CHILD HEALTH AND MALNUTRITION ISSUES

Geetha. J.R* and C. Gunasheela **

ABSTRACT
The word development in our country is primarily related to and mostly talked about with respect
to economic development as measured though GDP. Occasionally issues like poverty alleviation,
improvements in healthcare and education are taken up in the public forum but till date it is not
evident that these critical issues are being given the attention they deserve.
In reality problem of child health, not just limited to malnutrition, but overall healthcare is still
very acute in our country, which is shameful. This is amply corroborated by various indices
comparing which even sub-saharan countries or a few of our neighbouring countries fare much
better than us.
And this is in spite of remarkable economics progress the country has in the last two decades;
compared to none in 1991 we today have more than 100 declared billionaires. This is in stark
contrast to more than 37% population still being living below the poverty line and we have still
not been able to provide basic health care and nutrition to most of our children even in the age
group 0 6 years.
In the year 2000, 189 nations came together and pledged to free people from extreme poverty and
multiple deprivations. Eight Millennium Development Goals (MDG) were agreed upon, setting
up some primary goals to be achieved by 2015. Barring only a few smaller states in India no
other states have been able to achieve these targets. This read with the fact that today India
accounts for nearly 20% of childbirth requires us to address
Key words : Child Health, Child Mortality, Infant Mortality, Malnutrition
*

Assistant professor of Economics, Maharani Womens Art, Commerce and Management

College, Seshadri Road, Bangalore.

** Assistant professor of Economics, Maharani Womens Art, Commerce and Management

College, Seshadri Road, Bangalore.

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INTRODUCTION
In India there is a constant debate on the definition of a child. Census of India considers children
to be below the age of 14, even most government programmes consider this as a benchmark, even
though UNCRC considers anybody below the age of 18 as a child. For our analysis in the context
of Indian child health and nutrition we will consider children to be below 14 years age. In fact in
the context of child health, wherein the most critically affected age group is 0-5 years we will be
primarily focusing on this segments in this paper.
As per 2011 Census nearly 26 million children are born every year in India, which is almost 20%
of the birth across the world. India also has 20% of child population of the world in the age group
0-5 years. Although number of births is expected to gradually go down the relative load is not
going to lessen significantly in the near future. Therefore the progress that India achieves towards
the Millennium Development Goals (MDG) and targets related to children will reflect
considerably on the Worlds progress. If we really want us to be considered as a Global Leader,
then instead of just focussing on GDP we have to sincerely address and improve upon key issues
like child health and nutrition.
OBJECTIVE OF THE STUDY

To assess the progress our country has made in reducing child mortality and malnutrition
with respect to the Millennium Development Goals (MDG) both quantitatively and
qualitatively.

Challenges faced and steps being taken or can be taken towards achieving our goals

RESEARCH GAP
Numerous research data are available, either from the various departments of Government or
from the International Bodies like UNICEF, World Bank, etc. However many a times Govt. data
are being disputed or challenged by independent bodies. The effort of this study has been to
collate and analyse data from various sources and present a practical assessment of the subject.

METHODOLOGY
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The present paper has adopted both descriptive and analytical methods. Due to paucity of time,
detailed field survey could not be undertaken. However as already rich pools of data are available
from various recognized and accredited bodies the same have been utilized corroborated by
random authentication and verification at base level.
To address the issues of child health coupled with malnutrition in India objectively our study has
been sub-divided into the following critical factors, to be analysed individually as well as
collectively.
A. CHILD MORTALITY
As per recent estimates 12.7 lakh children in India die every year before completing five
years of age, out of which 10.5 lakhs or nearly 80% of these child deaths occur within the
first year that is before completing one year of age. More disturbing is the fact that nearly 7.3
lakh neo-natal deaths are reported within first one month of birth, or more than 55% of child
deaths in India.
MDG4 target for India was to bring down under five mortality death to below 42/1000 live
births. Even though reasonable progress has been made by some states, the country average
still is at 49/1000 live births. But when we analyse infant mortality that is 0 1 year, against
the target of 29/1000 live births actual figures are 44/1000 live births
This clearly shows that critical issues related to infant mortality have still not been addressed
as desired. Thus neonatal causes still results in 53% of child mortality followed by
respiratory infections (22%) diarrhoeal disease (12%) other infection specific diseases (8%)
Major causes of neo natal deaths are infections (33%) such as pneumonia, septicaemia and
umbilical cord infections prematurity (35%) that is birth of new born before 37 weeks of
gestation and asphyxia (20%) that is inability to breath immediately after birth and leads to
lack of oxygen.
Probably causes of these deaths and suggestions on possible remedies are discussed in the
subsequent segments.

