Independent India at 60
Where are the children?
That one in three malnourished children lives in India is a reflection of the failure of the Indian state
Recent newspaper investigations have revealed that several hundreds of children suffer from severe malnutrition in Thane district near Mumbai, India’s financial capital. For instance, two-year-old Manoj, whose weight should be 10 kg, weighs only 3.8 kg; his weight increased by only 2 kg since birth. Last year 1,100 children in Thane died of malnutrition-related causes. This year, in Mumbai alone, 501 children were found to be suffering from acute malnutrition. In Ma
dhya Pradesh, 55.1 per cent of children suffer from malnutrition, and in Bihar the figure is 54.4 per cent. The third National Family Health Survey (NFHS-3) of 2005-06 shows that nationwide 46 per cent of children under three are undernourished; down by only 1 per cent since the previous survey in 1998-99.
The number of children suffering from malnutrition in India even 60 years after Independence remains staggeringly high. Despite being one of the fastest growing economies in the world, severe malnutrition leading to high infant and child mortality puts India low (126th in 2006), in the United Nation’s Human Development Index (HDR), a key indicator of the well-being of populations. One in three malnourished children of the world lives in India. This is a critical reflection of the gross failure of society and the Indian state to implement and sustain measures to safeguard the lives and health of the children of this country.
Statistics indicate that 2.5 million children die in India every year, accounting for one in five deaths of children in the world. Girls are also 50 per cent more likely to die than boys in India. The HDR of 2006 points out that despite a steady growth of GDP in the country, the decline in child mortality has remained stagnant after going from 2.9 per cent a year in the 1980s to 2.2 per cent a year in 1990.
The alarming lack of progress in reducing child mortality and improving other poor indicators of child well-being underline the fact that increases in wealth and income do not lead to an improvement in human development. The consequences of early childhood malnutrition are well known; they include physical and mental impairment often leading to an early death. Survival is therefore the first issue of concern for the Indian child, followed by the challenges of malnutrition and undernutrition, poor access to health care and education, as well as a host of other threats ranging from sex selectivity and the discrimination faced by female children, to child labour, child abuse and trafficking.
Although in an overall sense in the six decades since Independence, child survival rates have improved and other factors such as school enrolment especially among girl children has increased, the rate of progress has not been commensurate with the overall growth of the economy. This is in part due to the many paradoxes that dog the Indian social and legal system. For instance, child labour has only been banned in certain occupations; there is no total prohibition of child labour. This contravenes a child’s right to free and compulsory education guaranteed by the Constitution. Measures to tackle other problems like child abuse, trafficking, gender discrimination and the special needs of disabled children are either ineffective or inadequately implemented. The failure to deliver on certain fundamental rights of children such as the right to food, the right to health and the right to education contributes to their deleterious condition. Focussed interventions and increased budgetary allocations for child welfare programmes coupled with the commitment to protect the entitlements of children constitute some of the most exigent needs of the country today.
While the Indian Constitution in Article 39(f) directs that States provide children “opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity,” little has been done to ensure this. India is also a signatory to the United Nations Convention on the Rights of the Child (CRC). The CRC sets out the basic rights of children, including the right to life, protection from abuse and exploitation; it also delineates the states’ responsibilities towards children. However, as economist Amartya Sen has said, human rights exist by virtue of being born a human being. Similarly, children’s rights need to be asserted as being basic to their existence — including the right to life, the right to food and the right to health, education and development. The plethora of laws that have emerged over the decades since Independence is of no consequence unless these rights can be asserted and safeguarded through such laws. Mina Swaminathan, an expert in early child development, has for instance stressed that child rights are often violated even before birth, such as by the sex-selective abortion of female foetuses, which continues to be prevalent despite the law against it. Even though there has been a marginal rise in the female-male sex ratio in the 2001 Census, there has been a disturbing decline in the female to male sex ratio in the under-6 age group. The 1991 Census shows the female to male sex ratio in the 0-6 age group as 945 girls per 1,000 boys, whereas in the 2001 Census in the same age group the ratio was 927 girls to 1,000 boys. The tragedy is that even if a girl child escapes death in the womb and survives an infancy dogged by poor health, malnourishment and inadequate access to food, she will probably be forced to work within the household and outside, and will in all likelihood be denied a proper education.
Adopting a rights approach ensures that the entitlements of all children are protected. This has been clearly demonstrated by the Supreme Court’s orders on the Integrated Child Development Services (ICDS), the only comprehensive programme that focusses on the needs of children under six in the country, especially for nutrition and health. The Supreme Court has called for the “universalisation” of the ICDS, which implies that every child under six, as well as pregnant and nursing mothers, are entitled to the package of services that include supplementary nutrition, growth monitoring and promotion, nutrition and health education, immunisation, health services as well as referral services and pre-school education.
In interim orders passed in 2001 and in 2004, the Supreme Court directed the Government of India to increase the number of anganwadi centres (for ICDS services) from 6 lakh to 14 lakh and to ensure that all Scheduled Caste/Scheduled Tribe hamlets and slums in urban areas be provided with these centres. The most far-reaching directive from the Supreme Court, however, came in December 2006, when a time-frame was given to State governments (December 2008) to create the proposed anganwadis. More radically, the Court mandated that all rural habitations, tribal hamlets and slums where there are at least 40 children under six are entitled to an “anganwadi on demand.” This is an explicit recognition of the ICDS as a right of all children.
The Focus on Children Under Six (FOCUS) Report published in December 2006, which surveyed in detail the condition of the ICDS in six States in 2004, and offered critical insights, revealed that the programme has done well in States where it receives more attention such as Tamil Nadu, where anganwadis are open every day and food and services are always available. Economist Jean Dreze, who was associated with the Survey, said that functional anganwadis with adequate staff, cooked lunches and health services seemed to be the norm in many villages in Tamil Nadu. More significantly, he observed that even uneducated Dalit women in Tamil Nadu were aware of their entitlements and knew how to enforce them. Anuradha Rajivan, an expert in child nutrition, said that in Tamil Nadu anganwadis cannot remain closed without immediate queries being raised. She pointed out that the coming together of political commitment and public pressure which perceives the ICDS as a right is yielding good dividends in Tamil Nadu.
There is no reason that the lead taken by States like Kerala and Tamil Nadu, where child indicators are better than in the other States, cannot be followed. If children’s issues are viewed as a matter of their right, it will not only positively affect their situation but will also strengthen Indian democracy. If 60 years after Independence, the majority of children in the country are still undernourished and continue to face severe deprivation and exploitation, there is an urgent need for concerted effort to tackle what has been described as a “humanitarian emergency”. Legislative protection, judicial intervention and social activism can push children’s issues centre stage, but political will backed by adequate resource allocation and a real commitment to recognising the human rights of children are needed if this nation is to progress in the real sense of the word.
Dr. Nirmala Lakshman is Joint Editor, The Hindu.
Independent India at 60