% Children Taking 'Minimum Acceptable Diet', 2005-06 to 2015-16
The proportion of children who take a minimum acceptable diet has reduced by almost half for all the social groups over the period 2005-06 to 2015-16.
Prevalence Of Anemia
Anemia is characterized by a low level of haemoglobin in the blood. Haemoglobin is necessary for transporting oxygen from the lungs to other tissues and organs of the body. Anemia in young children is a serious concern because it can result in impaired cognitive performance, behavioural and motor development, coordination, language development, scholastic achievement as well as increased morbidity from infectious diseases. One of the most vulnerable groups is children age 6-23 months.
According to NFHS 4, ST children have the highest cases of anaemia with 63.1% of the ST children as anaemic followed by 60.5% of the SC children and 58.4% of the children at all India level as anaemic.
Article 47 of the Indian Constitution states that it is "duty of the state to raise the level of nutrition and the standard of living and to improve public health".
The Integrated Child Development Services (ICDS) and Mid-Day Meal are the two major programs of the government of India which are aimed to improve the nutritional status of children in India.
ICDS is aimed to help the children and nursing mothers to break the vicious cycle of malnutrition, morbidity and mortality. The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers. The amount spent under the scheme by various states and the central government and the number of beneficiaries under the scheme had fallen considerably in the last couple of years despite the fact that India has failed to achieve the MDG target of reducing malnutrition among children. The supplementary Nutrition Program under ICDS is the major component of ICDS providing supplementary nutrition to the children and Pregnant Women and Lactating mother.
MDM scheme is the world's largest school meal programme and reaches an estimated 11 crore children across 12 lakh schools in India. The MDM scheme is aimed at improving the nutritional status of children in classes I – VIII in Government, Local Body and Government aided schools etc.
Budgetary Allocation and Expenditure Made Under MDM, 2012-13 to 2016-17
Source: MID Day Meal Website
The expenditure made under MDM schemes has reduced from 10867.0 crores in 2012-13 to just Rs.9483.4 crores in 2016-17, marking a reduction of Rs.1384.5 crores in just five years.
Along with the expenditure made under the MDM scheme, the number of children covered under the scheme has also reduced. The number of children covered under MDM scheme has reduced from 10,68,05463 in 2012-13 to 10,03,25867 in 2015-16 excluding 64.79 lakhs children from the scheme.
Even though India has missed the MDG target to reduce under-nutrition , over the last five years (2012-17), the expenditure made under MDM scheme has reduced by Rs.1384.crores, and the number of children covered under the scheme has reduced by 64.79 lakhs.
Also, as the share of the Union Budget, child health budget has seen a consistent decline over the last five years, going down from 0.18% in 2012-13 to 0.12% in 2016-17, showing the low priority accorded to this sector over the years. Right to health as a fundamental right remains a distant dream.
The analysis presented here clearly indicates that SC and ST children are still the biggest sufferer of under-nutrition. Even on the MDG target of reducing under-nutrition, the progress of SC and ST children has been the least over the period 1992-2015. The percentage of stunted and severely stunted children has increased in India in the last ten years and the proportion of children who take a minimum balanced diet has reduced by almost half for all social groups in the same period. According to WHO, nutrition-related factors contribute to about 45% of deaths in children under 5 years of age and that is the reason the SCs and STs have the highest Child Mortality cases in India. Given this situation, it was imperative for the government of India to increase its focus towards schemes like MDM and ICDS in the form of budgetary allocations and effective implementation. But what we have witnessed over the last few years is that there has been a huge decline in the expenditure as well as the number of beneficiaries covered under these schemes.
In the upcoming budget, the government of India should take in to account this grave situation of child under-nutrition and the gap between the nutritional status of SC/ST children and other children. The budgetary allocation to schemes like MDM and ICDS and other child health programs should be increased in absolute terms as well as the proportion of total union budget. Also, the reduction in the number of beneficiaries under the schemes like MDM and ICDS should not be ignored by the government and necessary measures should be taken in this regard.
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