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90
80
70
60
50
40
30
20
10
0

81

CHILD MORTALITY RATE (per

48 48

10

41
11

16

10

50 48

38

36
10

B. MATERNAL HEALTH
When asked most Indians understand that health of the mother is a key factor in determining
the health of the child. However this is never followed in practice. In rural India even a
pregnant women is required to do all regular household chores till the day she gives birth to
the child. Also social norms dictate that she will have food last from what is left over.
Also more than 45% of girls get married before the age of 18 without having reached the
child bearing age compounds the problem.
There have been concerted efforts for decades now to keep a gap of at least three years
between child births, but in reality this is not followed, specifically in rural areas, thus
creating more complications
It is estimated that nearly 36% of Indian mothers are severely malnourished and more than
50% anaemic thus their bodies are ill-equipped to handle child birth.
Our public health care systems, more specifically rural health care systems are not
adequately equipped to address issues of mothers health and for most families as private
healthcare is cost prohibitive the ultimate casualty is the mother. Only when situations get
critical do families resort to proper healthcare for the mother.
Apart from rural health schemes government has also initiated schemes like Janani Suraksha
Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) these programmes need to be
monitored for effective implementation.
C. IMMUNIZATION PROGRAMMES
In India estimated 58% of children below 2 years are not fully vaccinated and some reports
suggest 24% of the children do not receive any immunization at all. Latest report from ICDS

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show that only 51% of children how received all vaccinations programmed by the
government.
Keeping in mind that ICDS was launched in 1975 and in spite of health care schemes being
equipped fully towards immunization there are still loopholes in the system resulting in states
like Uttar Pradesh (30%), Assam (37%), Rajasthan (32%) and Bihar (40%) the level of
immunization are abysmally low.
Again in the case of immunization institutions like Anganwadis and other accredited social
health services play a crucial role in implementation, more specifically creating awareness
towards necessity of the same. So it is important for the Government to thoroughly review
implementation of immunization projects and strengthen the same.
While addressing issues of immunization following trends should be understood and tackled
i. Boys are likely to be more immunized than girls
ii. Level of immunization is directly proportional to the education level of the mother
iii. Immunization level is also linked to the economic status of the child (even though
efforts have been made by Govt. to provide essential immunizations at minimal cost).
D. MALNUTRITION
We often speak of malnutrition but very rarely have we taken concerted efforts to educate our
population on how to measure it. Malnutrition is not always easy to visualize except if these
are severe signs like discoloured hair, baggy skin or distended belly. Even when a child is at
risk of severe malnutrition he/she may appear energetic are normal, thus many times making
the parents fail to realise if their child is malnourished.
Malnutrition can be simply measured based on three parameters and the co-relation between
age, weight and height. A malnourished child can be categorised into
i. Stunted, wherein the childs height will be low compare to the age which is normally
attributed to chronic malnutrition over a long period of time.
ii. Wasted, wherein the childs weight with respect to height will be low, which again is
caused be acute malnutrition
iii. Underweight, wherein the childs weight is lower with respect to age which indicates
general malnutrition.
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In Indian context 43% of the children are underweight compare to 22% in sub-saharan
Africa. Various studies have shown that malnutrition specifically amongst infants is not
primarily due to poverty but other social economic factors. This is proven by the facts that
malnutrition is more prevalent in low income families but are also significant amongst
middle and high income groups
Key factors which can result in a child being malnourished are
a. Birth weight : Almost 22% of babies born in India are underweight primarily because of
malnourished or not properly educated nourishment programmes for mother during
pregnancy.
The only way to tackle this issue is to spread awareness amongst expecting mother and
their families about the importance of proper nutritional food for the mother during
pregnancy to ensure birth of a healthy child.
Also important are the daily routines of the mother during this period aimed at hygienic
practices like using of toilets, use of soaps for hand wash, clean environment and safe
cooking and storage of foods.
b. Anaemia : Nearly 70% of children below the age group of five are found to be anaemic
from iron deficiency. Even though health care programmes have been focusing on
addressing this issues with frontline service providers like Anganvadi Workers or
Accredited Social Health Services still the results are not satisfactory.
An primary source of iron are food items which are relatively costly to most Indian
families the only way to tackle iron deficiency anaemia in a child can be through iron
supplements. Even though programmes are in place, results are not encouraging and
hence need to monitor more closely for effective implementation.
c. Brest feeding : It is the first crucial step to ensure relatively healthy children in India.
Records of breast feeding patterns are poor, only 25% of mother initiate breast feeding in
the first hour after birth, 45% do it exclusively for the first 6 months and 55% nurse
beyond 6 months along with complimentary food
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Even though various government initiatives are in place to increase awareness amongst
mothers and their families essentially of breast feeding the effectiveness of these
programmes at grass rout level need to be assessed and monitored towards more
effective implementation.
E. HYGIENE
It is a well-established fact that in India diarrhoea and other water born infections are one of
the primary causes of almost 18% to 20% child deaths in India. Tis can be solely attributed to
inadequate sanitation, unsafe and contaminated water supply and poor personal hygiene of
both the mother and the child. Poor sanitation and contaminated drinking water lead to
intestinal worm infections leading to malnutrition, anaemia and retarded growth among
children.
Theoretically India has reached the MDG7 goal on improved drinking water sourcing
however practically only 24% of the population are privy to piped water. A bigger challenge
today is contamination of water sources with highly toxic elements including arsenic and
fluoride. This needs to be tackled on a war footing otherwise it may grow in to epidemic
proportions
Sanitation is a huge challenge in India. According various surveys and estimates more than
600 million people defecate in the open which is nearly or may be more than 50% of the total
population. This combined with unhygienic disposal of waste compounds the challenge.
Swatch Bharat has been the right step towards providing toilets across the country. But more
importantly we need to educate people on the necessity of using toilets and planned waste
disposal. In fact effective research should be carried out to find out why people are still wary
of using toilets and how that mindset can be changed.
Another hygiene issue which needs to be addressed on a more holistic level is washing of
hands with soap specifically before taking food and after defecation awareness programmes
have been initiated in school level, but as this involves changing another deep rooted mindset
aggressive awareness programmes need to be carried out at family level also.
F. SOCIAL DISPARITIES
Unfortunately India is a diverse country and child mortality also reflects the same. The
following chart signifies the disparity amongst various divides, be it economical, geographic
or social. It highlights that even today child mortality amongst the lowest quintile is still very
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high signifying that government policies and programmes have still not reached the lowest
economic strata effectively.
70
60DISPARITY
53.2
U5MR LEVELS
(India
51.3 IN
49.3
45.4
45.2
50Average
48)
40

