The first set of data from the National Family Health Survey-4 for 13 States and two Union Territories should be seen as a report card on how effectively India has used its newly created wealth to alter a dismal record of nutritional deprivation, ill-health and lost potential among its citizens, particularly women and children. Given the steady growth in real per capita GDP since the 1980s, and the progress made since Independence in overcoming severe undernourishment, enlightened policy approaches could have brought about a giant leap from 1992-93, when the first NFHS was conducted, ensuring that no child or woman was left behind in the quest for health for all. Evidently, the Indian state has not viewed the situation — even at the height of a prosperous phase of economic growth a decade ago — of 39 per cent of children under the age of five remaining underweight as constituting a national crisis. It comes as no surprise, therefore, that this failure to assume responsibility for child nutrition has left 34 per cent of children in that age group underweight today. There is also a lot of evidence to show that the deprived sections of India’s children have low weight even at birth due to the general neglect of women’s nutrition and well-being.
It is imperative that the data coming out of NFHS-4 lead to the charting of a new policy course that makes access to nutrition and health a right for all. Asserting this right would require the strengthening of the Integrated Child Development Services scheme in all States, particularly those with a higher proportion of underweight and stunted children. In the first set of data, Bihar and Madhya Pradesh bring up the rear on these crucial metrics of child development. It deserves mention that even within the ICDS, there is a clear deficit in caring for the needs of children under three. Nutrition in the first two or three years of a child’s life has a lasting impact on her development; care given in later years, including freshly cooked meals at school, cannot undo the setback caused by neglect during this foundational phase. Other key areas requiring intervention are access to antenatal care, reduction of high levels of anaemia among women, and immunisation; it is a cause for concern that a State such as Tamil Nadu with an active public health system recorded a reduced rate of full child immunisation compared with NFHS-3 data. Overall, there is a need to assess the health of citizens more frequently than the current NFHS cycle of seven to 10 years allows. Data gathered every two or three years would help make timely policy corrections. A fuller picture of the health of urban and rural Indians will emerge later in the year when data for all States become available. They should send out the message that sustained economic growth is not possible without state support to achieve the well-being of the population, especially women and children.
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