India: Hunger speaks the language of death
India: Hunger speaks the language of death in Madhya Pradesh
Sachin Kumar Jain
November 16, 2010
The Indian Council of Medical Research (ICMR) defines undernourishment as a situation arising out of low calorie intake by an individual. The National Nutrition Monitoring Bureau and the National Institute of Nutrition prescribes the 'Recommended Dietary Allowance' (RDA) in India. The effect of undernourishment on an individual differs depending on the person's age.
M. H Suryanarayana of the Indira Gandhi Institute of Development Research, in a background paper commissioned by the Planning Commission of India titled – Nutritional Norms for Poverty: Issues and Implications (2009), mentions that the calorie consumption per individual shows an alarmingly decreasing trend in Madhya Pradesh since 1972-73. A person in rural Madhya Pradesh used to consume an average of 2423 calories in 1972-73, which was on a par with the recommended minimum calorie requirement for a rural person by the National Nutrition Monitoring Bureau and the National Institute of Nutrition. However, it is constantly declining. For instance, the average calorie consumption in Madhya Pradesh dropped to 2323 in 1983; to 2164 in 1993-94; 2062 in 1999-00 and to 1929 calories in 2004-05.
It is interesting to note the contradiction in the new poverty estimates with the nutritional requirements and basic minimum needs of the society. While the experts say that during 1972-73 the average per capita per diem intake of calorie in rural areas was 2423 calories in Madhya Pradesh, which has now come down to 1929 calories. Consumption of protein, which was 68 grams, has declined to 58.8 grams.
The Millennium Development Goals (MDGs) set by the United Nations, decided to reduce extreme poverty and hunger by half in comparison to what that existed in the 1990. Millennium Development Goals - India Country Report 2009 claims that incidences of poverty in the country declined from 55 percent in 1973-74 to 36 percent in 1993-94 and further to 27.5 percent in 2004-05. These poverty headcount ratios were, however challenged in the Supreme Court of India.
The current definition of poverty alleviation in India is assessed based on individual spending capacity. On the contrary, level of individual spending capacity, accepted as a measure of poverty, does not correspond to the daily requirement to fulfil minimum living standards. The present all-India average of rural poverty is set at a per capita spending capacity of INR 446.68 per month; and the national urban poverty line is set at INR 578.8 per month. Poverty line thus is a per capita expenditure of INR 12 per day.
It is interesting, however, to note that the supporting data used by the Expert Group set up by the Planning Commission shows that in Madhya Pradesh, 90.55 percent of the population in the rural area consumes less than the prescribed 2400 calories and 64.52 percent of the urban population consumes less than 2100 calories, measures way below the prescribed ideal national standard. This means that the poverty level and its measure prescribed by the Planning Commission contradict the Commission's own finding concerning calorie intake. This means that the per capita spending capacity set as a standard for assessing poverty, will not meet the minimum requirement of an individual to secure his/her minimum dietary requirement. It also implies that a large section of the population, who are currently assessed to be above the poverty line are in fact in need of state help, and further, the alleged reduction of poverty by the government is nothing but a farce.
The present situation demands drastic transformation in the approach and an honest intention to address the terrible nature of hunger. Fundamentally, it must be understood that community controlled management of resources (land, water, forest and bio-diversity) is the only sustainable response to the present form of food insecurity. The state must ensure domestic and rural food production, in particular of the cereals, by prioritising and promoting it by adequate resource allocations. It is now established that the corporatisation of food grain production and its procurement has become a fundamental cause of hunger and curse for the poor.
Hunger in India and Madhya Pradesh in particular is the result of shoddy government policies. Without addressing the failures in the state policies, or even trying to understand them, the attempt is to depend on institutional and programmatic entitlement-based approaches. It must be recognised that institutional approaches for the elimination of hunger will not work unless the structural causes that result in starvation and malnutrition are addressed.
Local production, procurement and distribution and the universalisation of the Public Food Distribution System (PDS) must be established in the country as a first step to address widespread malnutrition. State policies that try to address chronic hunger by approaching the issue as a mere food security concern must change and the emphasis must be on guarantying nutrition security. The failure of the food security programmes like the Integrated Child Development Scheme (ICDS) and the Mid-Day Meals scheme is because that these programmes only addressed (partially) food security, not nutrition security.
Additionally, there must be conscious efforts to strengthen grass-roots level institutions, like the Panchayaths. At the moment the state government is not interested in empowering local institutions like the Panchayats, childcare workers and the public food distribution system operators, though they play a pivotal role in addressing hunger. Even though these are the state organs through which the benefits, of whatever nature, of the government policies reach the needy at the grass roots level, the approach of the government to these lower ends of the delivery system is to reduce their strength. Instead of empowering a childcare worker to discharge her duties effectively, the attempt is to ignore the training requirement of these low-paid workers, almost completely. The result is that these institutions fail to deliver the expected result. In addition, new structural adjustment programmes introduced by the government, like the cost cutting at the lowest levels of administration, forces an ill-equipped and ill-trained staff to discharge the duties of three to four persons, forcing the person to underperform in all aspects. For instance 20 to 30 percent of the supervisory posts are lying vacant since many years in the state ICDS. The demoralisation this environment creates among the staff also affects the programme delivery. To address this, the state government must introduce drastic changes.
