Confessions and blame will not save 30,000 children destined to die this year

(Edited statement issued by the Asian Human Rights Commission: AHRC-STM-053-2010)

Mr Anoop Mishra, Madhya Pradesh state Minister of Public Health and Family Welfare said in the state legislative assembly on 8 March 2010 that 30,000 children under the age of five die of malnutrition every year in the state. The shocking admission by the minister about the state government’s criminal neglect in addressing the need of its citizens is contrary to its known practice of denial about the pitiable affairs in the state, particularly concerning health and family welfare.

For all practical purposes, the minister’s statement can only be viewed as a belated attempt to accept the fact but to consciously deny responsibility. This is evident from the farcical explanation offered by the minister for the high infant mortality rate in the state; he blamed the mothers for their children’s poor health and eventual death.

The minister attributed child malnourishment to the early marriage of girls; pregnancy immediately after marriage; newly born children being underweight; want of complete vaccination; mothers not breast-feeding children up to six months; not providing supplementary food to children in time; and infections and poor economic conditions. The minister did not however, explain the source of the information, or the scientific basis for the opinion.

The government’s lack of seriousness in addressing the issue is highlighted by the minister’s response—to open 25 additional nutritional rehabilitation centers to the existing 200 centers.

Over the years, government and non-government studies have shown that the infant mortality rate in Madhya Pradesh is much higher than what has been admitted by the government. For instance, the central government sponsored National Family Health Survey (NFHS-3) has repeatedly held that an estimated 60 percent of the state’s children are malnourished. The state administration however, has been denying this data over the past several years. The NFHS-3 is conducted by the International Institute for Population Sciences (IIPS) in association with a number of grassroots organizations since 1992, on assignment from the Government of India.

In this context it is not surprising that out of the eight causes narrated by the minister resulting in child malnutrition and infant deaths, four (1, 2, 5, and 6), place the blame upon the mother. The minister can then avoid discussions on the root causes of child malnutrition and infant mortality that will invariably place the state administration in the dock.

In addition, the state administration does not have credible data to deal with the problem. Different state entities have inconsistent and mutually contradicting data concerning infant mortality and malnutrition. According to the Health Department for instance, there are no infant deaths reported in Dhar (from April 2005 to September 2008) and Chindwara districts (from April 2006 to September 2008). The Monthly Progress Report of the Department of Women and Child Development however, claims that 560 infants died in both these districts between November 2007 and May 2008.

For the last four years, Satna, Chhatarpur, Balaghat, Shivpuri, Guna, Rewa, Shahdol and Sidhi districts are reportedly highly affected by food and health insecurity, resulting in child malnutrition and mortality. Among them, the child malnutrition and deprivation of right to food in Rewa and Sidhi districts have been reported by the Asian Human Rights Commission [for details please visit http://foodjustice.net/].

As each case proves, the families of the malnourished children are mostly landless tribals living in rural areas. They do not have a regular source of income to feed their children. In addition, the NFHS-3 survey found that 57.7 percent of women in the state were anemic. It appears that the minister expects landless parents, deprived of a stable source of income, to nevertheless provide their children with supplementary food. That the malnutrition of the parents hampers their ability to guarantee their children’s food security is apparently not noticeable to the minister and his department, which he heads spending tax payers’ money.

Most of the malnourished children in the AHRC reported cases were not registered at the Anganwadi Centers (AWC, child care center). This means that those children are not officially recognized as undernourished by any of the government agencies. Furthermore, the mothers have not received proper information and lack knowledge about the specific nutritional needs of their children. This is a legally binding international obligation upon the government, under article 11 (2) of the International Covenant on Economic, Social and Cultural rights and article 24 (2e) of the International Convention on the Rights of the Child, both of which India has ratified. Thus far the AWCs have failed to play their role as a bridge between the government and the people concerning child care.

A 2009 report titled ‘Moribund ICDS’ on Madhya Pradesh states that 89 percent of the AWCs surveyed for the report did not possess any medicine kits and were therefore unable to provide medical relief to children. As a result, the NHFS-3 found that only 31.5 percent of the children from 0 to 71 months in Madhya Pradesh have received health check-ups in an AWC and only 37.8 percent of them had received immunization.

It is a sad irony that while the country projects itself as becoming a developed nation within the next few years through dramatic economic growth, its proportion of budgetary allocation for citizens’ health is far less than any developed country. In Madya Pradesh, the budgetary allocation to health out of the total state expenditure has been decreasing every year since 2000, dropping from 5.1 percent to 3.9 percent in the past year. The case of Sidhi district specifically reflects that the budget for health service accounts for merely 2.4 percent of the total state budget. While child malnutrition has been increasing for the last five years, not a single Public Health Center has been built in the district during this period. Of the 4,708 medical officers’ posts 1,659 are left vacant, and 1,098 Auxiliary Nursing Mothers’ posts are yet to be filled.

Similar anomalies exist in other government programmes. For the Reproductive and Child Health Programme aimed at reducing infant and maternal mortality, the government made a budgetary provision of 650 million rupees (USD 14 million) between 2005 and 2010. Only 379.6 million rupees (USD 8.2 million) has been spent so far.

The problems underlying child nutrition are so numerous and complex that the government’s response should not limit its scope to any single aspect of the issue. The opening of 25 Nutrition Rehabilitation Centers may provide short-term relief to local undernourished children, but will not address the root causes of the problem.

Most of the children whose right to food is violated belong to landless families, who are deprived of regular sources of income. In many cases, parents work as migrant workers and earn extremely low wages insufficient to feed the family. Therefore, the government must take broader measures to introduce land reforms in Madhya Pradesh and promote developmental projects favouring local employment opportunities notably through investment in local agricultural infrastructures. Feudalism, a wealth source for most politicians in the state, must end.

Effectively addressing the problem of child malnutrition requires strong coordinated policies between concerned ministries and departments, such as the Health and Family Welfare, the Women and Child Development, the Agriculture and Rural Development, which is unfortunately a remote possibility.