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Childcare as a social responsibility

By Jean Dreze

The rights approach, which led to wider acknowledgement of elementary education as a fundamental right, contributed to the rapid expansion of school education in the 1990s. The rights approach should also be used to ensure the survival and wellbeing of children under 6, by demanding universalisation of the Integrated Child Development Services, the only major national programme aimed at this age-group

Most Indian children are left to their own devices until the age of 6, when they are finally herded into school. Yet the first six years of life (and especially the first two years) have a decisive and lasting influence on a child’s health, wellbeing, aptitude and opportunities. The consequences of this neglect are staring us in the face: about half of all Indian children are undernourished, more than half suffer from anaemia, and a similar proportion escape ‘full immunisation’. Few countries have such disastrous indicators of child wellbeing. According to the latest Human Development Report, India has the highest proportion of undernourished children in the world, along with Bangladesh, Ethiopia and Nepal. In fact, in terms of the general situation of children, even Bangladesh now seems to be doing better than India. This contrast is all the more striking as Bangladesh is poorer -- much poorer -- than India.

Some time ago I attended a conference in a village in Kerala. The conference was a little boring, and, as a diversion, I visited the nearest anganwadi (childcare centre). It was located in a tidy and spacious building, well furnished with toys, charts, cooking utensils, a medical kit, a ceiling fan, even a smokeless chulha. The children, I was told, were given a glass of milk on their arrival in the morning, a full meal at noon, and some upma before they left at around 3 pm. There were also well-rehearsed routines for immunisation, de-worming, growth monitoring, micronutrient supplementation and health checkups. Details of the age, weight, height and immunisation status of every child in the neighbourhood were neatly posted on the walls. The registers, including detailed ‘minutes’ of monthly meetings with the children’s mothers, were in good order. When I asked the anganwadi worker how many anganwadis there were in the gram panchayat, she casually replied “twenty-five”. She said that about 90% of children below 6 years of age were enrolled in these anganwadis.

It is perhaps not an accident that Kerala has the best indicators of child wellbeing among all the Indian states, by a long margin. In other states, early childcare and development services (hereafter ‘child development services’) are grossly neglected.

Against this background, there is an urgent need to re-examine what India is doing for the survival, wellbeing and rights of children under the age of 6. Ultimately, this involves addressing the structural roots of child deprivation, including mass poverty, social discrimination, lack of education, and gender inequality. However, there is also an immediate need to protect children under 6, by integrating them in an effective system of child development services that leaves no child behind. The best way of doing this is to universalise the Integrated Child Development Services (ICDS), the only major national programme addressing this age-group. 

The quality of ICDS also needs to be radically enhanced. In other words, what is required is not just universalisation but “universalisation with quality”. A more complete expression would be “universalisation with quality and equity”. This stresses the need to prioritise underprivileged groups (for example, dalit and adivasi communities) in the process of universalisation, as well as to eradicate social discrimination of any kind in the implementation of ICDS.

A rights perspective on ICDS

The value of a ‘rights approach’ to social development has been well demonstrated in recent years. Wider acknowledgement of elementary education as a fundamental right (recently expressed in the 86th constitutional amendment) has contributed to the rapid expansion of school education in the 1990s, evident in age-specific literacy data from the 1991 and 2001 censuses. The Right to Information Act 2005 has lifted the veil of secrecy from government documents, a major step towards restoring accountability in public life. Supreme Court orders on the right to food have forced the government to take major initiatives in this field, such as the provision of cooked midday meals in primary schools. Similarly, the National Rural Employment Guarantee Act has empowered rural labourers and reversed the long-standing neglect of rural employment in public policy.

In the light of these experiences, there is a case for more active use of the rights approach in the context of children’s issues, including the survival and wellbeing of children under 6. Children’s rights are not, of course, a new idea. The idea is conveyed in the Indian Constitution, notably Article 39 (f), which directs the State to ensure that “children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity”. This Article belongs to the Directive Principles, and should be read along with Article 37, which states that these principles are “fundamental to the governance of the country,” and that “it shall be the duty of the State to apply these principles in making laws”. As Article 39 (f) illustrates, the Directive Principles (largely due to Dr Ambedkar) include a visionary emphasis on ‘positive freedoms’. The government’s formal commitment to child rights and positive freedoms was further affirmed in the international Convention on the Rights of the Child. In practice, however, little has been done to protect and promote the positive freedoms of children as a matter of right.

