Three months ago, when Jitendra was 15 months old, health workers found that he weighed just 12.1 pounds — less than two-thirds the minimum global standard for his age. The workers began visiting regularly and giving the family supplementary food, and Jitendra has gained about two pounds. But he remains severely malnourished.
Although he was not underweight when he was born, repeated illnesses have taken a toll.
“He has been sick for a long time,” said his slight, 18-year-old mother, Sundari Dhindor. “Where is the money? How do you expect me to feed him? He is still on my breast milk.”
The family’s situation illustrates what nutritionists call a perfect storm of factors driving India’s malnutrition crisis. Many children are born to teenage, anemic, malnourished mothers. Feeding practices are poor, and the environment — a crowded country where 600 million people have no access to toilets — is rife with fecal matter.
Health programs were largely failing to reach infants in the first two years of their lives, when malnutrition usually sets in and causes permanent mental and physical damage, Aguayo said.
Fewer than half of Indian children start nursing within their first 24 hours, receiving water rather than the early, antibody-rich breast milk that helps protect against infections. Most spend their first few years subsisting on protein- and vitamin-poor diets of rice or bread. Other major factors include persistent poverty in communities that have not benefited from economic growth, and the low status of women in India.
In Banswara, village health workers blame rampant malnutrition on the prevalence of child marriages. Dhindor, Jitendra’s mother, got married when she was 13 to a man she describes as a “good-for-nothing drunkard.” She said she spends most of her day cooking, washing, cleaning and fetching firewood or water for her in-laws, or trying to earn money as a day laborer in local fields.
India’s progress in fighting malnutrition fails to impress many experts.
Save the Children and World Vision recently ranked India alongside Congo and Yemen at the bottom of a global nutrition barometer for its commitment and performance.
While the nation frets constantly about whether economic growth and the stock market are up or down, the government has not collected data on child malnutrition since 2004 — something Purnima Menon of the International Food Policy Research Institute calls “mind-boggling.”
Last month, India’s president and a leading Bollywood actor launched a national publicity campaign to combat malnutrition. The government has also promised a huge rise in health-care spending during the next five years.
Nevertheless, experts say the government lacks a coherent plan to overcome the shortcomings of the child health program, which depends on village health workers who are overburdened and poorly educated, trained and paid.
Spending comes easily to the government, critics say, but setting up mechanisms to monitor performance and raise accountability seems far less instinctive. Meanwhile, the Ministry of Women and Child Development remains a junior cabinet post, a department where few civil servants want to work, said A.K. Shiva Kumar, an independent adviser to the government on development.
“The problem of malnutrition is not visible or in-your-face,” he said. “The political attraction of working on nutrition is very low. It doesn’t really sell.”