Accountability for malnutrition

The 2nd Convention on Children’s Right to Food held in Bhopal recently explored why malnutrition persists and grows in India, despite attention from the media, voluntary organisations, political parties and MNCs. Is it because malnutrition has still not become a big enough issue with the people, asks Sachin Kumar Jain

Hunger Malnourished children

The 2nd Convention on Children’s Right to Food was held in Bhopal from January 20-22, 2012. The leitmotif of the deliberations was the need for good governance and accountability to guarantee children their right to food and proper nutrition.

Lessons from the convention have specific relevance and meaning in the present context.

A few days before it got under way, an alliance of corporate-controlled institutions came out with a report on the status of malnutrition in India, intriguingly titled HUNGaMA (Hunger and Malnutrition Survey).

The report was released by the prime minister, who used the occasion to declare that malnutrition was a matter of “national shame”. Beyond this pious declaration there was little to show that the chief executive of India’s political and administrative system had the political vision or the administrative blueprint to tackle the problem of malnutrition.

The PM made no reference to the fact that over the past 20 years, the very policies that have been touted as ushering in a new dawn have not only exacerbated the problem of malnutrition among children but have institutionalised the condition as an endemic challenge. These policies have also led to the commodification of our resources, privatisation of welfare and other services, curtailment of our basic rights, introduction of new forms of discrimination, and a widening of the rich-poor divide. So much so that today we are faced with a crisis situation, with our basic rights to work, livelihood and security threatened and our environment ravaged.

Significantly, it was the PM who in 2008 constituted a National Council on India’s Nutritional Challenges. The council, of which he is chairperson, has not met even once since it was set up.

Whether it’s the PM or any other minister in the union cabinet, the consensus in government appears to be that malnutrition in India can be eradicated only by the factory-made tinned foods, fortified with nutritional supplements, that are being manufactured and marketed by multinational corporations. Both central and state governments turn a blind eye to the stark truth that malnutrition is not an illness but a problem linked to food insecurity and starvation. They refuse to accept that the solution to the problem lies in community management and strengthening of the local food distribution system.

Speaking at the Bhopal convention, Shanta Sinha, chairperson of the National Commission for the Protection of Child Rights (NCPCR), emphasised that we must stop seeing poverty as the root cause of malnutrition in children. The problem is a direct consequence of the official policy and administrative approach. It is a poverty of vision and of commitment. The sad truth is that child deaths continue to be swept under the carpet, whether in Madhya Pradesh or in West Bengal, with one government department holding the other accountable in a perpetual game of buck-passing. Such a situation arises only when the government has little stomach for resolving the problem.

The HUNGaMA survey, conducted in the most severely malnourished districts of the country, is an in-your-face avowal of a bitter truth. But somewhere below the surface lurks the fear that the report seeks to corporatise the problem of malnutrition. According to the survey, conducted in 100 districts of Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, Rajasthan and Orissa, 6.15 crore of the country’s 16 crore children -- 42% of our child population -- are malnourished. That places India just behind Bangladesh in the global census of malnutrition. This, despite disbursals of Rs 26,760 crore for health and Rs 56,000 crore for social welfare in the 2011 budget which contribute to the implementation of 10 planned central programmes.

Nowhere does the report point out that lack of accountability is an important reason for the situation having remained unchanged despite these massive disbursals. But it does consciously mention that mobile phones and electricity have reached 80% of the population, even if 66% of mothers have never seen the inside of a school.

The National Institute of Nutrition (NIN) points out that only 20% of women partake of the full dose of iron tablets distributed by anganwadis in the country. Similarly, the current budget shows that nutritious food is being provided to the vulnerable population for only 126 days in the year, despite a Supreme Court order to ensure such availability for 300 days.

Another outcome of the government’s lackadaisical approach towards malnutrition is that in a situation where 21% of births take place at home, mothers are not assured of the required nutrition during their pregnancy or whilst nursing their newborns.

Why are the prime minister and those responsible for conducting the survey silent about the fact that the government spends a measly Rs 4 per child per day to combat the problem of malnutrition? ‘Inhuman’ is the most appropriate adjective one could use to describe their attitude.

