Decoding Malnutrition

Gender discrimination and malnourishment are related. Women often eat least and eat last.

New Media Fellows 2013

By Anindita Sengupta

February 24, 2013

Also published at Bangalore Mirror

How is it that 46 per cent of children are stunted in Dharavi, one of the more organised slums in a city like Mumbai which also has one of the richest people in the world?” Nobody had answers to the question raised by writer and journalist Kalpana Sharma at a discussion organised by the International Reporting Project (www.internationalreportingproject.org). She was doing what many of us should be doing far more often: Putting healthcare issues in perspective. By bringing out both the human and the political aspects of nutrition, she was taking it away from the territory of the banal, the neutral. It was no longer divorced from personal and political dynamics.\

None of the steps taken to address malnutrition in children makes sense unless the mother is healthy

Stunting is one of the signs of undernourishment. According to UNICEF, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished. It’s hard to wrap one’s head around something as large as malnutrition. Where does one begin to understand the complexities of health, politics, corruption, poverty, caste and gender that underpin a shattering question: why are so many babies not getting enough to eat?

Dr Armida Fernandes, founder of SNEHA (www.snehamumbai.org), a Mumbai-based organisation that focuses on women’s health, spoke of something as simple as first milk. “Many people used to throw away the first milk, known as colostrum, because it looked yellow so they thought it was pus,” she said. As most of us know, colostrum improves a baby’s immunity and is considered precious. The fact that it is still discarded by many mothers is a tragedy. But such misconceptions abound and tackling them is one of the most intense challenges that health workers face. For example, mothers in Jharkhand seem to be throwing away first milk quite regularly. Only 33 per cent children are breastfed in the state within one hour of their birth, according to the Annual Health Survey (AHS) 2010-11. Only 45 per cent of children in the state are given mother’s milk at all.

In another startling report, Save the Children has said that practising exclusive breastfeeding for the first six months of a child’s life and complementing that with soft foods after could prevent 210,000 Indian children from dying each year.

These figures in themselves don’t mean much beyond a sense of alarm, quickly followed by a battle-weary sense of uphill walking. What we need to talk about, share and follow closely are practical implications and measures. For instance, women who work in the field or in factories or as domestic help have little choice but to go back to work. They simply don’t have the freedom to provide on-demand feeds. Besides awareness, a cheap or free breast pump might be something they could use. Are there companies or NGOs who can provide this as an intervention?

Then, there are women who are too malnourished or ill, or those who do not produce enough milk, or have problems with lactation. Some of these are problems among upper class women as well but encouragingly, there seems to be growing awareness about lactation and some help at hand in the form of lactation experts. But these come at a price too high for poor women to pay. An initiative like Divya Mothers Milk Bank, founded by an NGO called Maa Bhagwati Vikas Santhan, which will provide undernourished babies with free milk, may go a long way in helping such mothers.

None of this makes any sense unless the mother is healthy. One of the other things Kalpana Sharma talked about was the close relation between gender discrimination and malnourishment. “Women often eat least and eat last,” she said. If you don’t take care of the woman, you cannot ensure that she will have healthy children. Much of what is passed on to a baby during pregnancy (and after) has to do with the mother’s health. This would seem like common sense but isn’t. Even in many affluent families, the daughter-in-law is treated well for exactly nine months and neglected before and after, in the short-sighted hope that it will be enough. This is a country where most women fight anaemia from a very young age, often because they are underfed, and usually this is because they are girls.

Unless we tackle and surmount such root problems, our battle against malnutrition will be incomplete. It may even be futile.

The author reports on maternal and reproductive health with a New Media grant from the International Reporting Project in Washington, DC.. In February 2013, Anindita joined IRP on the Spring 2013 trip to India to report on child survival.