Poverty and hunger are the biggest challenges not only for the survival of the people but also for the development. Efforts have been made to reduce the crisis, but it is becoming clearer that in the lack of a clear perspective in the conceptualisation of hunger from the people’s point of view and life, the measures taken by the state government would not contribute towards meeting the Millennium Development Goals in Madhya Pradesh, especially on hunger and poverty.
Poverty grows, as it is manipulated!
There is an argument that the relation between hunger and development is full of contradictions. But it is not. The state government claims that it has managed to motivate industries to invest more than five hundred thousand Crore Rupees in the state for development. The fact is this investment would consume more than five hundred thousand hectare of land, thousands of hectare of forest. The implementation of the proposed (and promised) development will position the industries so that they could control the source of water meant for drinking and irrigation of the people. Any layperson can tell you that this approach to development will increase hunger and poverty in the state. Yet the state will not accept it.
There are many authentic analyses available to prove that poverty and hunger is no longer an invisible deity. It took 10 long years to establish that poverty level is not declining in the state. It is shocking to note that despite all existing lacuna in the poverty estimation exercises, the poverty level has increased in the state. In 1993-94, there were 44.6 percent people living below the poverty line. As per the target set by the MDG, this must go down 22.3 percent by 2015. However according to the poverty estimates suggested by Prof. Suresh Tendulkar Committee, the level of poverty in the state has increased by 4 percent. However other poorer states like Bihar (6.1 percent decline), Chattisgarh (1.5 percent decline), Jharkhand (6.4 percent decline) have shown some positive trend in the decline of poverty.
According to M. H. Suryanarayana, 10 percent of the state's population survives by consuming 1436 calories a day, and next 10 percent consumes 1596 calories. Only the better off, the top 10 percent of the population living in best conditions consumes 2552 calories a day (as per the 2004-05 figures).
This analysis also claims the declining trend in Urban Madhya Pradesh, where calorie consumption average has declined from 2229 in 1972-73 to 1944 calories in 2004-05. On the other hand, Kerala has acknowledged the increase in daily calorie consumption by 29.19 percent, from 1559 in 1972-73 to 2014 in 2004-05 in rural areas and 15.84 percent from 1723 calories to 1996 in 2004-05 in urban areas. This vast difference between Kerala and Madhya Pradesh is due to the difference in approach of addressing the issue by the governments in both states and that of its society.
Kerala addressed hunger by strengthening decentralised governance through significant efforts. In Madhya Pradesh, however even in 2010, the state government keep all powers to its own. Even today the governance, implementation and monitoring of any food-welfare programs (PDS, MDM, ICDS, NMBS, JSY, etc.) is not with the community institutions. These programmes are run resembling puppets, where often one fails to locate the controlling thread to its operator, rendering the system completely unaccountable.
Analysis based on the data of the government of India (2006 & 2007) paints a bleak picture on Madhya Pradesh. Today 90.55 percent rural population and 57.07 percent of the urban population in the state live under calorie insufficiency. They are unable to find means to have food that would provide them 2400 calories a day, the essential minimum required for a healthy living. It is unfortunate that the state's economists and planners do not reflect on this deficiency as a base indicator of poverty. However, they manipulate the poverty line, thereby excluding 36 percent people living in hunger and giving them no opportunity to move out from the cycle of chronic poverty.
The state also plays gimmicks with its poor. Some of the welfare programmes are of such nature. For instance the 1.3 million strong poor, but aged persons paid INR 275 per month as old age pension, and the one-time payment of INR 1400 to women living under the poverty line for women (2 million in Madhya Pradesh) to cover their basic nutritional needs. The government expresses concern regarding child malnutrition. Yet the daily spending allocation of the state for children under the age of six years for their food is just INR 4 per day. The amount spent per child for mid-day meals is a mere INR 3.
Prof. Tendulkar Committee's report fails to debate the multidimensional nature of poverty. The Committee's assessment is based on the data available on private household consumption and expenditure. It misses the structural and political issues that lead to poverty, for instance the exclusion of people on different grounds, such as gender, caste, disability. The outcome of this narrow perspective keeps 3.8 million people out of the poverty line in Madhya Pradesh and makes them ineligible to receive any benefit under the food subsidies, health care or any other form of support that will help them to come out of the actual poverty they are in.
It is unbelievable to register this fact that the Global Hunger Index drawn by International Food Policy Research Institute (IFPRI), based on three indicators (the proportion of people who are calorie deficient, the prevalence of underweight in children under the age of five and Infant Mortality Rate), declared the conditions in Madhya Pradesh as 'most alarming' in the world, and placed the state between Ethiopia and Chad. However, the government-sponsored experts continue to avoid this report, the result of which is the death of more than 150,000 children from starvation and malnutrition in the state during 2005-10.
