Stunted India Needs To Grow Up

From Ayurvedic remedies to nutritional drinks that “keep them shooting up”, there are any number of products available that claim to add magical extra inches to your child’s height. Open any parenting magazine and there almost always is an article offering tips to boost your child’s height.

Height does have something to do with genetics, but also, with nutrition and hygiene. So when one looks at data that shows that India is the fifth most stunted nation in the world, there is serious cause for concern. Indian children are among the shortest in the world – children born here are on average shorter than those born in the poorest African countries.

Globally, an estimated 25% of children under the age of five are stunted, which means they are shorter than normal for their age. But in India, nearly 40% of such children across all income groups are stunted — a subject that was also the focus of research by this year’s Nobel winner for economics, Angus Deaton.

In his 2009 paper ‘Food and Nutrition in India: Fact and Interpretations’, co-authored with development economist Jean Dreze, Deaton documented how malnutrition is linked not just to lack of calories but also to a lack of variety in diet, poor maternal health and inadequate sanitation.

Stunting is more than simply a matter of appearance. It’s a marker for a range of developmental problems, says Dr. Armida Fernandez, former dean of Mumbai’s Lokmanya Tilak Hospital, one of the city’s largest public health facilities, and founder of the NGO SNEHA (Society for Nutrition, Education and Health Action), which works closely among women and children in slum communities.

“When you are short there are many things that are affected”, says Dr. Fernandez. “The immediate risk is associated with wasting, where the weight to height ratio is very low. The other risks are that the brain is not fully developed and the child is vulnerable to developing hypertension, heart disease and diabetes”.

Stunting also has an economic impact as it affects productivity. Various studies have linked childhood stunting with poor IQ and school performance.

The 2014 Global Nutrition Report places India in a group of 38 nations that includes least developed countries like Sudan, Somalia and Ethiopia. While we have been able to reduce the incidence of stunting, children in India continue to rank among countries with far lower GDP. Why does stunting remain so widespread, affecting even well fed children and decades of investment in programmes targeting child malnutrition?

Recent studies suggest that one of the potential causes for persistent malnutrition may be poor hygiene and inadequate sanitation. The problem is no longer so much the lack of food, but rather a lack of toilets. A recent trial by Stanford University among some communities in the Republic of Mali, West Africa, has established how increasing access to, and promoting use of, toilets has helped improve child growth. The study says that children who were less than a year old when the programme was launched showed the maximum gain in height and weight.

However, getting people to use toilets and observe basic hygiene is just one part of the problem, say experts. There is a need to effect a larger change in gender attitudes to address the problem of chronic malnutrition.

“There are many, many factors responsible for stunting –beyond just the lack of toilets”, says Dr. Fernandez. “It also has a lot to do with the state of the mother’s health and well-being – what she is fed, her general health and the violence she is exposed to’’.

Dr. Aparna Hegde, founder of Mumbai-based NGO ARMMAN (Advancing Reduction in Mortality and Morbidity of Mothers, Children and Neonates), concurs. ARMMAN works towards improving the wellbeing of pregnant mothers and newborns.

“Malnutrition in pregnant women leads to poor pre-pregnancy body-mass index (BMI) and inadequate weight gain during pregnancy, along with severe micronutrient deficiency. These heighten the risk of intrauterine growth retardation and low birth weight, which affects the physical and intellectual development of the child’’.

According to NFHS-3 figures, over 36% women between the ages 15 – 49 years had a BMI less than 18.5. Even in Mumbai, more than 70% of pregnant women are anemic, says Dr. Hegde. “We have to realize that years of poor nutrition cannot be wiped out in one shot”.

It took about a century for the Dutch to go from being among the shortest in the world, to among the tallest, thanks to nutrition and good hygiene. We have much less time if we are to indeed reap the demographic dividend of 1.2 billion productive Indians.

This article was published in the Business Standard under the headline Why are Indian Children stunted?

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