The primary role of the rights approach is to change public perceptions of what is due to Indian children. In particular, the rights approach can help to put children’s issues on the political agenda, and to forge new social norms on these issues. To illustrate, the recent recognition of elementary education as a fundamental right of every child has helped to dispel the resilient notion that education is ‘unnecessary’ for some sections of society. A similar consensus needs to be built regarding the rights and entitlements of children under 6.

Aside from its political value, the rights perspective has practical implications for public policy on child development services. First, this perspective is the main foundation of the demand for ‘universal’ child development services. Indeed, one implication of the rights approach is that all children are entitled to certain “opportunities and facilities” (as the Constitution puts it) that do not have to be justified on a case-by-case basis, let alone submitted to cost-benefit tests. The main role of ICDS is to act as an institutional medium for the provision of these facilities.

Second, the rights perspective points to the need for strong monitoring and redressal mechanisms, so that people are able to claim their entitlements. There are few redressal mechanisms in the present scheme of things. In some states, for instance, nutrition programmes under ICDS have been interrupted for months at a time without any action being taken. One reason for this apathy is that these services are regarded as a form of state largesse, rather than as enforceable entitlements.

Last but not least, the rights perspective highlights the possibility of putting in place legal safeguards for children’s rights. Many Indian laws, of course, deal with children’s rights in one way or another. But these legislative provisions tend to be of a ‘negative’ kind, in the sense that they are aimed at protecting children from various evils (such as child labour or child marriage), rather than at guaranteeing the positive “opportunities and facilities” mentioned in Article 39 (f). The proposed Right to Education Bill, flawed as it may be, is an example of the sort of legislation required to guarantee positive freedoms to Indian children. More can be done in this respect, including similar legislation for children under the age of 6.

Needless to say, the protection of children’s rights involves much more than better laws and policies relating to “child development services”. It also calls for far-reaching action in fields such as elementary education, gender relations and even property rights. Nevertheless, the universalisation of ICDS has a crucial role to play in this context.

Universalisation with quality

In concrete terms, what does “universalisation with quality” mean? It means that (1) every settlement should have a functional anganwadi, (2) ICDS should be extended to all children under the age of 6 (and all eligible women), and (3) the scope and quality of these services should be radically enhanced.

ICDS is the only major national programme that addresses the needs of children under 6. It seeks to provide young children with an integrated package of services relating to nutrition, health and pre-school education. Because the needs of a child cannot be addressed in isolation from those of his or her mother, the programme also extends to pregnant women, nursing mothers and adolescent girls.

Basic ICDS include supplementary nutrition, growth monitoring, nutrition counselling, health education, immunisation, healthcare, referral services, and pre-school education. These services are provided through a vast network of ICDS centres, better known as anganwadis. Each anganwadi is managed by an anganwadi worker, assisted by an anganwadi helper. An anganwadi is supposed to cover a population of about 1,000 people -- roughly 200 families.

The coverage of ICDS has steadily expanded since its inception in 1975. Today, the programme is operational in almost every block, and the country has more than 700,000 anganwadis. However, the effective coverage of ICDS remains limited: barely one-fourth of all children under 6 are covered under the supplementary nutrition component.

The basic premise of the demand for universalisation of ICDS is that all children have a right to nutrition, health, pre-school education and related opportunities. The anganwadi is an institutional medium to protect these rights, or at least to bring them within the realm of possibility. There are at least four other arguments in favour of universalisation: a legal argument, a political argument, an economic argument and an equity argument.

The legal argument is that, like midday meals in primary schools, the universalisation of ICDS is mandatory under Supreme Court orders. On November 28, 2001, the court directed the government to ensure that every settlement has a functional anganwadi, and that ICDS is extended to all children under 6, all pregnant or lactating women, and all adolescent girls. This order was reiterated and extended on April 29 and October 7, 2004, along with further directions on ICDS. The latest Supreme Court order on ICDS, dated December 13, 2006, goes even further. For instance, it states that an anganwadi should be created “on demand”, within three months, in settlements where there are at least 40 children under 6 years of age.

The political argument is that the universalisation of ICDS is one of the core commitments of the Common Minimum Programme (CMP) of the United Progressive Alliance (UPA) government. The CMP clearly states: “The UPA will also universalise the Integrated Child Development Services (ICDS) scheme to provide a functional anganwadi in every settlement and ensure full coverage for all children.” Thus, aside from being important in its own right, the universalisation of ICDS can be seen as an aspect of the need to hold the government accountable to its promises. It is in this spirit that the National Advisory Council formulated detailed recommendations on ICDS, in line with commitments in the CMP. These recommendations, unfortunately, have had little impact so far.

