Nandurbar 3

77 babies die of hunger every day in Maharashtra

 50% rise in malnutrition deaths, but state government depts. pass the buck, According to the Maharashtra government’s own figures, 18,486 children in the age group of 0-6 years have died of malnutrition this year alone (Jan-August 2011). The figure is quite high, say health ministry sources. In 2010, 12,792 children had died of hunger and malnutrition during the same period. But this year, 5,694 more babies than last year have starved to death. Most of the dead babies are adivasi children. The maximum deaths have occurred in the five districts with large adivasi populations.

Every government department DNA spoke to passed the buck to some other department. Maharashtra’s tribal welfare commissioner Vikas Thakur said, “Once we release funds to the health, revenue, and education ministries for various schemes, it is their lookout. The local collectorates and zilla parishads should coordinate to ensure everything works on the ground. Ask them what they are doing.” The state health minister Suresh Shetty washed his hands off the whole issue, saying, “This is completely under the women & child welfare ministry. My ministry has nothing to do with it.”

Women & child welfare minister Varsha Gaikwad too wanted to wriggle out of it, claiming that tribal welfare, health, social justice, and public health ministries were responsible. When asked what her ministry, which is the nodal agency for tribal welfare, was doing, she said, “We conduct periodic workshops so that malnutrition is better understood.” She then went on to talk about her ministry’s new Kuposhan Mukt Gaon (malnutrition-free village) scheme, to be launched by Prime Minister Manmohan Singh on October 1 in Mumbai.

But it is doubtful whether it will bring any succor to Pratap Shankar Mundola or his wife Jani in Shahpur tehsil of rural Thane. Last monsoon, their four-year-old daughter Ujwala starved to death. This year, already, their four-year-old son, Nivrutti, and six-month-old daughter Pinti have been diagnosed with severe acute malnutrition (SAM). Their condition is so serious that they have been brought to the Takipathar primary healthcare centre (PHC). “We are very worried. He can’t even walk and has to be carried,” says Mundola of his son, who weighs only 10 kg instead of the 16 he should.

But Pinti and the Nivrutti aren’t the only ones starving in their Thakar (an adivasi tribe) village. The anganwadi (government-run mother & child care centre) register of the village (which has a population of 300) shows that nearly 27 children in the 0-6 age group suffer from malnutrition.

In what is perhaps the most damning indictment of the administration, even the children of anganwadi workers are not exempt from the scourge of hunger. In the Thakar village, among the 13 babies in critical condition that have been brought to the PHC for a check-up is 11-month-old Karan Kishore Ughde. Karan is the only child of anganwadi worker Pramila, and weighs only 6.5 kg when he should be 10kg.

This story repeats itself in the Korku (an adivasi tribe) villages of Churni, Vairat, Pastalai, Memena, Bori, Gullarghat, Dhargad, Kelpani, Dolar, Dhakna, Rora, Adhao, Koha, Kund, Pili, Mangia, Semadoh, Raipur, Makhla, Madizadap, Chopan and Malur in Amravati district, where malnutrition figures show that the clock has turned back to the mid-nineties.

Doctor and health activist Dr Ravindra Kolhe, who has worked with the adivasis for nearly 30 years, told DNA, “In 2006, the state’s Infant Mortality Rate (IMR), which used to be 200 per 1000 children, came down to 40 per 1000 children. But instead of reducing further, it has now gone up to 66.” According to him, this is a direct outcome of the pathetic state of the service delivery systems. “Instead of strengthening our health infrastructure, like the PHCs and rural hospitals, the government plans to hand them over to NGOs of its choice. This kind of abdication of social responsibility of the state is why we are in such a mess.”

Kumar Nilendu of Child Rights and You (CRY) echoes Dr Kolhe. “The Supreme Court has directed that anganwadi be opened wherever demanded but Maharashtra, Gujarat and Chhattisgarh lag behind other states. Even where they have been opened, they are ill-equipped and understaffed. The government should tackle this, and address issues like why marginalized communities have poor access to resources and hence nutrition. Unless that is done we are staring at a problem that is set to grow.”

