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Mainstream, VOL L, No 11, March 3, 2012

No Guarantee of Food Security in Children’s Incredible India

Sunday 4 March 2012

by RAZIA ISMAIL

India’s decision-makers seem to find it difficult to see that there are children in the country. Being unable to see them, they are unable to perceive that they are hungry. In an age when we are able to use euphemisms like ‘under-nutrition’, this is perhaps not surprising. But it is disgraceful none the less.

This country has a large population of children. Fortyone per cent of its total numbers. The national leadership has been unable to recognise them for what they are: the nation’s greatest resource. India has failed—and still fails—to give them their due in foundational attention and investment. This failure is manifest in the fact that more than 48 per cent of that precious 41 per cent of the people are malnourished by international standards. Or by any standard of natural justice.
In twice declaring malnutrition to be a national shame, the Prime Minister has publicly acknowledged that it is children who are the most at risk and the worst afflicted. National data has affirmed that babies of under-nourished mothers face the risk even before birth, and certainly through their earliest months. This is the stage of greatest risk to staying alive—and of the gravest stagnation in the survival graph. Recorded statistics also show worsening nutritional anaemia in the 0-3 age-group. The 2011 country report on Millennium Development Goals says: ‘India is going slow in eliminating the effect of malnourishment.’ It certainly is. In the base year 1990, the proportion of under-weight children in the below-three age-group was 52 per cent, in 1999 it had fallen to around 43 per cent, and by 2005-06 it was about 40 per cent. The MDGs’ target for 2015 is 26 per cent; but is not expected to dip below 33 per cent by that deadline year.

This is the climate in which the Food Security Bill moves for political consideration. It is supposed to answer an enormous challenge. Good money will be needed, in some quantity. Good sense will be needed even more, and honesty of purpose most of all. The language of Press forecasts of mid-February—‘India’s expenses on food handouts will likely rise by 2.2 per cent’ —shows some understanding that more is needed, but also hints that the media think the issue at stake is handouts rather than food rights to shift nutrition from dream to reality.

CHILDREN’S entitlements are not a charity issue, to be answered with some welfarist gesture. Nor is the food security legislation to be dismissed as political gimmickry. The Food Ministry has argued that the 2.2 per cent expenditure increase will not pose a ‘huge additional subsidy burden’. Be that as it may, the core question is: why has India condoned national hunger for so long, and not made it a central index of its claim of progress?

Survival, and the quality of survival, are the real national shame. Data shows the size of the persisting problem among the children aged below five years. The worst level of nutritional anaemia is in the 0-3 age-group, and it is worsening. All official analyses on health and causes of death cite malnutrition a major contributing factor in child mortality and morbidity. Lack of data—with lack of enquiry—cloaks the serious fallout of hunger and malnutrition among older children and the child-mothers among them.

Information readily available from National Family Health Surveys (NFHS) and District Level Health Surveys (DLHS) shows that the children’s bare survival is still a massive national challenge, and children’s health and nutrition status are unacceptably poor. But since they continue to be politically and administratively condoned, it may be inaccurate to call them ‘unacceptable’.

Statistics of the nutrition-hunger gap and its impact clearly show the children’s vulnerability in both urban and rural settings. Less is known about the migrants and socially depressed among them, but available data indicates negative scores. While the government machinery is slipshod in tracking and recording the fallout, and often fails to capture data on the above-sixes, these ground realities remain negative.

A bad start in nutrition security leads to lifelong health insecurity. Anaemia in adolescent girls is on record. Information on boys gets scant notice, but is available; they also endure malnutrition, and they suffer from nutritional anaemia too. It is well known that children who suffer malnutrition in early childhood are condemned to lifelong deficits in general health.

The well-publicised new HUNGaMA Report reiterates country and district data on how malnutrition leaves children underweight, wasted and stunted. Back in the mid-1970s, the National Institute of Nutrition published a research report on “paperback children”—physically and inte-llectually stunted by denial of the nutrition they needed for robust growth and development. To the argument that they suffer deficits in mental and cognitive development—research suggests that the shortfalls may be in energy limitation and related capacity to pay attention to stimuli. Foetal deprivation of iodine does prevent normal brain development in the unborn child, leaving it incurably deprived.

Overall, today’s children continue to be of the paperback variety. The fallout of their nutrition insecurity, as well as that of their mothers, calls for a food security perspective that addresses both general food rights and micro-nutrient and key nutrition requirements.

