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Poor response to child malnutrition

A recent report on malnutrition by the United Nations Children's Fund drew attention to the worsening crisis of malnutrition among Indian children. They account for one-third of the world's malnourished children, with a shocking 47 per cent malnutrition rate. Now, the World Bank has published a report that provides details of the characteristics of malnutrition in States across India and the effectiveness of the programmes set up to address this problem. This report says undernutrition with micronutrient deficiencies alone may cost the country $2.5 billion annually owing to lowered productivity. Efforts at targeting malnutrition have been in place for several decades and India has the world's largest development programme, the Integrated Child Development Services (ICDS). But the reach of the ICDS has been inadequate, and it has had only limited success. India's progress in reducing malnutrition over the last decade has been much worse than the record of other countries with comparable socio-economic indicators. Unless efforts are greatly stepped up, the country is unlikely to meet one of the United Nations' Millennium Development Goals — halving the number of underweight children by 2015. What is worrying is that despite economic growth, the levels of undernutrition are very high, intensified by inequalities across regions and groups; the worst affected are girls and the most marginalised among the rural poor, including Scheduled Castes and Scheduled Tribes. In six States — Maharashtra, Orissa, Bihar, Madhya Pradesh, Uttar Pradesh, and Rajasthan — half the children are underweight. Undernutrition, which includes protein-energy malnutrition and micronutrient deficiencies such as iron deficiency, Vitamin A deficiency, and iodine deficiency, is also endemic and has not declined much in the second half of the 1990s. It is clear that the current policy response to this crisis is skewed and inadequate.

The Food Insecurity Atlas of Rural India, a valuable initiative of the M.S. Swaminathan Research Foundation and the World Food Programme, has pointed out that where child and maternal malnutrition, including micronutrient deficiency, co-exists with high levels of food supply, more attention needs to be paid to food delivery strategies and direct nutritional intervention. The World Bank report also underscores this, finding a mismatch between ICDS intentions and implementation. For instance, not enough attention is paid to child feeding practices, education and counselling for mothers, and service delivery is not sufficiently focussed on children below three. Given the Central Government's proclaimed intention to expedite the expansion of the ICDS and other national nutritional initiatives, the focus for all stakeholders must be on identifying the most important determinants of malnutrition and urgently improving the quality of nutrition delivery to the most vulnerable segments of the population.

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