Jharkhand Assembly Election 2019| Malnutrition neglected as poll issue
More than half of all newborn children are stunted (low height for age) and a third suffer from wasting (low weight for height), according to a report of public health experts from Harvard University and Tata Trusts, who are mapping India’s development indicators for each district.
Saluka Sawain, 24, is mother of six malnourished children in Khuntpani area in Jharkhand’s West Singhbum district, where 67% of the children are underweight — the highest proportion of such children in the country.
In her village, Hisband, 10 km from Chaibasa town, deep inside the thick Sal forests in Maoist country, nearly every child is malnourished. “All children are like this here. This is how God made them,” said a frail-looking Sawain, sitting outside her hut.
Malnutrition is not an election issue in poll-bound Jharkhand, especially in tribal-dominated districts such as West Singhbhum, where the hot button issues are potable water, access to foodgrains through the Public Distribution System, and electricity. Around 45.3% of children in the state are malnourished, according to the National Family Heath Survey 2015-16, compared to the national average of 38.4%.
In Hisband, most children are born at home like in many other parts of the district. More than half of all newborn children are stunted (low height for age) and a third suffer from wasting (low weight for height), according to a report of public health experts from Harvard University and Tata Trusts, who are mapping India’s development indicators for each district.
The government mandates that pregnant mothers should be monitored and that children should be born at a community health centre (CHC) within 5 km of home. But for Hisband and other villages, the nearest CHC is 10-15 km away, keeping mothers away from healthcare.
There is scientific consensus on the consequences of malnutrition: A huge proportion of Singhbhum’s children is likely to die young (common cold is life threatening for malnourished children), and even if they somehow manage to survive, as adults, they will suffer disability, have impaired physical and cognitive development, and perform badly at school and work.
What’s more, many children in the region, including Sawain’s eldest son, who is 10, don’t go to school. Even if they enrol in school, they drop out early.
“The most educated person in our village is a matriculate,” said Vinita Boipoi, who works in a local anganwadi (child healthcare) centre; only eight children were there at the centre at the time. “Both boys and girls drop out of schools early,” she added.
Hisband and other nearby villages suffer from factors that hinder the eradication of malnutrition — pilferage in the public distribution system, non-functioning anganwadis, lack of manpower and doctors, defunct sub-health centres, and issues between the Centre and state.
Sarju Roy, who was food and civil supplies minister in the Jharkhand government till earlier this month when he resigned from the state cabinet to contest against chief minister Raghubar Das from Jamshedpur (East), blames the Centre for not being able to provide rations through PDS to all the poor in Jharkhand.
“We still give free rations as per 2011 Census because of which many people have been left out. We have asked the Centre to raise the PDS coverage as per population estimation for 2016-17 but it did not agree,” Roy said, adding that despite this, malnutrition is more a problem of the health department than that of distribution of food under the PDS.
Then, there is the complete disconnect between policymaking and social realities on the ground. For example, the ANMOL-ANM online app for auxiliary nurse midwives (ANM) developed by the ministry of health and family welfare is aimed at enabling real-time access to information about the health of women and children in malnutrition-hit districts.
But in most parts of Singhbhum, there is no phone connectivity, making it difficult for ANMs to track health indicators of malnourished children. Poor connectivity also leads to locals not getting free rations under PDS, which further aggravates the malnutrition situation. Jharkhand has the highest poverty rate in India, according to a World Bank evaluation report released in October 2018.
Ranchi-based right to food activist Siraj Dutta of Jan Adhikar Mahasabha said ration cards not being issued to everyone and linking disbursement of free ration with the biometric based Aadhaar have led to 23 starvation deaths since 2016 in the state with the latest being of Savitri Turi in Jamua in Giridih district on November 6.
Roy denied the claim and said most of the deaths were due to normal causes and not starvation. Authorities found enough rations at the home of the deceased, he added. Nor do the post-mortems indicate starvation as the cause of death, he added. Roy, however, admitted that there have been “a few stray” instances of denial of rations to people because of wrong seeding of Aadhaar numbers.
At the Chaibasa government run malnutrition treatment centre (MTC), one of the four in the state, most mothers are first-time visitors. Mathari, one of them, has black and white threads wrapped around her neck, wrist and ankles. It is a sign that all of them have visited quacks. “Earlier, people here were convinced that malnutrition was an incurable illness. The parents couldn’t imagine that the child would recover only by eating right. Even now, they keep saying ‘the child is fine, he just looks weak’, or attribute it to the evil eye,” said Dr Jagannath Hembrom, who runs the MTC at Chaibasa.
Indeed, even the word ‘kuposhan’ (malnutrition in Hindi) is alien to villagers. Hembrom said poverty, lack of awareness and high illiteracy were the common reasons for lactating mothers not going to CHCs and availing the benefits of different government schemes here. “Most mothers don’t know that the government will take care of them during pregnancy, and also of their newborns,” said Shomi Savia of Mirabasatola village.
Kunal Sarangi, the BJP candidate from Baharagora, said, “It is very unusual for local people to even ask why a health centre is defunct, let alone worry about malnutrition. It is only in case of a death that some questions are asked.” As a result, he adds, there’s little demand from people that the issue of malnutrition be addressed. “Only if I am interested on my own as a leader, will it will become an issue.”
Jharkhand Mukti Morcha chief Hemant Soren said malnutrition was a bigger issue linked with poverty and the denial of rights to tribal people. “It is part of our bigger narrative of injustice done to tribal people for decades. We have been fighting for the cause and will do in the future also.”
Most of the right to food and tribal rights activists believe that malnutrition and starvation have been brushed aside by the political parties in the Jharkhand in the name of local traditions and lack of awareness.
“The political disdain for malnourishment and starvation is the reason for under five children death in the mineral rich Jharkhand still being highest in the country,” said Ranchi-based economist Jean Dreze, who has worked extensively on food and health issues in Jharkhand.
In most tribal-dominated villages of Jharkhand, the public health care system is almost absent. The situation has been made worse by the recent agitation by tribal groups against the government’s bid to change land laws that prevents the state from acquiring land without consent of the gram sabha — a decision making body in villages. The tribals have also not allowed doctors and health care workers from outside to be deployed.
“There is mistrust among tribals for outsiders. But, we are working to ensure they get proper treatment,” Hembrom said. The Jharhand government has deployed doctors and nurses in Chakradharpur (another area with high malnutrition in the district) with the help of international non-government organization Doctors Without Borders and is also creating a pool of health care workers through angandwadis and community health centres.
“We are moving towards community management of malnutrition,” he added.