The nutrition challenge that children face is thus one of both quantity and quality. It must be addressed with both factors in view. There is deprivation of food in bulk, and there is deficit in the range of foodstuffs children need. Ergo: a national legislation for food security which must consciously aim at securing adequate nutrition.

Strangely, and unfortunately, most official national reporting on nutrition is written in the future tense—much is to be done and is pledged to be done. The 2011 country report on MDGs action recites several intended actions. It should have been able to report more on work done—and children and households fed.

THE Food Security Bill is supposed to transform the national picture. The Children’s Right to Food Campaign (CRTF)1 has already declared the need to transform the Bill itself, and listed a score of changes it requires if it is to really work for the good of children and their communities. The CRTF argues that the Bill needs to recognise people’s rights to land, water, forests, and other natural resources for liveli-hoods and food security. It makes the case that the Bill must admit that tackling malnutrition is government’s responsibility, and must uphold all the currently available entitlements for children guaranteed by the Supreme Court’s Interim Orders and judgments under the ‘Right to Food case’.

Tavleen Singh2 is among attentive commentators warning that the legislation could be defeated by its own design faults. One of these flaws is that it presupposes that a central diktat will make all kinds of connectivities flower across the land without conscious attention to building the infrastructure this requires, and generating genuine decentralisation to make it work in the field. The Bill hints at building large silos. Singh points to the importance of developing road and transport links where there are none, and of setting up community granaries for local storage.

For those constantly in search of the next meal, and forced by circumstance to make do with the barest minimum, being adequately nourished is a chronic uncertainty. The price rise, especially in food, has undermined purchasing power, virtually eliminated protein-providing ‘dals’ from the daily diet, and aggravated the nutrition insecurity of millions of households, and the children in them. What it has done to the food access of children living on their own is another, and un-recorded, tale of woe. A legislation of the kind now in the pipeline cannot compensate, because it does not contain the needed correctives.

In setting out to tackle malnutrition mainly by improving food availability, India has still not acted on the importance of addressing the nutrition requirements in greater depth. The whole issue of deficiencies at critical phases of childhood awaits attention. So does the fact that many of those deficiencies are due to planning and programming defaults.

Timeliness is a key factor in tackling malnutrition and‘under-nutrition. Food provision and essential nutrition must reach those most in need when their need is most acute. Such key moments come when childhoods mark their developmental milestones. They also occur when normal conditions of comparative stability, solvency and security are upset.

In the 2011 run-up to making new proposals for the 12th Five-Year Plan, the Ministry of Women and Child Development was informed that its bid to enhance food provision to adolescent girls in order to strengthen their potential for safe motherhood would miss the intended objective, because it will target the teenaged girl instead of the pre-teen. It is during the brief age-span of nine to 11 years that girls get their second growth spurt and could benefit from iron supplementation to their diet. Good feeding later would be good for their general health, but would not effect body development including pelvic growth, to improve their prospects for safe child-bearing.

The Ministry’s intention to expand its services for teenage girls is still going ahead into the next Plan period. The government’s preoccupation with RCH and safe motherhood concerns as its sole ambition for girl children will remain unsupported by this vital nutrition input at a vital phase of childhood. Boys, it is assumed, will get fed because of ‘son preference.’ It is not realised that getting the prince’s share in a famished household may still leave many boys hungry and under-nourished. The state’s rejoinder to son preference should not be boy-blindness. ‘Many’ in India means millions.

Many vulnerabilities confront access to food and nutrition. One relates to natural resources and the space and means to produce or gather food. The CRTF’s Bhopal 2012 conclusions3 point to people’s declining control over natural resources vital to food production—land, water, seed, forests and biological diversity. These are increasingly coming under the private sector. Economic growth, meanwhile, is bereft of employment guarantees, decent work conditions or wages. The CRTF has situated the issue of children’s right to food in this structural context. It is not very certain that the government does.

Then there are factors of identity and status that limit nutrition rights. The campaigns for food justice have sought attention to the powerlessness of children of Dalit, tribal or minority communities, of migrants, of children with disabilities, children of groups displaced or dispossessed by development projects. Children in conflict-affected areas and settings are especially at risk. Street children and children on their own do not seem to figure in food supplementation designs that seek to use the household or family conduit. No one seems to know about the nutrition status of children shut away in institutions. Government policies must reach out to all such ‘labelled’ children. But do they?

