Opinion Help the little ones live

In the many speeches and statements on the Children's Day last week,no one talked of millions who have died in infancy.

New DelhiNovember 19, 2009 06:45 PM IST First published on: Nov 19, 2009 at 06:45 PM IST

In the many speeches and statements on the Children’s Day last week,no one talked of millions who have died in infancy because of inadequate government policies. Government’s failure to implement much-needed strategies means the death toll of Indian babies keeps mounting. It is a reflection of the failure of our planners that India has one of the highest infant mortality rates in the world. We rank a lowly 66th in a list of 88 countries.

In his column last sunday,Swaminathan Aiyar noted that unnecessary delay of two decades in launching economic reforms has killed 14.5 million Indian children. He argues that social indicators like infant mortality rate,literacy and poverty have improve proportionately to economic growth. Aiyar calculates that had there not been this delay,infant mortality would have been down to 27 deaths per 1000 births against the existing 54 deaths per 1000 births.

While not rejecting Aiyar’s thesis completely,I should point out that he ignores one important aspect. Poverty alone is not the reason for our disturbingly high infant mortality rates.

At least 30 per cent infant mortality can be traced directly to malnutrition,since an under-nourished child is at much higher risk of succumbing to diseases than other children. And malnutrition is not linked to just poverty or providing food,as many assume. India,in fact,has a higher malnutrition and infant mortality rate than many poorer countries in sub-Saharan Africa.

India’s malnutrition rate is almost 20 per cent higher than the poverty rate. And yet,our planners have for decades waffled over implementing cheap and easily doable technical interventions which would help eradicate malnutrition at a much faster pace. Though India spends more on government-run nutrition programmes than any other country in the world,our malnutrition rates have declined at a much slower rate than in other countries. Malnutrition rates in Bangladesh have declined at the rate of six per cent compared to India’s two per cent.

Tackling malnutrition is not just about making food available. True,improving agriculture,food security and poverty reduction are key elements. But it is also about improving maternal health,sanitation,safe drinking water and breast feeding,preventing child marriage and fighting malaria,all of which are social and infrastructural hurdles which can not be eradicated overnight. Unfortunately,a very important intervention which could be easily implemented is still to receive government’s full attention,that is figuring out how to reach the right nutrition for our children,particularly those below two years of age,who are most susceptible to under-nourishment and disease.

The late Prof V Ramalingaswami,former director general of ICMR and AIIMS,in a path breaking research paper highlighted the fact that Indian children were at a disadvantage compared to African kids in terms of diet. Seventy five per cent of Indian children under three years of age suffer from iron deficiency (anaemia) and 50 per cent have less than half their daily requirement of vitamin A.

Zinc and foliate deficiency among mothers and children is also very high.

Food fortification,the simple technology by which essential micronutrients are added in small quantities to staple foods,is the best strategy to combat vitamin and mineral deficiencies. It is both cheap and easily doable. In fact,at a conference in Copenhagen last year,a panel of eight leading international economists,including five Nobel laureates,were asked to study ten challenges facing the world. The panel was tasked to suggest “the best way of advancing global welfare,particularly of developing countries,by an additional $75 billion spent over a four year period.”

The problems assessed ranged from expanding immunization coverage to malaria prevention,HIV combination prevention,rural water supply to Doha development agenda,peace keeping in post-conflict situations and the increase in number and improvement of girls schools. The experts concluded that spending the money on providing micronutrient supplements for children,specifically vitamin A,zinc,iron and iodine,was the most effective option.

Our National Nutrition Policy,which emphasizes fortification of micronutrients in food as one of the most cost- effective strategies in fighting malnutrition,has been in place for over a decade but it is only this year that the government finally recommended fortification in food served to children under six years of age in ICDS programmes.

The state governments,however,continue to drag their feet on implementing the guidelines. There is even talk at the Centre of setting up a fresh committee to study the whole issue once again. Some sections of civil society working in the field of nutrition argue that since the best source of micronutrients is fresh food,we should simply chose food stuffs rich in micronutrients rather than add artificial micronutrients. The argument is simplistic.

Since the poor do not have the luxury of the best option,should they be denied access to a viable alternative? How many more avoidable infant deaths have to take place before the government makes up its mind to act more decisively on this key issue.