57.1

33.5

30

24.2

65.2

62.1

38.4
21.9

20
10
0

Trust along with announcement of policies and programmes , Govt. also puts in place proper
implementation and monitoring systems to ensure that the benefits of these programmes
reach the people they are aimed at.

INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)

In 1975 under the national policies for children, to provide necessary services and supports to
children throughout the period of their growth, before or after birth, to ensure full Physical,
Mental and Social Development the Integrated Child Development Services (ICDS) was
launched. Objectives of the programme were to
i. Improve nutritional and health status of children between 0 to 6 years.
ii. Control Motility, Morbidity and Malnutrition
iii. Enhance capability of mothers to look after their Childs health and nutritional needs
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iv. Achieve these through co-ordinated implementation of policies of various departments.

The integrated services where to focus on supplementary nutrition, health check-up, primary
health care, immunization, nutrition and health education. Clear guidelines where laid down
towards co-ordination between Central and State Governments and external agencies like
UNICEF, NIPCCD, etc.
ICDS has been able to achieve some success in implementation of various policies but even after
40 years we still have a long way to go as amply demonstrated In the narratives above.
We hope the present as well as future Governments continuously review and tighten the policies
and implementation mechanisms further to achieve infant mortality rate of 25/1000 live births by
2017, as targeted in National Health Mission.
CONCLUSION
From the review of child mortality and health issues it is apparent that concerted efforts through
various government policies and programmes have yielded some results in bringing down child
mortality and malnutrition.
But the achievements till date still lag behind desired levels. To achieve so we need to
strengthen our programmes and also have comprehensive monitoring mechanisms specifically
related to basic factors like (a) health care facilities and services, (b) disease specific health
programmes, (c) diet and health behaviour of mother and children. We should also lay equal
emphasis on drinking water and sanitation programmes and also basic education for future
mothers to understand the primary requirements during child birth and child care.
One area in which we still lag behind is in our immunization programmes. Even though a child is
considered fully immunized if provided with BCG and DPT injections and polio and measles
vaccines, we have still not been able to provide these to nearly 50% of our children. We need to
ensure that at least these basic immunizations are provided to our children.
Malnutrition is a major factor affecting the new-borns and young children and also is a key cause
of child mortality. Even though we have attained some success in providing basic nutrients to our
school going children we have not been able to streamline programmes ensuring basic nutrition
and supplements to the mothers and infants. Tackling this issue will go a long way in reducing
infant mortality figures, which are still very high.
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In conclusion it is hearting to note that various Government policies and programmes have
brought down child mortality and malnutrition issues across the country and we hope that
implementation and monitoring mechanisms will be reviewed and further strengthened to achieve
our desires goals.
REFERENCES

National Health Mission publications

The Situation of Children in India A Profile, published by UNICEF
World Bank data on child mortality
Integrated Child Development Services (ICDS) survey reports
Publications from Institute of Economic Growth, University of Delhi
Child line India Foundation publications
Press releases and media reports

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