Geeta Sahoo, a young mother of two, works as a daily wage labourer in Odisha’s capital, Bhubaneswar. She lives in a one-room hut in a slum. The salary she earns is not enough to ensure that her family of six has nutritious food. “We can manage only rice,” she says.
By enrolling her three-year-old daughter in a nearby anganwadi centre and her seven-year-old son in a government school, Geeta ensures that her children get at least one meal a day. But despite the anganwadi ‘didi’ keeping an eye on Geeta’s youngest child, there can be no hiding the fact that the child is alarmingly underweight.
The scene in a remote village in Odisha’s nine most vulnerable districts of the KBK (Kalahandi-Bolangir-Koraput) region is hardly any different. This region has a higher Infant Mortality Rate than Sub-Saharan Africa.
Other state figures related to child mortality and maternal health are not encouraging either. National Family Health Survey (NFHS)-3 data shows that Odisha has an under-five mortality of 91, one of the highest in India. According to the Food Security Atlas of Rural Orissa, prepared by the World Food Programme (WFP), in terms of malnutrition levels, almost all the districts in Odisha have more than 40 per cent children in the moderately underweight category, and districts like Malkangiri, Rayagada and Sonepur have more than 20 per cent children severely underweight.
Aradhana Nanda, who works in Kalahandi district for the Odisha-based organisation, Friends’ Association for Rural Reconstruction (FARR), lists a few reasons for these dismal figures. “The child malnutrition rate is high, particularly in the KBK region, as women’s nutritional intake here, as well as the feeding and caring practices for the young, are inadequate. This reflects larger realities, from poor education levels and early marriage to low weight at pregnancy.” A vicious cycle, where underweight mothers produce low birth weight babies.
Persistently high malnutrition levels coupled with high mortality among children also points towards poor feeding practices. According to a 2010 study by the Odisha-based Indian Institute for Social Development, entitled ‘Nutritional, Health and PSE Status of Children Covered under the ICDS Scheme in Orissa’, the majority of the respondents did not adopt weaning practices at the appropriate time. In the study area – the six districts of Khurda, Cuttack, Nayagarh, Puri, Kandhamal and Rayagada – children were introduced to semi-solids as late as two years. It was also found that children living in rural areas had a better nutritional status than children in tribal communities and in urban slums. Observes Nanda, “In fact, tribal groups emerged as greatest victims of malnutrition and hunger, living as they do outside the reach of the government and administration.”
An already complex situation is made more complex by other disturbing realities. A study conducted by the Food and Agriculture Organsation (FAO) in 2007 found that food insecurity is caused by slow economic growth, limited or no access to welfare provisioning and public service, the lack of land reform and difficulties in accessing credit.
What Odisha’s hungry populations need most is an urgent policy boost. Although the Integrated Child Development Scheme (ICDS) continues to be the primary tool for battling malnutrition in India, the time has come for a more broad-based approach. Says Nanda, “The multi-dimensional nature of malnutrition needs to be recognised and reflected in the programmes initiated by both state and non-state actors.”
The Odisha government seems to have understood this and has recently decided to adopt a multi-pronged strategy. There are plans to implement a policy on food fortification, ensure convergence between various government departments and establish nutrition rehabilitation centres for treating children with acute malnutrition. Arti Ahuja, Commissioner-cum-Secretary, Women and Child Development Department, has words of reassurance, “Reducing malnutrition, especially among children and women, will be the topmost priority for the Women and Child Development Department.”
Ahuja’s department is now spearheading this much-needed process of change. It started in 2008, when it constituted an advisory committee comprising external experts, development partners and government officials, under whose oversight, primary and secondary data on undernutrition in Odisha were analysed and debated. Their conclusions pointed to the need to refocus ICDS services on the most important determinants of malnutrition and strongly suggested that interventions need to be better target the most vulnerable age groups – children under two, adolescent girls and pregnant women. A decision was also taken to strengthen state-wide systems and have intensive actions focusing on the 15 high burden districts of a state that has 30 districts in all.
These changes are being implemented under the Nutrition Operational Plan led by Department of Women and Child Development with financial and technical support from the UK government’s Department for International Development (DFID). One of prominent initiatives under this plan is the recently-launched Conditional Cash Transfer scheme, ‘Mamata’, introduced for pregnant women and children, covering crucial interventions from pregnancy until the child turns one. Besides this, a decentralised procurement system for a Special Nutrition Programme along with the management of feeding practices has also been started. Says Ahuja, “Entitlement charts and a daily menu have been developed to ensure proper feeding of the children. This has begun showing positive results.”
Additionally, Janch Committees and Mother’s Committees have been formed for the quality implementation of the Decentralised Feeding Programme, which began in 2011. Local women’s self help groups have been involved in the programme to provide ‘Take Home Rations’ and ‘Morning Snacks’ under the supplementary nutrition component of ICDS.
In order to ensure effective convergence and to track implementation, Ahuja informs that “mapping of all interventions related to children under two will be carried out”. Currently, 20 lakh children, in the age group of six months to three years, are getting take home ration from anganwadi centres.
Project Surakshya has also been launched to ensure better results from the ‘Infant and Young Child Feeding’ practices, crucial for the nutritional status, growth, development and, ultimately, survival of the infant. Although Odisha has demonstrated good results in terms of infant and young child feeding practices in comparison to the rest of the country, the percentage of children who are benefiting is still low – at 30 per cent.
“Food insecurity and malnutrition should be dealt with as an emergency because it affects children and the vulnerable the most,” says Nirmala Gupta, the World Food Programme (WFP) representative in Odisha. The agency has been assisting in Food for Work activities in the state, mapping locally available nutritious food and encouraging good regional feeding practices. “It is very important to learn from local cultures and we need to encourage good practices,” adds Gupta.
But even as the state authorities implement the slew of programmes, the big challenge it faces continues to be proper implementation and quality control. Convergence actions and schemes need constant monitoring for effective service delivery, especially at the grassroots. Experts also caution that it’s not just nutrition and health that require attention – nutrition programmes, they argue, should be combined with enabling measures like expanding livelihood options for tribals, Dalits, marginal farmers, and women.
Helping this process would require the close attention of the state’s legislators. Their efforts to put nutrition on the discussion table will have multiplier effects: For one, by projecting themselves as change-makers, they will inspire other legislators to articulate the issue too. Secondly, they will send the right signal to administrators right down to the local level on how seriously both the government and the opposition are engaging with the issue, which, in turn, should translate into better monitoring of the various nutrition-related interventions.
Panchanan Kanungo, three times MLA from Gobindpur constituency and former Odisha Finance Minister, agrees, “Nutrition offers plenty of scope for discussion in the House, because it has so many aspects – from food availability to food quality to the purchasing power of people.”