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Child Malnutrition

Author(s): Shanti Ghosh


Source: Economic and Political Weekly, Vol. 39, No. 40 (Oct. 2-8, 2004), pp. 4412-4413
Published by: Economic and Political Weekly
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from the Rajya Sabha. Thus, the Lok Sabha


numerically dominates in this committee.
The Estimate Committee is, however, a
body completely made up of the members
of the Lok Sabha and it exclusively decides
how the financial estimates of different
schemes should be kept at a minimum in
orderto preventgovernmentalextravagance.
In other words, it shows the way in which
the policy andobjectives of the government
could be carried out with the least expenditure of public resources.15Thus, it is a
cardinal truththat in financial matters, the
Lok Sabha enjoys almost exclusive authority. Obviously, in orderto uphold the democraticprinciple,the makershave not placed
them at par.16So, unlike the Rajya Sabha,
the Lok Sabha can bring down the cabinet
by throwing out the budget.
Then, from the point of view of the
constitutional position, the Lok Sabha has,
surely, a consequential advantage. The
Rajya Sabha consists of 250 members 12 of them are, under Article 80(1)(a),
chosen by the president and others are,
according to clause (a)(b), elected by the
state legislatures. In other words, none of
them is directly elected by the people's
ballot. But, as Article 81(l)(a) indicates,
almost all the members of the Lok Sabha
are directly elected. 17In a democratic setup, such a popularchamber is sure to claim
a superior position to that of the other
House. This is why, M M Singh has
commented, "The Lok Sabha is the heart
of parliament".18
Thus, while the members of the Rajya
Sabha representeither the president or the
vidhayaks, the Lok Sabha directly stands
for the people. So, it truly ventilates public
grievances and authoritatively raises local
demands so that the ruling authorities may
pay heed to them.19 Naturally, its debates
attract public notice in a far broader way
and, more often than not, the luminaries
of public life prefer it as the only forum
for theadvancementof theirpolitical career.
All these have made the Lok Sabha a
much more importantpartnerof the Rajya
Sabha which is sometimes regarded as
almost an ornamental superstructure or
even an inessential adjunct.20Though the
founding fathers created a bicameral parliament, they surely felt that as the Lok
Sabhawas anelected House, it must assume
a special role in our administrative system.
For this reason, they granted a limited role
to the other House.21 On occasions, however, a conflict between the two Houses
has created a temporaryconfusion, but due
to the constitutional advantage, the Lok

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Sabha has ultimately consolidated its own


position. Once, the late Hiren Mukherjee,
a member of the Lok Sabha, made some
adverse comments about the other House,
but he was not required to apologise,
because the matter was amicably settled
before it headed to a crisis.
For all these reasons, it can be claimed
that our Constitution has adopted the
English patternin the distributionof power
between the two Houses of parliament.22
In this scheme of affairs, the Lok Sabha
really plays the key-role. [S1

6
7
8
9
10

Notes

16
17
18
19

1 M V Pylee - A Introductionto the Constitution


of India, p 181.
2 Our Constitution, p 182.
3 Pylee, Introductionto theConstitutionof India,
p 201.
4 Democratic Constitutionof India, p 149.
5 H H Das - India:DemocraticGovernmentand
Politics, p 207.

Child

11
12
13
14
15

20
21
22

Op cit, p 171.
Op cit, p 200.
Pylee, op cit, p 181.
Indian Government and Politics, p 173.
ParliamentaryDemocracy of India, p 142.
Significantly, Sikri writes, 'The Rajya Sabha
Cannot Make or Unmake the Government,
op cit, p 173.
As S C Kashyap has written, 'The Prime
Minister is Usually a Member of the Lok
Sabha', Our Parliament,p 25.
Ivor Jennings - The Queen's Government,
pp 42-43.
B B Majumder- Rise and Development of
the English Constitution, p 229.
B Bhagwan, V Bhushan - Indian Administration, p 349.
C P Bhamlbri- PublicAdministration:Theory
and Practice, p 215.
J C Johari - Indian Politics, p 327.
G N Joshi - The Constitutionof India, p 133.
The Constitution of Indian, p 884.
V D Mahajan - The Constitutionof India,
p213.
Sachdev Gupta- IndianConstitution,p 120.
Kedia Pandey - The Essentials of the Indian
Constitution, 19.
G S Pandey - ConstitutionalLaw in India,
p 244.

Malnutrition

The IntegratedChild DevelopmentServices (ICDS)programme


was expected to prevent the incidence of severe malnutritionof
the kind that has been reportedin some parts of the country.
However, after 30 years of operation, the ICDS is yet to have an
impacton the poor nutritionalstatus of children. The ICDS has to
be convertedinto a true health, nutritionand development
programme,and not limited to a food dole programme.
SHANTIGHOSH

hereweredistressingreportsin the
newspapersas well as on television
earlierthis year aboutsevere malnutritionamongyoung childrenin some
areasof Maharashtra
and
drought-affected
Orissa.Whilechildrenandelderlyarethe
worsteffectedin anydeprivation,we need
to keep in mind the spectrumof malnutritionin Indiaeven in so-callednormal
times. Almost 30 per cent of newborns
havea weightbelow2.5 kg, amongwhom
mortalityis muchhigherthanamongbetter
birth weight babies. According to the
NationalFamily HealthSurvey 1998-99
(NFHS-2),almosthalfthechildren(47 per
cent) underfouraremalnourished(-2SD)
and 18 percentareseverelymalnourished
(-3SD).Thereasonsaremany,chiefamong
thembeingpoorlivingconditionsandlack
of awarenessof the young child's food
requirements.Even though nearly all
mothersbreastfeedthe child,whichis the