Five worst hit districts
Place MAM (Moderately Acute Malnutrition) / (SAM) Severely Acute Malnutrition / Dead (Babies killed by malnutrition)
Nasik: 10,342/ 7,543/ 892
Nandurbar: 12,312/ 9,854/ 681
Amravati: 10,013/8,543/ 693
Thane: 9,974/6,543/ 323
Bhandara: 8,764/ 7,342/ 572

‘Visit Nandurbar to take stock of the situation’

MUMBAI: State BJP general secretary Eknath Khadse has asked chief minister Vilasrao Deshmukh to tour Nandurbar district’s tribal taluka of Dhadgaon, Akrani and Akkalkuva, where around 350 children have died due to malnutrition. Stating that the administrative machinery in the taluka had come to a standstill, Khadse urged Deshmukh to visit the affected areas and ensure that more lives of children were not lost. While the state government claimed that 135 children had died due to malnutrition, the actual number was 350, the former finance minister claimed. Remarking that the whole area had been hit by an unprecedented drought, Khadse said that during his visit to around 70 tribal hamlets before the budget session, he found that ration was not available, there was a serious shortage of drinking water and employment guarantee scheme (EGS) work was not being undertaken anywhere, pushing the tribals to the brink of starvation. He said that a large number of tribals had migrated to Gujarat last year because of the drought. “However, most of them returned after the quake, only to face a worse fate. Government officials are refusing to make available EGS works,” he alleged, adding that the condition of primary health centers was “horrifying”. According to him, X-ray machines at most centers were out of order and none of the centers were open after 7 p.m.

Dying young

This article is excerpted from a feature written by LYLA BAVADAM in the September 23, 2005, issue on the large number of malnutrition-related deaths among children in Maharashtra.

 A malnourished child being weighed at Nandurbar in Maharashtra, A file picture

 LAST YEAR, in what seemed like a crusade to awaken the conscience of the Maharashtra government, the Marathi-language press relentlessly published reports on the continuing deaths of large number of children owing to malnutrition. The reports said that between April and May 2004, as many as 234 children had died in Nandurbar and Dhule districts, 2,000 in the five tribal-dominated districts of Amravati, Yavatmal, Gadchiroli, Chandrapur and Bhandara in the Vidarbha region and 72 in Dharni and Chikaldhara taluks in the Melghat region, and that 600 children were afflicted with Grade 4 malnutrition, which is life-threatening.

The distressing statistics and photographs had the desired effect. Chief Justice Dalveer Bhandari and Justice Dhananjay Chandrachud of the Bombay High Court were spurred into action and the suo motu writ petition No.5629 of 2004 was born. A notice was issued to the State government, bringing the issue of malnutrition-related deaths and other causes of infant mortality to the forefront once again.

In July 2004, the court issued the first set of directives to the government seeking immediate action. The government was directed to provide the factual health status in representative villages in Gadchiroli, Yavatmal, Amravati, Nandurbar and Dhule districts. The findings in the status report were depressing, but predictable. They brought up the issue of inadequate medical facilities and chronic undernourishment among children for discussion yet again. The State government set up the Committee to Evaluate Child Mortality, headed by the community health specialist Dr. Abhay Bang of the Society for Education, Action and Research in Community Health (SEARCH), whose 2001 report in Marathi on child deaths (Kowali Pangal, or The Fall of Tender Leaves) had also been instrumental in the suo motu action by the court.

In August 2004, the committee submitted its first report. The 55-page report estimated that between 1.20 lakh and 1.75 lakh children died every year in the State for medical reasons. It warned that 38 lakh children would die in the next 20 years if the authorities remained “insensitive to their sufferings”. The report blamed an insensitive bureaucracy for the plight of nearly eight lakh children whose lives were threatened by Grade 3 or 4 malnutrition.

Reviewing the 15-year record of the State in this matter, the report said it found little improvement. The percentage of children affected by Grade 3 or 4 malnutrition had fallen by a mere 0.6 per cent between 1988 and 2002. It also quoted from a study of the National Nutrition Monitoring Bureau (NNMB), which said that more than 40 lakh children were affected with Grade 2 to 4 malnutrition in Maharashtra. It estimated that 82,000 children died every year in the rural areas of the State, 23,500 in the tribal areas and 56,000 in urban slums.

Although the report was tabled in the Legislative Council in December 2004 and the Health Minister accepted it saying that its recommendations would be implemented, not much has happened. In March 2005, the committee presented its second report. This report took the next logical step of making detailed recommendations on how to reduce malnutrition and child deaths. In July, the court inquired what the State government had done. The government admitted that this year there were 1,600 deaths of children.

According to government statistics, the total number of child deaths in the entire State between July 2004 (when the court took an interest in the matter) and June 2005 is estimated to be 45,000. Interestingly, the estimate based on the Sample Registration Survey of the Government of India for the same period is 1, 20,000 deaths.

