Child malnutrition in the Indian state of Maharashtra

By Karen Holland
9 February 2006

Two studies on child deaths in one of India’s most economically-developed states, Maharashtra, vividly expose the social reality faced by millions across the country as a result of decades of neglect and deceit by both Bharathiya Janatha Party (BJP) and Congress-led governments at state and national levels.

The studies were conducted over almost a decade and revealed shocking levels of malnutrition and child deaths alongside entrenched state government neglect and corruption. The results reinforce recent statistics published in the UN’s Human Development Report 2005, which ranks India at 127th of 177 countries for progress in human development as measured by a range of social and economic indices.

Maharashtra is India’s third largest state by area and, with more than 96 million people; it is second largest by population. Its capital, Mumbai or Bombay, is the country’s financial and commercial centre and home to India’s huge film industry. The state’s heavily industrialised economy produces 13.2 percent of India’s GDP. Maharashtra receives 17 percent of India’s foreign investment, accounts for 32 percent of national exports and pays a staggering 61 percent of all corporate taxes and 37 percent of personal income taxes. Of all the states in India, it has the second highest per capita income.

In this context, the level of poverty in the state reflected in child mortality rates assumes an even more grotesque character. It is no wonder, as the research reports dating back to 1998 show, that successive state governments have sought so persistently to cover up the terrible facts.

The first comprehensive statewide study was carried out between 1998 and 2000 by an alliance of non-government organisations (NGOs) called the Child Deaths Study and Action Group (CDSAG). The group was headed by Dr Abhay Bang of the Society for Education, Action and Research in Community Health (SEARCH). The results of the research were published in 2002 and summarised in the Economic and Political Weekly (EPW) in December of that year.

The EPW article explains that the CDSAG study was prompted by the SEARCH’s discovery of serious discrepancies between government figures on child deaths and those based on its own studies in the eastern district of Gadchiroli. The state government—at the time a coalition of the right-wing Hindu communalist BJP and Shiv Sena—was forced to order the district magistrate to investigate.

The magistrate confirmed that the figures were much higher than those recorded by the government’s family welfare department. For example, while the state had previously recorded the still birth rate in Gadchiroli at four for every 1,000, the magistrate estimated the figure at 68. The infant mortality rate (IMR) stood at 118, instead of 13. The EPW article noted that the 1983 National Health Policy called for the IMR to be reduced to less than 60 per 1,000 by the year 2000, however, the annual report of the Sample Registration System, Government of India for 2000 stated that the IMR in India had stagnated since the 1993 at 72.

CDSAG recorded child deaths over two years at 13 sites in Maharashtra, including rural, tribal and urban districts across the state. Its report concluded that the IMR and child mortality were “under-recorded and under-estimated” and that the IMR for Maharashtra was estimated to be 66.2, well above previous official estimates. It found the family welfare department’s statistics on infant mortality were “woefully incomplete, recording only 21 to 24 percent of infant deaths”.

The second and most recent research into child deaths in Maharashtra, conducted by the Committee to Evaluate Child Mortality (CECM) and again led by Dr Bang, was instigated by the state government in 2004. Congress and a breakaway party, the Nationalist Congress Party (NCP), formed a coalition government in Maharashtra after the 1999 elections, ousting the BJP-Shiv Sena alliance.

The fortnightly Indian magazine Frontline in its September 10-23, 2005 issue, explained that the CECM was initiated after public outrage over press reports exposing continued appalling levels of child deaths in the state. Within two months, up to 2,306 children in nine of the state’s 35 districts had died of malnutrition-related causes.

The first of two CECM reports, published in August 2004, documented the under-reporting of statistics by a government “insensitive to their sufferings”. The report reviewed the state’s 15-year record and found that the rate of malnutrition in children had only fallen by 0.6 per cent between 1988 and 2002.

