• Dr. Vikrant Bhuria

Renowned economist and social activist Jean Dréze has clearly blamed the policies of the Narendra Modi government for the persisting problem of malnutrition and hunger, saying that despite the deteriorating condition of the country, it does not seem that the Government of India is worried about it. In fact, for the last seven years, the tribal have been facing the problem of severe malnutrition due to the policies of the Modi government and remain the most malnourished section of the Indian society. The latest available data shows that India’s 47 lakh tribal children suffer from acute nutritional deficiency which is affecting their survival, development, learning, performance at school and productivity as adults. In fact, malnutrition and poverty are two sides of the same coin. The problem of malnutrition is rampant in areas where poverty is present in extremity. According to Jean Dréze, this government’s understanding of development is reversed. This government considers economic growth to be the only aspect of development, whereas development does not mean only that. There is a huge difference between economic growth and development. Development also means that the per capita income or GDP of a country increases, and also the condition of health, education, democracy, social security improves.

Why Malnourishment? We get energy and nutrients from food to stay healthy, but if we don’t get enough nutrients, including proteins, carbohydrates, fats, vitamins and minerals, we can become malnourished. Due to lack of balanced diet (required by the body) for a long time, the immunity of children and women decreases, due to which they easily become victims of many diseases. Malnutrition is at the root of most diseases caused in children and women. Anemia or goiter disease in women or rickets or night blindness in children and even blindness are the side effects of malnutrition. Malnutrition affects children the most. It begins at or even before birth and progresses rapidly in children between the ages of 6 months to 3 years. The most terrible consequence it causes is the economic loss. Malnutrition reduces human productivity by 10-15 percent which can reduce GDP by 5-10 percent.

Malnutrition and Basic problems It is a well-known fact that there are many causes of malnutrition. These can be divided into immediate (inadequate diet and disease), basic (food insecurity in the family, poverty, lack of access to facilities such as health, clean drinking water and sanitation) and primary (social, political and economic environment) causes. Among the tribals, there are other reasons as well like discrimination, geographical separatism, limited access to public services, cultural differences. Since tribals are heavily dependent on the government for essential services, the government’s responsibility towards them for nutritional and health related services becomes manifold.

Because the tribal settlements are scattered far away and Anganwadis have not been established accordingly, the problem of nutrition persists. Also, there is acute shortage of doctors and staff in the health centers which were set up under the National Health Mission and this is the reason why adequate treatment is not available after one suffers from diseases. A national survey shows that up to 28 per cent of doctors’ posts and 22 per cent of staff posts are lying vacant in primary health centers and community health centers in the country.

In order to overcome the budget discrepancies in the tribal areas, the Tribal Sub-Plan was formed in 1974 so that a fixed amount of 8.6 percent in the country according to the proportion of population and according to the population ratio in the states, can be given only to the tribal areas. But it was found that the TSP allocation has always been well below the prescribed criteria. For example, between 2014-15 and 2016-17, a study of TSP spent for ministries related to nutrition shows that the central government has allotted only 4.4% where8.6% was to be allotted.

There is a severe lack of infrastructure and human resources in all the schemes implemented by the government, due to which their quality and their access to tribal areas are affected.

Malnutrition and the Absence of Vitamin B-12 from the National Programme This has been revealed in two separate researches conducted on malnourished children at RNT Medical College. In the first research, it was found that the body of malnourished children did not have Vitamin B-12 as compared to iron and folic acid and they became malnourished due to anemia. The same reason was found in another research, but a new malnutrition named “Infantile Tremor Syndrome” emerged.

The team of HOD Dr. Suresh Goyal, Dr. Lakhan Poswal, Dr. Kuldeep Singh and Dr.YaiToiram did this research. In the first research, tribal children in the state were found to be suffering from malnutrition named “Infantile Tremor Syndrome”. Due to this, along with the lack of blood, the mental development of the child is also stopped. It was found most commonly in children who did not receive complementary foods along with breast milk after 6 months of age. According to other research, the major cause of malnutrition in children is the lack of vitamin B-12.

