NEW DELHI – Small, sick, listless children have long been India’s scourge – “a national shame,” in the words of its prime minister, Manmohan Singh. But even after a decade of galloping economic growth, child malnutrition rates are worse here than in many sub-Saharan African countries, and they stand out as a paradox in a proud democracy.
China, that other Asian economic powerhouse, sharply reduced child malnutrition, and now just 7 percent of its children under 5 are underweight, a critical gauge of malnutrition. In India, by contrast, despite robust growth and good government intentions, the comparable number is 42.5 percent. Malnutrition makes children more prone to illness and stunts physical and intellectual growth for a lifetime.
There are no simple explanations. Economists and public health experts say stubborn malnutrition rates point to a central failing in this democracy of the poor. Amartya Sen, the Nobel prize-winning economist, lamented that hunger was not enough of a political priority here. India’s public expenditure on health remains low, and in some places, financing for child nutrition programs remains unspent.
Yet several democracies have all but eradicated hunger. And ignoring the needs of the poor altogether does spell political peril in India, helping to topple parties in the last elections.
Others point to the efficiency of an authoritarian state like China. India’s sluggish and sometimes corrupt bureaucracy has only haltingly put in place relatively simple solutions – iodizing salt, for instance, or making sure all children are immunized against preventable diseases – to say nothing of its progress on the harder tasks, like changing what and how parents feed their children.
But as China itself has grown more prosperous, it has had its own struggles with health care, as the government safety net has shredded with its adoption of a more market-driven economy.
India runs the largest child feeding program in the world, experts agree it is inadequately designed, and has made barely a dent in the ranks of sick children in the past 10 years.
The $1.3 billion Integrated Child Development Services program, India’s primary effort to combat malnutrition, finances a network of soup kitchens in urban slums and villages.
But most experts agree that providing adequate nutrition to pregnant women and children under 2 years old is crucial – and the Indian program has not homed in on them adequately. Nor has it succeeded in sufficiently changing child feeding and hygiene practices. Many women here remain in ill health and are ill fed; they are prone to giving birth to low-weight babies and tend not to be aware of how best to feed them.
A tour of Jahangirpuri, a slum in this richest of Indian cities, put the challenge on stark display. Shortly after daybreak, in a rented room along a narrow alley, an all-female crew prepared giant vats of savory rice and lentil porridge.
Purnima Menon, a public health researcher with the International Food Policy Research Institute, was relieved to see it was not just starch; there were even flecks of carrots thrown in. The porridge was loaded onto bicycle carts and ferried to nurseries that vet and help at-risk children and their mothers throughout the neighborhood.
So far, so good. Except that at one nursery – known in Hindi as an anganwadi – the teacher was a no-show. At another, there were no children; instead, a few adults sauntered up with their lunch pails.