The CECM report cited a study of the National Nutrition Monitoring Bureau (NNMB) which found that in Maharashtra over four million children were affected with Grade 2 to 4 malnutrition (where Grades 3 to 4 are considered life-threatening). It estimated that over 160,000 children die every year: 82,000 in rural areas, 23,500 in tribal areas and 56,000 in urban slums. This, according to Frontline, was three-and-a-half times the state government’s estimate for the 12 months between June 2004 and July 2005, and almost one-and-a-half times the estimate given for the same period by the Sample Registration Survey of the Government of India.

Broader poverty

There has been almost a decade of attempts by SEARCH, other NGOs and the media to pressure the state government to implement various programs to reduce the IMR and to improve the reporting of child deaths. Each time the government has acknowledged the under-reporting of child deaths and made various promises but virtually nothing has changed.

Far from being a problem peculiar to Maharashtra, the reports provide a glimpse of the appalling conditions facing millions of urban and rural poor throughout India. The 2005 UN Human Development Report estimated that 30 percent of infants across India are of low weight at birth and 47 percent of children under the age of five are underweight.

The report stated: “India has been widely heralded as a success story for globalisation. Over the past two decades the country has moved into the premier league of world economic growth; high-technology exports are booming and India’s emerging middle-class consumers have become a magnet for foreign investors.... But overall the evidence suggests that the pick-up in growth has not translated into a commensurate decline in poverty.

“More worrying, improvements in child and infant mortality are slowing—and India is now off track for these MDG [Millennium Development Goals] targets. Some of India’s southern cities may be in the midst of a technology boom, but 1 in every 11 Indian children dies in the first five years of life for lack of low-technology, low-cost interventions. Malnutrition, which has barely improved over the past decade, affects half the country’s children. About 1 in 4 girls and more than 1 in 10 boys do not attend primary school.”

The latest UNICEF statistics estimate the percentage of people using “adequate sanitation facilities” at 30 percent; that only 43 percent of child births are assisted by a skilled attendant and that the lifetime risk of maternal death is one in 48. Facing desperate circumstances, 14 percent of children aged between 5 and 14 years are compelled to work and 46 percent of children forced into marriage.

An estimated 35 percent of the Indian population earns less that $1 a day and the central government allocates just 2 percent of its expenditure to health and 2 percent to education. At the same time, a massive 15 percent of total expenditure is poured into defence.

The Maharashtra government’s own Human Development Report of 2002 acknowledged that growing wealth, particularly in Mumbai, exists alongside widespread poverty. In addition to malnutrition, the report cited statistics no less alarming. Some 49 percent of women in the state are anemic. The unequal ratio of 917 girls to every 1,000 boys was attributed to the frequency of female feoticide and the neglect of female infants. Maharashtra accounts for over 50 percent of Acquired Immune Deficiency Syndrome (AIDS) cases in India.

The majority of the population does not have access to adequate medical treatment. Outside the urban areas, which have over 80 percent of hospital beds, Maharashtra has just 24 doctors per 100,000 people. The report noted that this would only worsen if the state’s public health expenditure continued to decline. It also noted vast social disparities in urban areas.

Some 49 percent of Mumbai’s population lives in slums where chronic malnutrition is rife. For the rural population about 57.4 percent of people consume inadequate daily calories. In the urban areas, the figure is no less appalling—54.8 percent do not get enough calories each day.

During the national elections in 2004, the ruling BJP based its campaign on the slogan “India Shining” and spent heavily on advertisements showing well-off and well-fed middle class Indians who had benefitted from its policies of market reform and economic restructuring. Congress responded in kind proudly declaring that it had been responsible for initiating the free market program in 1991.

The vast majority of Indians, however, have not experienced an improvement, but rather a further decline, in their living standards. The BJP was unceremoniously dumped at the poll—to the surprise of the entire political establishment, particularly Congress, which has continued the same regressive economic measures.

The case study of child malnutrition in Maharashtra confirms that behind the glowing media reports of India’s economic growth rates is a terrible reality of social inequality along with government callousness and indifference whichever of the major parties is in power.