Although iron and folic acid tablets are provided free of cost to expectant mothers in all health centers and hospitals under the government’s national programme to provide nutrition to unborn babies, but Vitamin B-12 is not in the national programme’s list.

This research has also been published in AIIMS Delhi’s magazine “Indian Journal of Pediatric”, but since it would have brought disgrace to the BJP government, most of the media did not give importance to this news. *The only sources of B-12 are eggs and meat, which are not included in any national programme.

Malnutrition and Sickle Cell Anemia Crisis Sickle-Cell Disease (SCD) or Sickle-Cell Anemia or Drepanocytosis is a genetic blood disorder that is passed from parent to child. It reduces life expectancy.

It is spreading rapidly among the tribals and there is no treatment available for it. It has been proved that due to malnutrition, this disease is increasing among the tribals due to ‘Genetic Mutation’ and due to marrying in their own society, its effect is increasing in children.

Constitutional Right to Adequate Food Articles 21 and 47 of the Constitution compel the Government of India to take appropriate measures to ensure a dignified life with adequate food for all its citizens. Article 47 states that it is the duty of the State to make continuous efforts to raise the level of nutrition and the standard of living of the people and to improve public health. Whereas according to Article 21, no person can be deprived of his life or personal liberty. Therefore, the provisions related to the Fundamental Rights of the Constitution talk indirectly and the provisions related to the Directive Principles of State Policy talk directly about eliminating malnutrition.

Modi Government is Indifferent The behavior of the Narendra Modi government with the citizens of its state, during the time of Corona, is in stark contrast to the constitutional framework of the Public Welfare of India. The Directive Principles of State Policy guarantee employment to the citizens. According to Article 39, the state shall provide equal means of livelihood to all citizens. According to Article 43, the State shall provide work, subsistence, wages, decent standard of living and social and cultural opportunities for workers and shall make efforts to promote cottage industries in the villages. At the same time according to Article 46, the State shall make efforts to promote the educational and economic interests of the weaker sections. But in reality, there was no far-reaching vision by the states, as far as the policies of the Public Welfare are concerned, and this is the reason for the development model getting limited to a very small population, due to which inequality also increased.

Inequality is on the Rise There is a big difference between the development of the total population of this country and one percent of the people. 60 percent of the people in this country struggle to earn a two-square meal. 86 crore people in the world are victims of starvation, of which, about 21 crores are from India itself. 40 percent of the children and 50 percent of the youth in the country are malnourished. According to the 2011 census, 1.53 lakh children beg. Normally in India, a farmer suicides every half an hour. About 60 crore quintals of foodgrain remain in godowns in the country and the foodgrain requirement of the poor can be fulfilled in just one crore quintal. Executive Director of Oxfam International, Winnie Byanyima, had said that it is morally cruel that in India, where the poor are struggling to earn a two-square meal and their children’s medicines, the wealth of some of the already rich people is continuously increasing.

Where is the ‘Right to Food’ The Supreme Court had recognized the ‘Right to Food’ as a fundamental right in 2001. The National Human Rights Commission in its interpretation had said that the ‘Right to Food’ is Indians’ fundamental right. Also in 2003, it was further clarified that ‘The right to be free from hunger is a fundamental right’. The states are directed by the Constitution to make such a policy that every citizen should have equal right to get proper means of livelihood and the state should try to raise the nutrition and the standard of living of its citizens and improve public health. Articles 39-A and 47 have said that this will be the primary responsibility of the state.

Reality of ‘Sabka-Saath, Sabka-Vikas’ Bearing in mind to ‘Take Everyone Along’, a resolution was passed in the annual meeting of the United Nations General Assembly in the year 2015, with the aim of establishing a prosperous society by eliminating poverty, inequality and unemployment across the world. For this with a deadline of 15 years to come, a better world was envisioned to be achieved by 2030 and a plan was presented in which 17 topics related to improving human development were included. In India, it has been named ‘Sabka-Saath, Sabka-Vikas’. Four years after the implementation of this agenda, when the Sustainable Development Report 2020 came, India’s place in it was 117th in the list of 166 countries, which clearly means that it was at a very low level. India’s neighboring countries performed better in this index and Bhutan was ranked 80th, Sri Lanka 94th, Nepal 96th, Bangladesh 109th and Pakistan 134th.