The struggle to make the State accountable has a long history. The problem of under-reporting child deaths was discovered in Gadchiroli, one of the State’s least developed districts, almost a decade ago by SEARCH. The organization runs a vital statistics measurement system in about 100 villages in the district. In 1998, its team noticed a huge discrepancy between its own findings and those reported by the Health Department. The matter was taken up with the Chief Minister, and the District Collector was asked to recheck the facts. Although an entirely new set of figures emerged from the Collector’s report, it did ultimately validate SEARCH’s findings. The Health and Family Welfare Department had said that the still-birth rate was four. The Collector’s report found it to be 68. The Department claimed an IMR [infant mortality rate] of 13. The Collector found it to be 118.

The differences were shocking and the Health Department stood exposed. The government reacted by transferring the Collector. SEARCH, however, kept up the pressure and with 13 other non-governmental organizations (NGOs) formed the Child Death Study and Action Group (CDSAG), which studied births and deaths in 226 villages and six urban slums for two years at 13 different sites in the State. There were two major facts that the study brought out:

1. While the IMR for the State was a high 66, it was the highest in the tribal areas, at 80.
2. The government was severely under-reporting deaths – in 1998 there were an estimated 1, 75,000 child deaths but only 30,000 were officially recorded. This happened apparently with the knowledge of local officials. The CDSAG study found that neonatal deaths accounted for 58.7 per cent of the child deaths, pneumonia for 13.2 per cent, malnutrition 10.4 per cent, and diarrheal diseases 10.1 per cent. The remaining 14.3 per cent were attributed to unknown causes.

Global experts estimate that two-thirds of child deaths can be averted by simple health interventions. Proof of this comes from what SEARCH has achieved in Gadchiroli. In a field-based trial, Bang first treated pneumonia in children and brought down the IMR from 121 to 79 in two years. Thereafter, the IMR remained steady despite further reduction in pneumonia and diarrhea cases. It was only in 1990 that Bang realized that 75 per cent of the dead were newborn children.

Three years later, the internationally acclaimed field trial by SEARCH began in Gadchiroli. It showed that an approach called Home-based Newborn Care could make a huge difference to babies, living or dying. The basis of the programme was an understanding of the region and of tribal culture. SEARCH was aware of the tribal belief that a pregnant mother must starve herself so that the fetus remained small and enabled easy delivery of the baby. Working with these cultural constraints, SEARCH trained village women and dais (midwives) in maternal and neonatal care.

The approach was so successful that the IMR of Gadchiroli was bought down from 121 to 30 per 1,000 births, almost equal to that of China, which has made rapid strides in bringing down the IMR.

A recent report of the Punarvasan Sangharsh Samiti (PSS), a group that fights for tribal rights, says, “The root [of malnutrition] is because of deprivation from natural resources.” In a survey carried out in 22 villages and two resettlement sites of the Sardar Sarovar Project in Nandurbar district, the PSS found that more than 98 children died in April, May and June this year, and 71 of the deaths were related to malnutrition. The survey also verified what the Committee to Evaluate Child Mortality had said: that the government only records 10 per cent of the actual deaths and that malnourishment is rampant among tribal mothers as well.

The other north Maharashtra region to be afflicted with malnutrition is Melghat. The problem is so pernicious here that the government came up with what was thought of as a solution and came to be referred to as the Melghat pattern. Essentially, this involved pumping in a lot of money prior to the monsoon. It was not particularly successful in addressing the problem. The case in north Maharashtra is complicated by the existence of vast forest tracts and, in Melghat, by the presence of large nature reserves, which have been the target of ire of tribal rights groups.

In the new interactions between tribal rights NGOs and conservationists, the focus is on facilitating livelihood earnings and self-determination and not on edging out the tribal people.

Simultaneously, the health care needs of the tribal people in Melghat are being addressed. A mobile health unit started by the Nature Conservation Society Amravati holds regular health camps in remote hamlets.

While much has been done at the ground level by NGOs and sometimes by the local administration, the government has made no comprehensive changes in its approach. After a light rap from the High Court last year over the mounting infant deaths, the State government went into what is referred to as “mission mode” to tackle the problem. It initiated the Malnutrition Eradication Mission. Started in Thane, Nandurbar, Amravati, Dhule and Gadchiroli districts, the mission was meant to follow nutritional guidelines based on a child’s age. With the Chief Minister at its head, it was planned on the same lines as the polio eradication and literacy campaigns. Not much is heard of the mission now.