The economic argument is that providing health and nutrition services to children is a good ‘investment’, so to speak. Many recent studies indicate that the ‘returns’ on child nutrition programmes are quite high, or at least can be quite high. The methods underlying these estimates of economic returns have serious limitations, and the results are at best indicative. Further, one should guard against allowing economic criteria to become the arbiter of public policy in this field. Nevertheless, these studies strengthen the case for a major expansion of child development services in India.

Lastly, there is an equity argument for universalisation. Indeed, the universalisation of ICDS would curb the inter-generational perpetuation of social inequality, by creating more equal opportunities for growth and development in early childhood. It would also foster social equity by creating a space where children eat, play and learn together irrespective of class, caste and gender. This socialisation role of ICDS is very important in a country where social divisions are so resilient.

Taken together, these arguments add up to a fairly strong case for the universalisation of ICDS.

Two counter-arguments should be briefly addressed. One is that ICDS does not and cannot work. It is easy to provide superficial support for this claim by citing horror stories of idle anganwadis or food poisoning. These horror stories, however, are a poor reflection of the general condition of ICDS. Indeed, recent evidence suggests that ICDS is actually performing crucial functions in many states, and that there is much scope for consolidating these achievements.

The recent Focus On Children Under Six (FOCUS) survey sheds some useful light on these issues. The survey was conducted in May-June 2004 in six states: Chhattisgarh, Himachal Pradesh, Maharashtra, Rajasthan, Uttar Pradesh and Tamil Nadu. It involved unannounced visits to a random sample of about 200 anganwadis, and detailed interviews with about 500 mothers with at least one child under the age of 6, enrolled at the local anganwadi. It is encouraging to note that, according to a large majority of the sample mothers, anganwadis open regularly. This is, in fact, consistent with direct observation: nearly 80% of the sample anganwadis were open at the time of the investigators’ unannounced visit. Similarly, 94% of the sample mothers stated that supplementary nutrition was being provided at the anganwadi. Even pre-school education, the weakest component of ICDS, was happening in about half of the sample anganwadis.

This is not to deny that the quality of ICDS services is low in many states, and needs urgent improvement. But there is no basis for the claim that ICDS is a non-functional programme. Aside from debunking this myth, the FOCUS survey draws attention to the enormous potential of ICDS. The sensible way to go is to make better use of this potential, given that the foundations of ICDS are already in place throughout the country. To put it another way, opposing the universalisation of ICDS on the grounds that there are serious quality issues in some states would be like saying that primary schools should be closed because schools are not working very well in Bihar, or Kalahandi.

Another counter-argument is that universalisation is unnecessary, even wasteful: instead, public provision of child development services should be “targeted” to disadvantaged children. This advice is based on the familiar case for targeting social services: targeted interventions are more “cost-effective” and also help to reduce inequality. Whatever its relevance in other contexts, this argument has little merit as far as ICDS is concerned. For one thing, there is no reliable way of “targeting” children who are vulnerable to malnutrition or ill health. Indeed, undernourished children are found in all socio-economic groups. Even among relatively privileged households, a substantial proportion of children are undernourished. To look at this from another angle, the causes of malnutrition and ill health are diverse and these deprivations have no obvious, measurable “correlates” that could be used for targeting purposes. Thus, any targeted system is bound to leave large numbers of children exposed to malnutrition and ill health. It would effectively convert ICDS into a “hit-and-miss” programme. This is incompatible with the notion that nutrition, health and pre-school education are the fundamental rights of all Indian children.

(Jean Dreze is a leading development economist and Honorary Professor at the Delhi School of Economics and the Govind Ballabh Pant Social Sciences Institute. He has been closely associated with the Right to Food, Right to Information and NREGA campaigns. This article is based on excerpts from ‘Universalisation with Quality: ICDS in a Rights Perspective’, Economic and Political Weekly, August 26, 2006.  The arguments and evidence are further developed in ‘Focus on Children Under Six’(FOCUS), a recent report prepared by Citizens’ Initiative for the Rights of Children Under Six; this report is available at www.righttofoodindia.org)

InfoChange News & Features, June 2007