Swachh Bharat Mission, if implemented in a holistic fashion, holds the key to curbing not only the problem of diarrhoeal deaths for which India holds the world record, but also malnutrition. However, the World Toilet Summit, which was held in the national capital this year as part of the Mission, was unable to see the link: how diseases caused by poor sanitation are inextricably linked to chronic malnutrition among the country’s children.
The apathy displayed by successive governments towards the issue of malnourishment was laid bare in the 2014 Global Hunger Index Report, which ranks India at the 55th position. According to the index, 17 percent of India’s population is undernourished, 30.7 percent children under five years of age are underweight and 5.6 percent dies before completing five years of age. The numbers show a decrease from the last decade but their accuracy is in doubt.
The ministry of women and child development and UNICEF had conducted a Rapid Survey on Children (RSOC) in 2013-14. However, the results of the survey have not been released by the government on the grounds that it is still under review. This national survey covering all 29 states in India was used along with National Family Health Survey-3 (NFHS-3), a decade-old survey, to come up with the Global Hunger Index findings.
Significantly, the global nutrition report itself questions the RSOC figures. It says, “Most of the data are from different reports, and this often meant that the years when data were collected varied. The temporal diversity in the data made it difficult to compare nutrition data at the district and state levels or even different types of indicators for each district.” Perhaps this gives an explanation why the government looks unlikely to release the report anytime soon.
Comparing the nfhs-3 data with the rsoc report, the average annual rate of reduction in stunted growth is 2.6 percent, below India’s target rate of 3.7 percent. According to nfhs-3, which gives the data of 2005-06, 47.9 percent kids had stunted growth due to malnourishment. Going by the rsoc, this number had decreased by 9.1 percent by 2013. Even wasting (the process by which a debilitating disease causes muscle- and fat tissue to atrophy) under five years of age has reduced by five percent.
Since India has such a large population and high prevalence of stunted growth, this decrease even affects the Global Hunger Index.
According to health experts, open defecation and unhygienic environment are making children more vulnerable to stunting of growth, wasting and being underweight. Nutritionists call this phenomenon ‘environmental anthropathy’. The chief of child development and nutrition at Unicef, Saba Mebrahtu, tells Tehelka, “The microvilli present in the intestine, if infected with faecal matter, cause chronic infection in the stomach. Due to this, the nutrient absorption capacity of the intestine decreases. Therefore, despite intake of nutrient-rich food, children suffer from malnutrition. The nutrients are consumed in fighting infection rather than physical development.”
According to studies, open defecation leads to 54 percent of international variation in child height (stunting). In contrast, variation in GDP has a contribution of only 29 percent. According to the Demographic Health Surveys (DHS), Indian children are very short compared to international standards. This lack of height is exactly what is predicted as a result of widespread open defecation in the country.
The link between open defecation and child height is stronger in countries with high population density such as India, as germs released into the environment due to poor sanitation affect a large number of growing children. Open defecation causes negative ‘spillover’ because germs from one person’s faeces, released into the environment, can make other people sick. Even if everybody in the family uses a toilet, children are exposed to germs by other people’s behaviour.
The immune system of children is further affected by the poor quality of supplementary food provided in Integrated Child Development Services (ICDS) centres and anganwadi schools.
The who recommends the introduction of solid or semi-solid food for infants around the age of six months because by that time, breast milk by itself is no longer sufficient to maintain a child’s optimal growth. However, almost half of breastfed babies are not given solid or semisolid food even at eight months.