Development of Tribal Children Hindered About 40 percent of India’s tribal children under the age of five are stunted (dwarfs), and 16 percent of them are severely stunted. Low and medium levels of stunting are similar among tribal and non-tribal children. But severe dwarfism is more common in tribal than non-tribal children.

At All-India level, the number of sub-centres, primary health centers and community health centers in tribal areas are far less than their prescribed numbers. This lack is even more visible in tribal-dominated states.

Problem of Malnutrition Malnutrition is the condition in which the body does not get complete nutrition due to disorderly intake of nutritious substances and food. Since we get energy and nutrients through food to stay healthy, if we do not get enough nutrients, including proteins, carbohydrates, fats, vitamins and minerals, we can become victims of malnutrition. Malnutrition also occurs when the right amount of nutrients is not available in a person’s diet.

India’s Plight Exposed in the Global Hunger Index India has been ranked 94th out of 107 countries in the Global Hunger Index, 2020. Since India has been ranked even behind countries like Sri Lanka, Nepal, Pakistan, Bangladesh in this index, there is a lot of discussion on it. Out of 107 countries, only 13 countries are shown to be worse than India in terms of malnutrition. In the year 2019, India was ranked 102 out of the list of 117 countries, while in 2018 it was ranked 103. According to the report released with this index, 14 percent of India’s population is undernourished and the rate of stunting among children is 37.4 percent. In the Global Hunger Index, 2020, poverty, lack of diversified diet, low levels of maternal education, etc. have been considered responsible for malnutrition.

In a report released by the magazine ‘The Lancet’, it was revealed that out of 1.04 million deaths of children under five years of age in India, almost two-thirds of deaths are due to malnutrition. The above data regarding malnutrition in the country is quite worrisome. Around 200 million children worldwide and every second child in India suffer from one or the other form of malnutrition.

Tribal Children Malnourished in Madhya Pradesh In July this year, a two-and-a-half-year-old innocent Satyam died of malnutrition in the Chandmari tribal basti of Purushottampur, a Gram Panchayat in Panna district of Madhya Pradesh. Three other innocent children had died in this basti within seven days. The Human Rights Commission has got strict on this. But this is not the first time that the Shivraj government has shown insensitivity towards the tribals. In the year 2016, the National Human Rights Commission had issued a notice to the state government on the death of 116 children in five months in three development blocks of Sheopur district.

It is also depressing that five years ago, Shivraj Singh’s government had shown extreme inhumanity by abdicating its responsibility. At that time, Madhya Pradesh Health Minister Rustam Singh had shown extreme negligence by saying that 70 thousand children in the state who are malnourished is due to superstition spread in the area. He had said that people do not want to be treated. Whereas the reality is that Shivraj Singh’s government never paid any attention to the development of tribal areas and this insensitivity continues.

Many tribal districts in Madhya Pradesh are currently in the grip of malnutrition. About 12 lakh children are caught by it in the state. The nutrition of children and pregnant women has been the worst affected due to lockdown during Corona. Nutritional food could not even be distributed in many districts. The nutrition system has collapsed during the Corona period. The position of Madhya Pradesh is also not very promising in terms of malnutrition. In rural areas, the government’s emphasis is on privatization of health services, which will in no way be beneficial. The private sector will only focus on earning profits.

According to the National Agency Sample Registration System set up by the Government of India, 11 lakh children are malnourished in the state, while 1.20 lakh are severely malnourished, which completely tarnishes the image of the state. Malnutrition has become formidable in tribal areas. Maternal mortality rate and infant mortality rate is also the highest in tribal community. 76.1 percent tribal children up to 5 years of age in Madhya Pradesh are anemic.

The author is President of Madhya Pradesh Youth Congress