Along with new promises about food security, the government is also speaking of increasing food production. Shifts in land use from food to non-food crops will have to be addressed. Emphasis on rice and wheat cultivation, and displacement of millets and local coarse-grains from the local small-holdings will have to be reviewed. This again casts change into the future tense.

Pending a new green revolution, will there be enough food to go round? The burden of possible food imports has been rumoured. Will there be money to pay for this? There is talk of funds becoming retrievable from the telecom scam-control effort. But as the Bill transits through its formative avatars, the appropriate body of pundits is forecasting another bumper harvest of rice and wheat. This will doubtless make many non-children in positions of authority go to sleep worried. Where will all this bounty be stored? Will it rot this time too? Better storage standards, and the building of silos have been flagged as urgent needs. But if a primary question is about storage, will the outreach have to await a great big construction project? High priority should be given to prompt movement of the food to consumption destinations

Will plentiful supplies without forwarding addresses lead to more corruption among suppliers? Or just plain inefficiency? Or just the customary inattention? The Minister for Food has reportedly said he is all for food subsidies being decreed. But he is worried about the frailties of the PDS as a major conduit, and the tendency for supplies to go astray. The Minister is not wrong. His concerns could equally apply to other flagship measures particularly targeting children and expectant mothers. The National Planning Commission has a recent report on its website which shows that about 60 per cent of the food component resources assigned to the Integrated Child Development Services programme (ICDS) goes missing en route to its mandated utilisation and its target beneficiaries. This directly affects the children and needy women fortunate enough to be on the ICDS coverage lists. Field checks by the National Human Rights Commission in parts of Orissa bear out this information.

So food meant for children gets siphoned off into the wrong kitchens, or into the market. Does it suffice for the state to deplore the dishonesty? Can it leave such theft unchecked? The real question before the Government is: what is the state’s responsibility? The people have already said they do not want food coupons or pocket money: they want food.

The Minister for Finance has also been reported as worried. His worry is about where to find the funds to pay for needed food to reach the needy people. Can India afford to spend all this money? Should the government not instead be asking itself whether it can afford not to? The poorest households and providers are the foremost victims of the rise in food prices. Their huts and shacks are where the much-vaunted ‘demographic dividend’ is struggling through famished childhoods. Is the Finance Ministry looking at optional expenditure or necessary investment?

CLEARLY, there is an operational challenge, an urgent need for infrastructure, and a call on the national leadership to commit itself and get to work. The Bill lists many proposed institutional mechanisms, local bodies and committees. The CRTF calls for the children’s right to food to be included in the mandatory agenda for ‘gram sabhas,’ and for child nutrition issues to inform all processes of panchayat capacity building.

Motivation and local ownership of the food security aim are as necessary as the accountability standards and mechanisms. Equally, both national and State legislators should make food security their primary task in each of their constituencies. The funds they receive for local area development could hardly be better utilised. Local nutrition needs assessments would be the first investment. Regular monitoring and auditing of action and impact should follow, with community involvement, support and accountability.

For the crops counted and listed in harvest reports, the answer would appear to lie in timely distribution. Food is meant to be eaten. Ideally it should be locally grown in sufficient quantity where it is needed—or provided with dispatch. Those who do not grow it to eat are supposed to be able to buy it to eat. Those who cannot manage to buy what they need are supposed to receive the state’s attention.
The Bill focuses on supplying wheat and rice, and ‘coarse foodgrains’. There are other commo-dities that must be taken into account. What about other foods and nutrients? What about protein requirement? The new Bill mentions them, but does not specify. What about safe drinking water? That too is mentioned, but without detail. Apart from quantum scarcities, water potability is a serious concern. Water-borne and water-related diseases are among leading causes of children’s illness and death. Consumption of unsafe water can wipe out the benefits of better food access. The Bill mentions the importance of sufficient and potable water, but it does not clarify how provision would be assured.

What is actually on the proposed menu? Some is cooked, some is described as “energy–dense”, without saying what this is. All the take-home handouts are to be 50 per cent energy-dense. This sounds like the kind of ready-to-eat packet that the government had disapproved not long ago, on policy grounds. The planned food provision should also contain some edible oils; it does not mention oil. The CRTF has expressed informed concern about this deficiency.4

Activists and experts of the Right to Food Campaign, the CRTF and child rights NGOs firmly support hot cooked meals as the preferred option for provision to all beneficiaries of food security programmes or supplementary nutrition measures, especially for children. The option of hot cooked meals should be available to all: could it extend to those listed for take-home rations?