Revisiting institutional approach for eliminating hunger
At any point of time, when our governments say that there is a political will to fight malnutrition, it sounds like changes are forthcoming. The unfortunate fact is that such changes never happen. The creation of Atal Bal Mission (ABM) in the state is an example. The ABM at least provided an opportunity to bring the government's understanding on a public platform, to debate it. The commonsense is that such an opportunity will pave way for a dialogue between the state and the subjects, thereby pushing the state to engage in meaningful interventions. Yet this did not happen.
MDGs with a motive to eradicate extreme poverty and hunger never reached Madhya Pradesh. Changing the mindset of our experts and policy makers is a huge challenge. They often blame the victims, for instance accusing the parents as careless and try to absolve from the responsibility. They conveniently forget that the state is responsible for every child within its territory. The state and its experts still need to realise that malnutrition is just not a matter of the non-functioning of the Anganwadi centers (child care centre), but addressing it is the constitutional responsibility of the state.
The ICDS, an institution created to look after the supplementary nutrition, immunisation, health and growth monitoring of the children under the age of six years and pregnant and lactating mothers was launched in 1975 as world’s biggest early-childhood scheme to deal with the crisis. Through the programme was grand, the execution was shoddy. An Anganwadi worker who had neither the training nor the skill to do the job operated the ICDS centres. Often each unskilled employee at these centres was required to take care of 60 to 80 children. They are to fill seven registers regularly.
Then it was decided that the children should be provided supplementary nutrition with energy value of 300 calories and 8-12 grams of protein. It took 34 years to realise that such quantities of calories and protein were insufficient to the children. In 2009, our experts increased the calorie provisions to 1000 calorie per day. Under these conditions, the state government could hardly touch four to six percent growth rate in last 10 years against the country’s eight to nine percent growth rate. This is because the capability deprivation and exclusion caused by under-nutrition pulled the state back in the growth rate.
The state has seriously failed to recognise the fact that more than 55 percent of infant death of children below the age of five years is those of children below the age of 28 days. Seventy percent of these deaths occur before a child reaches one year old. Food insecurity, under-nourishment and gender bias promotes are attributed as the main reasons for such alarming infant mortality rate.
Now the government policy is to promote 'institutional delivery' in the name of safe motherhood. The state continues to fail in realising that food insecurity and malnutrition during pregnancy and lactation results in infant mortality. The state still deals the issue of safe motherhood through discriminatory policies. There are programs, policies and resources available for pregnant women, either working or associated with the organised sector. In reality, the women in the unorganised sector are shockingly pushed out of the socio-economic safety net.
In this context, the institutionalisation of the Atal Bal Mission is seen as a political mandate. But the state will have to show its honesty by addressing the structural causes that leads to malnutrition and bring in policy forums. The mission has lost the first battle, when it refused to support the providing of eggs (a key source of protein, calorie and micronutrient and prescribed as a best option) to the children succumbing to political and religious interests.
The sentiments of any religious sections must not be hurt. In addition, it must be noted that it is not the children of those who oppose the distribution of eggs to the children who suffer from malnutrition. They are the children of the tribal and the Dalits who do not have any religious or cultural taboos in eating eggs. Then why they should be deprived of having eggs?
Commonsense is if the livelihood security for the poor is not created, if the Mahatma Gandhi National Rural Employment Guarantee Act and the Forest Rights Act are not properly implemented, if the agriculture polices are not formulated to be pro-people, if the forced displacement and eviction from the natural resources continue, the curse of malnutrition will become more universal. But the Atal Bal Mission hesitates in taking strong convergent actions in terms of creating a functional framework to address malnutrition.
I believe that this mission must have been given enough powers with a leadership agenda to an officer not less than the state's Principal Secretary, who could work independently in coordination with the Chief Secretary of the state to facilitate a much required reform process. Then only the bureaucracy would respond to the mandate created by the mission. It is fundamental, because a single department cannot deal malnutrition and hunger. It is significant that for the mission to take a stand on the decreasing of the food grain/cereals production in the state and concerning the genuine implementation of the decentralisation of the administrative and financial powers under the 73rd and 74th amendments of the Constitution, thereby bringing in active community participation in the formulation of the food-livelihood-production policies and actions. At the moment, the mission takes a narrow position on these very elementary issues.
It will be a key challenge to make malnutrition a people’s own issue, because a certain section of the society has learned how to live with hunger! We must not ignore this fact in the debate, that the community ownership is the foundation for rendering the battle against malnutrition sustainable and effective. Hired experts must not be allowed to define the society's role. Instead, we should accept that community based knowledge on nutrition and its sources can change the present austere scenario; experts should not be allowed to be experts in killing community strengths by proposing technicalities and making existing challenges unnecessarily more difficult.
The views shared in this article do not necessarily reflect those of the AHRC, and the AHRC takes no responsibility for them.
About the Author: The writer is a Social Researcher, Development Journalist, honorary State Advisor (Madhya Pradesh) to the Commissioners of the Supreme Court in Right to Food Case – WR 196/2001 and heading Vikas Samvad.