Ensuring the right to freedom from hunger is our national duty. Stating this unequivocally at the convention, Kavita Shrivastava, national convener of the Right to Food Campaign, drew attention to the distressing fact that whenever the government raises the issue of child nutrition, it first does a backroom assessment of the profit-loss and economic benefits to the corporate sector. For the government it is those who control the capital who are important; it does not see children and people as capital.

The opening paragraphs of the National Food Security Bill, 2011 states that the central government seeks to enact the law to guarantee food and nutrition security for the people. But the provisions of the proposed legislation accord them the status of beggars.

Can adequate nutrition be ensured by distributing only wheat, rice and coarse grains? Can the needs of an individual be met with 7 kg of foodgrain? Is food security possible without talking about agriculture and land rights? Is it possible to implement the law without including adequate provisions for punishing corrupt officials and other individuals? Can cash transfers to families in place of foodgrain ensure food security for women and children? Can the nation hold its head up with pride when farmers continue to commit suicide?

The answer to all these questions is a resounding ‘No’!

The bill ignores these questions. In such a scenario, we need to strengthen the struggle of the deprived for their rights. Otherwise, they are in danger of being classified as beggars under the law, not as legal claimants of their rights.

As Nikhil De of the Mazdoor Kisan Shakti Sanghatan (MKSS) pointed out, until and unless we have a system of accountability in place for those in positions of power and responsibility, any attempts at complaint redressal will prove ineffectual.

The right to maternal health and security was also addressed in depth at the convention. The proposed bill has a provision to provide cash support of Rs 1,000 for six months to pregnant and nursing mothers. Participating delegates were of the opinion that it should include other equally important provisions such as leave and minimum employment.

It is now beginning to dawn on people that whenever the government talks about nutritionally fortified canned foods it is, in fact, extending an open invitation to companies to enter its food welfare programmes. But combating malnutrition is more than just formulating programmes to supply nutritious food. We need to go beyond such thinking.

The stark reality today is that greater numbers of people are joining the ranks of the malnourished. Given the way prices are spiralling, leading to increasing livelihood insecurity, it is inevitable that people from the middle class will find themselves trapped in the web of malnutrition. After all, if we examine the statistics we find that 76.8% of our population does not receive adequate nutrition as per defined standards.

Wheat and rice may fill one’s stomach, but we shouldn’t forget that in addition a person needs to consume dals, milk, animal products, vegetables, fruits, tubers, oil and beans to ensure adequate nutritional intake. The government does not seem to accept this fact. It is bent on pursuing the cheaper alternative of providing micronutrients instead of freshly cooked food, and is fashioning its policies accordingly.

This is a dangerous development that threatens to dismantle the system of community-based food security. Children should have the right to be served hot, cooked food rich in animal products, fruits and vegetables. Without such a provision, it is impossible to eradicate malnutrition. That is why the convention demanded that contractors and companies be prohibited from playing any role in anganwadis and the midday meal scheme, urging instead that mahila mandals, self-help groups and panchayati raj institutions be given a central role in these programmes. In this context, it also called for a ban on testing of micronutrients and other nutritional supplements for the programmes.

Malnutrition is clearly linked to food security and hunger. It is also evident that its eradication is possible only at the level of the community. Nowhere does the proposed bill acknowledge this fact or make any provisions for community-based management of the problem. Instead, the government wants to present malnutrition as a problem to be addressed by hospitals and suvidha kendras. This is a matter of grave concern.

Of equal concern is the role being played by people’s organisations. Can we honestly ask ourselves whether we -- non-government institutions and organisations -- have any real connection with our society? We target the government, but all that ever happens is limited to the government and us. Where does society fit into the equation? Does it have any place in this debate and analysis that goes on endlessly day after day?

Laws are enacted, policies are formulated, budgets and systems are discussed. But who is all this for? Where are the people? Where do they figure?