Local foods should be well-used. Neither the Bill nor the activists’ listing mentions local fruits, even though local food traditions show aware-ness of their nutritional value, such as the seasonal benefits that the mango and papaya offer. To enhance the diversity and quality of the ICDS diet, the CRTF recommends the use of millets, animal products like eggs, milk, yogurt, and meat (for those who eat it), and other locally available foods. Midday meals in schools should similarly draw on local food varieties. The most suitable mix for any location can be decided in consultation with the community.

There are various opinions on what would constitute good nutrition and what is safe for children to consume. The Bill should not rest on readymade or processed ‘packet’ foods, and should guard against ready-to-eat commodities. The ‘energy-dense’ food component needs to be explained. What is it? If it is meant to provide important micro-nutrients, could these not be obtained by diversifying the local fresh food available? Millets and animal products can help to met micronutrient requirements locally. The best routing for micronutrient administration would be via established government supple-mentation programmes, rather than by loading additives into bulk food supplies. Supply of iron-fortified wheat flour is contra-indicated in areas affected by malaria or minority conditions like thalassaemia. Likewise, the Bill should not legislate unthinkingly in favour of food fortifi-cation or use of GM foods, while the jury is still out on their safety, especially for children. Good sense requires suspension of open field trials of GM seeds or crops while their safety is still being researched.

Statistics of the nutrition–hunger gap and impact not only establish children’s prominence among the deprived and afflicted, but also show that the youngest are the worst off. What is the essential nutrition input that should go directly to the below-three age-group, or even the below-five group? Is it sensible to use only indirect nutrition, via the mothers?

Even though small children are to be served, there is no mention of milk anywhere in the Bill. There is, however, a provision to promote breast-feeding for the baby’s first six months. How this promotional effort would be carried out, and by whom, is not stated. The MDGs country report also speaks of promoting early initiation of breastfeeding (within an hour of giving birth), exclusive breastfeeding up to 6 months, and continued breastfeeding along with complementary foods up to 24 months. It is not clear how under-nourished mothers could guarantee breastfeeding. If a mother is at risk or incapable, what emergency or short-term provision is proposed to safeguard the nutrition security of the infant?

At the neonatal stage of childhood, the government plans or promises ‘integrated management’ of illness and severe malnutrition. Since the country deals with 26 million births every year, the numbers of F-IMNCI providers ((2,970) and nutritional rehabilitation service centres (455) to deal with ‘severe acute malnutrition’ seem too low.

OVERALL, the Bill’s promised operation may be dogged by the risk of misdirected or ambiguous logistics, as accessibility seems tied to some peculiar classifications. Eligible beneficiaries are categorised by age, location and status. Something called an ‘age-appropriate meal’ will be given to children in the six-month to six-year age-range. It is not stated what this might be for each of the sub-sections of the age group. This appropriate food will be offered at angan-wadis, presumably of the ICDS. Since only a third of the children of the ICDS age-group are actually within ICDS coverage, it is not clear what would be the eligibility or access of those in the age-group but not in the anganwadi. The nutrition provision for the six-month to three-year sub-group is 500 kilo-calories and 12 to 15 grammes of protein—and it is a take-home ration. For the three-year to six-year sub-group, it is the same nutritional standard, but in the form of a cooked meal. If the child is classified as malnourished, the entitlement is 800 kilo-calories, with 20-25 grammes of protein, as a take-home ration. If the supply point is the anganwadi, and the malnourished child is not in the ICDS catchment population, where should he or she go for the additional calories and grammes? Elsewhere in the Bill, there is an assurance of “a free meal” for all children with malnutrition, but no mention of age limits. In another part of the draft text, an age bar of ‘children up to 14 years’ is mentioned.
Three supply points are identified: the anganwadi, the school and ‘community kitchens’.

On the assumption that mothers-to-be can access the anganwadis, that is where all ‘pregnant and lactating mothers’ would line up for a daily take-home ration of 600 kilo-calories and 18-20 grammes of protein—but if they are also classified as destitute or needy they come under other provisions. The Bill offers a meal a day to ‘all destitute persons’. It does not say for how long, or predict an end to the destitute condition. It offers two meals a day to households affected by emergencies or disasters—for a period of three months. It does not name any supply point.

