Prof. Rupal Dalal, Assistant Professor at the Centre for Technology Alternatives for Rural Areas (CTARA), IIT Bombay speaks to The Probe’s Saksham Agrawal
In the heart of Jharkhand's Pakur district, the piercing cry of a distressed mother cuts through the silence. "My child is very thin. He's constantly running a fever," she says, her voice trembling with a mix of despair and helplessness. Her son, not even a year old, is caught in the cruel grip of malnutrition, a silent epidemic that continues to haunt countless households across the country. "I went to the doctor, but even with medication, my child continues to suffer," she cries, handing over the phone to Shankar.
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In these secluded hamlets, multiple challenges converge to amplify the crisis. The most critical problem facing the people is the sheer geographical isolation. For families with ailing children, malnutrition centres often lie at daunting distances, making timely access nearly impossible. Even the nearest hospitals, which should ideally be places of immediate relief, are frustratingly remote. Worse still, upon reaching these government-run hospitals, many are turned away, despite their desperate need for treatment. This issue is further worsened by a pervasive lack of awareness among the local people about their rights. However, underlying all these challenges, the problem of poverty stands out as the primary catalyst for the vicious cycle of malnutrition.
In an attempt to combat the overwhelming number of children suffering from Severe Acute Malnutrition (SAM), the National Health Mission (NHM) and the Department of Health and Family Welfare, Government of Jharkhand rolled out a network of Malnutrition Treatment Centres (MTCs) in the state. While the Government of India sanctioned the establishment of 103 MTCs for Jharkhand, as of now, 96 of these centres are up and running.
However, when juxtaposed with the enormity of the malnutrition crisis in the state, these numbers seem woefully inadequate. The existing MTCs, while serving a crucial purpose, are often located at considerable distances from those most in need. Furthermore, many of these functional centres lack the essential infrastructure to efficiently handle the ever-increasing inflow of patients. This problem of limited accessibility and subpar facilities have severely hampered the state's ability to address the malnutrition epidemic.
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Jharkhand is among the states with a notably high prevalence of child wasting. Based on the World Health Organization (WHO) growth charts, 11.4% of children (0-59 months) in Jharkhand suffer from severe wasting due to malnutrition. The state's core nutrition services, including Severe Acute Malnutrition (SAM) treatment, faced disruptions during the COVID-19 pandemic. Despite long-term efforts to combat malnutrition, India remains one of the countries most affected by it. The Global Hunger Index (2022) ranks India 107th out of 121 countries, considering factors like child stunting, wasting, and mortality.
In 2017, a heart-rending incident encapsulated the grim reality of Jharkhand's battle with malnutrition and its entangled web of bureaucracy. Taramani Sahu, a human rights activist, narrated the chilling tale of a 11-year-old dalit girl who was denied ration because she did not have an Aadhar card. The family, already marginalised and vulnerable, found themselves in an even more dire situation when, after lodging a complaint to the District Collector regarding denial of ration because of the lack of an aadhaar card, the district administration went ahead and cancelled the ration card also instead of providing relief to the family. Tragically, before any amends could be made, the young girl succumbed to her hunger pangs. The last words she uttered before her death was “rice”.
“The story of the 11 year old girl is gut wrenching and it serves as a reminder about the deep seated problem of malnutrition in Jharkhand but this is not an isolated case. Another case that left an indelible mark on all of us is that of Seema Devi, a pregnant woman from an underprivileged background. Being a part of a marginalised family, they eked out a living through daily wage labour, always teetering on the brink of extreme poverty. Seema was initially taken to an Anganwadi centre for treatment, but as her labour pains intensified during the night, she was referred to a local government hospital several kilometres away. The ordeal began in the vehicle en route to the hospital, where her water broke. When she reached the government hospital, she was turned away saying no doctor was available.She was asked to go to a private hospital in Ranchi,” says Taramani Sahu, a social activist from Jharkhand.
Taramani sheds light on the grim situation surrounding malnutrition in Jharkhand. "Even when malnourished children or frail mothers are brought to Anganwadi centres, we are confronted with a blatant inadequacy of facilities. Initially, the state government had committed to providing eggs to these children thrice a week. This was stopped after Covid-19. The Saksham Anganwadi and the Poshan 2.0 schemes were introduced as integrated nutrition support programmes. These were designed to address malnutrition across vulnerable groups – from children to lactating mothers. One of the key components of these schemes was the distribution of nutrition packets but the execution of this scheme is far from satisfactory.”
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Prof. Rupal Dalal, Assistant Professor at the Centre for Technology Alternatives for Rural Areas (CTARA) in IIT Bombay, paints a sobering picture of malnutrition in India. She states, "When examining the broader scenario, a staggering 80 to 90 percent of children in our country are malnourished. And I'm not only referring to those who are undernourished, although that figure itself is alarmingly significant." She further elaborates using the data from the National Family Health Survey 5 (NFHS 5): "36 percent of children are stunted and this is according to the government figures which means that every third child in the country is suffering from stunting."
Prof. Dalal draws attention to the more pronounced malnutrition challenges faced by rural India, especially regions like Jharkhand. "In these rural pockets, the magnitude of the problem is even more severe," she points out. The root of the issue, according to her, begins with expecting mothers. "Owing to a lack of adequate nutritious intake during pregnancy, many babies are born in suboptimal health. A significant number are either born with deformities or are malnourished right from birth. Our children aren't receiving the required amounts of proteins which are fundamental for growth. The average birth weight of newborns in India stands at a mere 2.7 kilograms. Contrast this with the World Health Organisation's standards: a baby boy, on average globally, weighs 3.3 kgs at birth, and a girl child is expected to be 3.2 kgs. This leaves us with a deficit of around 500 to 600 grams, a gap that is stark, especially when multiplied by the vast population of India."
Beyond these immediate health challenges, there's another pressing concern that amplifies the issue: the training of health workers. Prof. Rupal Dalal explains, "Post-birth, it's vital to consistently monitor a baby's weight, week after week, month after month. However, many of our healthcare professionals lack the requisite training." She goes on to highlight the gaps in knowledge and practices: "There's a significant void when it comes to understanding the nutritional requirements of both mothers and babies at various developmental stages. The nuances of monitoring infant weight, understanding the intricate nutritional needs at each phase of growth, and imparting this knowledge to mothers — all these crucial aspects are often missing in their training."
Hazaribagh MP, Jayant Sinha, recently sounded the alarm in Parliament about the dire state of nutrition in Jharkhand. Citing data from NFHS-5 and IFPRI, he shed light on the poor statistics: of the 38 lakh children under five in Jharkhand, a staggering 23 lakh are anaemic. Additionally, 15 lakh of these children are stunted, and over eight lakh are categorised as weak.
But the situation doesn't end with children. The women of Jharkhand, too, face severe health challenges. Sinha pointed out that over 26 lakh women in the state are underweight, meaning their weight doesn't meet the standard metrics for their age and height. Alarmingly, 66% of Jharkhand's women population grapple with anaemia. But perhaps the most concerning figure shared by the MP was about expecting mothers: a whopping 57% of pregnant women in the state are anaemic.
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