I know from my personal experiences in Madhya Pradesh exactly why the HUNGaMA report states that people have not even heard of the word ‘malnutrition’, which the prime minister says is “a national shame”. The 2008 and 2009 elections in Madhya Pradesh were fought almost entirely on the issue of malnutrition. Many advertisements were published and the media was vociferous, talking openly about the issue. The government was our target as we brought all its shortcomings to the fore. We wanted to fix accountability. We wanted to point out that even if children could not voice their concerns, we who advocate people’s rights and support people’s struggles would become their voice. But, as always, it was the clique of ruling powerbrokers that triumphed in the elections and once again took the reins of power. Why? The answer is simple. Malnutrition may have become an issue for the media, voluntary organisations, political parties and researchers. And, most importantly, it may have provided the opportunity for multinational companies to increase their gross and net profits. But it has still not become an issue among the people, among society.

If society stays silent, inequality, exclusion and violation of rights become the character of state functioning. Children continue to go hungry as there is no mass movement to ensure their survival in the given context.

Governments are affected by agitations, struggles, advocacy and public petitions. They cannot remain impervious to them. But how long does this effect last? That depends entirely on how persistently society demands accountability from government. If the struggle is momentary, its impact is also temporary. If society is strong and persistent, then the government is forced to become accountable for its actions. In such a situation, it cannot dismiss the death of even a single child by claiming it to be the consequence of illness or familial neglect, not malnutrition. The government will then be forced to become the constitutional guardian of our children.

According to O P Rawat, Additional Chief Secretary, Government of Madhya Pradesh, the bureaucracy still believes that negligence by the family and mother is the chief reason for malnutrition. He pointed out that we have been unable to find a way to deal with malnutrition despite devoting so much time to analysing the problem. He wondered how society could ensure a secure motherhood and a healthy childhood if 80% of girls were anaemic. He said it was not enough to set up a chain of anganwadis, no matter how well they functioned. Nor should we seek solutions to problems with isolated packages. What is needed is to bring about behavioural change in society.

Rawat promised to bring the findings of the convention to the notice of every department in the administration.

B R Naidu added that the sense of permanence in government service is what makes officialdom so smug and unaccountable. He agreed that there was no accountability in government on the issue of malnutrition, which is why no action could be taken against those who were responsible for this state of affairs.

Kavita Shrivastava pointed out that government had curtailed community rights to water, forests and land through its many laws. As a result, malnutrition has now become a universal problem. In earlier years, people did not die of hunger even during the most severe famine. Now, people are dying when there is no famine! Shrivastava accused the government of spending lavishly from the public exchequer to encourage industry. No state has shown resolve in ensuring that its children grow up healthy.

Vibhanshu Joshi, a member of the Madhya Pradesh Commission for Protection of Child’s Rights, noted that whenever a child dies of malnutrition in the state, the women and child development department and the health department trade charges and seek to hold each other responsible. According to him, accountability has to be fixed somewhere if the plight of children in the state is to be ameliorated. In this context, he came out strongly against the drug trials being conducted on children and the system of using factory-made canned nutritional products in our food programmes.

During the three-day convention, 25 parallel workshops were conducted on the subject of malnutrition and related issues including breastfeeding, locally available food, role of the gram sabha and panchayat, negative effects of genetically-modified seeds, infrastructural changes needed in the anganwadi and midday meal programmes, importance of setting up crèches, and the need for a people’s struggle to modify the National Food Security Act. It was decided that over the next six months, this campaign would be taken to the village level. At the same time, a blueprint for an organised campaign reflecting the viewpoint of children will be prepared to ensure government accountability for malnutrition.

The absence of a dialogue between the government and society on the issue of malnutrition, and the growing distance between activist organisations and the people, was also clearly brought out at the convention. Although our society is riven by caste and class discrimination, we must remember that it is this society that ensures that no one dies of hunger at the village level.

Some key aspects of the Bhopal Charter on Children’s Right to Food, accepted at the 2nd National Children’s Right to Food Convention:

 (Sachin Kumar Jain is a social researcher and journalist. He also works with the Right to Food Campaign and Working Group for Children Under Six)

Infochange News & Features, February 2012