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Malnutrition amidst high growth

The imperatives of putting nutrition at the centre of development are apparent in a new World Bank report that warns that malnutrition could cost countries up to 3 per cent of their GDP. The report highlights the fact that investment in better nutrition has tangible effects on economic and social conditions in developing countries. Epicentres of malnutrition are South Asia and Sub-Saharan Africa. While there is a general decline in malnutrition, South Asia still has the highest rates and numbers of children who are malnourished; its rates of undernutrition are double those in Sub-Saharan Africa. Shockingly, according to UNICEF, India is home to one in three of the world's malnourished children; nearly half of Indian children are undernourished compared with a quarter of those in Sub-Saharan Africa. Malnutrition retards brain development, the capacity for learning, and physical growth. Adults who were malnourished as children have low immunity against infection and fall sick more often. This, in turn, results in diminished capacity for gainful activity. Some causes of malnutrition are obvious and some are not. Certainly the lack of access to food, an obvious cause, is not the only one. At the national level, inequitable food distribution, poor access to health services, poor sanitation, the lack of safe water supply, and inadequate immunisation coverage are major contributory factors. At the family level, girls tend to be given less importance than boys and do not have a first claim over food in the home. In many families, mothers are not aware of the necessity to breastfeed for at least six months. Also, malnutrition often perpetuates itself: malnourished mothers tend to have low birth weight and sickly babies, continuing the cycle into the next generation.

India may show spectacular economic growth, but under this lie dire poverty, chronic malnutrition, and a consistent decline in living standards for large segments of the population. Madhya Pradesh records the highest rates at 55 per cent and Kerala the lowest at 27 per cent. Research into child deaths in Maharashtra, an economically advanced State, shows more than four million children are affected by malnutrition. While the importance of programmes like mid-day meals in schools cannot be overemphasised, the World Bank report points out that urgent interventions are needed much earlier. Undernutrition is most damaging when it occurs during pregnancy and in the first two years of life. Its effects on the brain, physical development, and the vulnerability to disease are often irreversible. Feeding older children is important but just not enough; focussed action is required by governments and communities to make the best of the window of opportunity that occurs before the age of two. This should include nutrition and health counselling for pregnant women and for mothers of infants, and other direct interventions across regions to ensure the health of children who are the country's future.

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