The Madhya Pradesh Support Group of the Right to Food (RTF) campaign recently reported 85 deaths due to malnutrition and related diseases in the state in the last seven months - a matter that requires urgent intervention. The alert prepared by the group states that 55% of children in Madhya Pradesh are malnourished and hence require special attention. The main cause is the non-availability of the required minimum level of nutrition; often this results in disease or death. For example, on October 26, the village of Badwani-Hingua in Sendhwa tehsil lost five children because of food insecurity; the Chief Medical Officer of Badwani has confirmed malnutrition as the cause of death. There are 40 more children in this village who are severely malnourished, and another 184 are said to be in the third stage of malnutrition. Twenty-four surrounding villages face similar conditions.
The situation in other parts of the state shows a similarly dismal picture. In Chatterpur district, 8 children died due to malnourishment and measles within a period of 12 days in August and September this year. In Damoh district, within a span of two months, 7 tribal children died of malnutrition. Khandwa, Shivpuri, and Morena districts have also suffered many losses due to malnutrition and starvation.
It is well established that 80% of a child's mental and physical growth takes place in the first two years after birth. During this time, the child requires high nutrition and ample care. In a malnourished child, these are absent, and hence the child's overall development is hampered. The child's resistance capacity is minimal, paving the way for a number of ailments and diseases like fever, vomiting, measles, diarrhea, etc. Under normal circumstances, these diseases are not very dangerous and easily curable. But in a malnourished child, they often become a death trap. But although this is well known, malnutrition deaths remain a recurring phenomenon. Ending these requires the coordinated efforts of a number of parties - parents, doctors, the state machinery, the courts, etc., and without all of these coming together, children continue to be lost to malnutrition.
The Supreme Court has made some commendable efforts in guaranteeing people's right to food. In the case technically known as the PUCL vs Union of India and others (Writ Petition [Civil] No. 196 of 2001), the SC passed significant orders. In its interim order dated 28 November 2001, the Court issued directions pertaining to 8 food-related schemes sponsored by the central government. These are: Annapoorna Yojana, Antyodaya Anna Yojana, Family Benefit Scheme, Integrated Child Development Scheme, Maternity Benefit Scheme, Mid-Day Meal Scheme, Pension Schemes, and the Targeted Public Distribution Scheme. Briefly, the order directs the Union and State Governments to implement these schemes fully as per official guidelines. This, in effect, converts the benefits of these schemes into legal entitlements for the citizens. Further, the court has given directions pertaining to certain other schemes, notably the Sampoorna Gramin Rozgar Yojana.
In May 2002, the Supreme Court also designated two commissioners to monitor the food security situation around the nation, as well as compliance with the SC orders. These Commissioners, with the support of grass root organizations, analyze data from government and non-government sources, and submit their findings regularly to the Supreme Court.
The Integrated Child Development Scheme
Amongst these government's efforts, the ICDS is the most significant. It is perhaps the largest of all the food and supplementation programs in the world, and was initiated in 1975 with the following objectives identified by the Planning Commission:
- To improve the health and nutrition status of children 0-6 years by providing supplementary food and by coordinating with state health departments to ensure delivery of required health inputs.
- To provide pregnant and lactating mothers with food supplements.
- To enhance the mother's ability to provide proper child care through health and nutrition education.
- To achieve effective coordination of policy and implementation amount the various departments to promote child development.
The food is provided to the children through Anganwadi Centers (AWCs). One Center is provided for a population of 1000 (700 in tribal areas). Most significantly, it has been explicitly stated that all State Governments/union territories shall utilize the entire state and central allocation under ICDS and under no circumstances shall the same be diverted, and preferably also not returned to the Center.
This grim reality is underlined by the statistics available for MP. Of the total population of 10,618,323 who are in the age group of 0-6, only 2,334,789 are enrolled under the SNP - a mere 22%. While the norm for the average number of children to be enrolled per AWC is 80, only 57 is the actual enrollment figure. Similarly where the norm set for pregnant mothers is 20 per AWC, only 15 are actually enrolled.
The inadequate allocation of funds is another major issue, showing up the state officials' attitude towards malnutrition. The annual report 2002-03 of the Planning Commission shows that funds needed for the Supplementary Nutrition Program for children of age 0-4 years and mothers in MP is a total of Rs. 211 crores. However only Rs.59 crores have been made available by the state government. The Center has also set a norm of Re.1 per beneficiary per day, but the state only spends 49 paise on each child daily. Further, even this norm of Re.1 was set in 1991 and has not been subsequently revised. A letter sent to all states by the Commissioners of the Supreme Court states, "The financial norms need review if prices escalate over the years." The Commissioners' Fifth Report sets the need currently at Rs. 2.00 per child per day.
The SC Commissioners have also tried to raise the issue of malnutrition and non-compliance with the Court's orders in many letters to the State Government, but have received no response. Despite the Court's orders that ICDS must be implemented in full in Shivpuri district of MP in the year 2003-04, the State spent only about Rs. 90 lakhs out of the allocated Rs.2.5 crores on supplementary nutrition. The result: long and frequent disruptions in the supply of nutrition to highly vulnerable children and mothers living in the area. The pattern of malnutrition deaths continues.