To the homeless and needy, the Bill offers an ‘affordable meal’, at a community kitchen. It is reasonable to assume that there would be children in all these categories of deserving people, but the Bill is silent on how the various age-related periods of entitlement would operate for them, or how they could access age-appropriate meals or the assigned kilo-calorie and protein amounts through whatever pipelines are set up to serve the various kinds and categories of beneficiaries. The same question arises in respect of expectant or nursing mothers, who are also listed as deserving of nutrition supplements.

The Bill is not silent on perceived neediest categories. Persons living in ‘starvation or akin to starvation’ can get two meals a day for six months. Quantities and content are not mentioned. How children in these conditions will be served, during or after these six months, is not stated. The Bill also says nothing on what supplementary nutrition will reach women in this category who are starving or nearly so—or their babies, for whom breastfeeding is to be encouraged.
While the Food Security Bill seems to set 14 years as the eligibility ceiling for children, the oldest child—aged from 15 to 18 years – poses another challenge. This age group will include child brides who are already bound for motherhood, as well as child workers of either sex. Will these girls’ eligibility hinge on whether they are pregnant or nursing? The CRTF has called for the Mid-day Meals entitlement and provision to be extended to all children up to the Class XII age-group, whether they are on school rolls or not. But those in such situations are not always accessible.

It is not explained what community kitchens are, or who operates them. The CRTF recommendation is to involve community members and to tap their energies, and to use locally available goods and services, with the added spin-off of stimulating the minor local economies. The Bill refers to ‘community kitchens’ as the source of food supply to ‘homeless and needy’ people, who will get ‘affordable’ meals. What would this affordable rate actually be? Tavleen Singh has argued in favour of communities taking local responsibility, and village women running ‘free kitchens’. It is important to underline that the core responsibility of ensuring that food is available for local provision still rests with the state.

The Bill has a provision for providing cash or some kind of authorisation to the beneficiary if actual food supply happens to be unavailable. This implies the possibility of food being replaced by some kind of coupon system. Field enquiries have shown that the people want food, not coupons or cash. The CRTF is opposing any provision for introduction of cash transfers in the place of food subsidies. The Bill should not have built-in loopholes.

This implies universalisation of the Public Distribution System, with a genuine change in its standards of honest delivery. If local bodies, including PRIs, can be motivated and mobilised to take ownership in a national drive for child nutrition, could that work?

How important is it to India that its children should not be starved of the nutrition that is their right? Who among those in power will take responsibility to act upon the Supreme Court’s call?

The state is after all answerable to the people. The CRTF has demanded both official and popular action to undertake up nutrition surveillance and ongoing social audit. It is calling for activation of the proposed Bill on Grievance Redressal5 to take all schemes related to children’s right to food and nutrition under its purview. This would be a fitting positioning of the right.

Both the state and society are answerable to the children. Whatever the imperfections of the Food Security Bill, it is a legislative effort whose time has come. The government is on test to get its act together, examine the proposed provisions through the lens of human rights, consult and confer with non-governmental counterparts, and bring forward an Act worthy of children.
Making good food and nutrition security available to the people is a matter of ethics in governance, and should be a hallmark of the legislation, and an evidence of the State’s guardianship of people’s food security. The sphere of nutrition and related basic health is not for privatisation. Nor is it a development option to be taken up at will, or left open to penetration of private sector and commercial interests. It should herald the development and pursuit of a national mission to overcome the malnutrition, hunger and food poverty of millions. The ruling party’s authorship of the move has been given more attention than either the ethical imperative for such legislation, or the inherent frailties of the Bill itself. The issue deserves more intelligent analysis.

The only ‘profit’ that India should seek from its action for food security is public good. The saving of children’s lives will be the first marker of commitment.

[Credit is due to the Children’s Right to Food initiative (CRTF) and in particular to its 2012 national convention, from which some valuable insights and recommendations are drawn.—R.I]

FOOTNOTES

1. Children’s Right to Food Campaign/ Second National Convention, Bhopal, 2012.

2. Tavleen Singh: ‘This is not food security’: The Indian Express, December 25, 2011.

3. CRTF: Second National Convention, Bhopal, 2012: final statement and recommendations.

4. Children’s Right to Food Campaign/Second National Convention, Bhopal, 2012.

5. The Right of Citizens for Time Bound Delivery of Goods and Services and Redressal of their Grievances Bill, 2011.

Razia Ismail advocates ethical policy and practice for development with justice with a special focus on the social, economic and cultural rights of children. She is a founder-convenor of the India Alliance for Child Rights

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