best food for the baby, most do it for 3-4


months only while the WHO recommends
exclusive breastfeeding for six months.
The Breastfeeding Promotion Network
in India (BPNI)l conducted a study in 49
districts in 2003. The study revealed that
only 39.7 per cent of infants were exclusively breastfedduringthe first six months.
The role of artificial feeding was quite
high. The situation regarding introducing
semi-solids is even worse. Overall in India,
only one-third of children were offered
any semi-solid food between six and nine
months and in Uttar Pradesh, Bihar,
Madhya Pradesh and Rajasthan it varied
between 15 per cent and 30 per cent. Even
in prosperous Punjab, the figure was only
38.7 per cent and in Haryana41.8 per cent.
Overall for India, the figure was 33 per
cent (NFHS-2). There is no concept of
feeding the child modified family food.
This is the beginning of malnutrition,which
is worst between six months and one-anda-half to two years, when the child is

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October 2, 2004

dependent on a caretakerto feed him/her,


after which it tends to improve because
now the child is mobile and can access
food whenever it is in the household.
We have a countrywide IntegratedChild
DevelopmentServices Programme(ICDS),
whose main objective is the improvement
of nutrition of pregnant and lactating
women and young children. It operates at
the village level andin urbanslums through
an anganwadi centre (AWC) manned by a
anganwadi worker (AWW) who usually
belongsto thevillageanddispenses services,
includingnutritionsupplementsto children,
and pregnant and lactating women. The
programmebegan in 1975 in 33 blocks and
a few urbanareas, and now after 30 years it
covers most of the country. It is considered
the biggest child welfare programme in
Asia andprobablyin the world.The priority
groups are low socio-economic group
families, scheduled castes and scheduled
tribes.The package of services consists of
supplementarynutritionto children and to
pregnant women during the last trimester
of pregnancy and during lactation, as well
as health and nutritioneducation and some
activities for child development. However,
the functioning of the programme leaves
muchto be desiredandmuchof the AWW' s
time is taken up by routine recording and
reporting,andmindlessweighingof children
(growth monitoring) after which no action
is takenoradvice given to thecaretaker.Her
main responsibility should be health and
nutritioneducation,encouragingwomen to
breastfeed exclusively for six months and
add semi-solid family food three to four
times a day in appropriatequantities after
that, which alone can improve nutrition.
Teamwork with the auxiliary nurse midwife (ANM) would result in better care of
pregnantwomen, immunisation and management of any illness. However, the way
the programmefunctions is that,even after
30 years, it has not been able to make a
dent in the poor nutritionalstatus of young
children.2' 3 However, in-depth nutrition
education regarding feeding with foods
within the family resources can help to
improve nutrition.4The Tenth Five-Year
Plan has not been very ambitious in this
regard. It postulates a reduction of malnutrition from 47 per cent to 40 per cent.
It is time, therefore, to change the direction of the programme and make it a true
nutritionandchilddevelopmentprogramme.
Now a Nutrition Mission is proposed
with more attention to 200-250 districts
where the level of malnutritionis high. The
Tenth Five-Year Plan proposed the prime
minister's Gramudyog Yojana with an
Economic and Political Weekly

and
allocationof Rs452 crore.Thetotalbudget haveto strengthen
properbreastfeeding
for nutritionin the TenthFive-YearPlan complementary
feeding,togetherwithcomis Rs 1,280 crore.Experiencewith food plete immunisationand prompt managedistributionhas not been very positiveso ment of any illness. Nutritionof young
far. There are large gaps in distribution, childrenis nobetterintheurbanareaswhere
often the food is not attractiveor suitable it shouldbe easierto deliverservices.6
andthereis evidenceof misappropriation. The government,press and concerned
TheWHOestimatesthatmalnutrition
was citizensgetenergisedsuddenlywhennewsassociatedwithoverhalfof alldeathsin the papersreportdeathsanddiseasesbutwhat
thatweresupdevelopingcountries.Theriskof deathfor happenedto theprogrammes
commonchildhooddiseasesis relatedto the posedtopreventsuchsituations?
Somecomdegree of malnutrition.Pelletier5 has mitteeortheotherwill be appointedto look
thathappenfrequemphasisedtherelationshipbetweenchild intoit.Thesearesituations
andmortality.
anthropometry
entlyandafterthefirstpublicityandconcern,
AWWis a goodresourcewhoif properly it fadesfromeveryone'smemory,andthe
trainedandsupervised,canachievea great programmesgo on in the same way. IE3
dealincollaboration
withthehealthsystem.
Insteadof ensuringthatthejobsheis assign- Notes
ed is doneas stipulated,she is beingpulled 1 BreastfeedingPromotionNetworkof India2003.
Status of infant and young child feeding in 49
in differentdirections- fordomiciliary
care
districts 98
of thenewborn,forintegrated
management 2 Integrated (blocks).
Child Development Services
of childhoodillness and so on. She has
Programme:Need for Reappraisalby S Ghosh,
Indian Pediatrics 34, 911-18, 1997.
becomea handyfrontlineworkerforevery
Development Services Prothatthegovernment
startsrather 3 Integrated Child
programme
gramme by S Ghosh, The National Medical
thanbeingleft aloneto carryout herown
Journal of India, 15, No 2 (Supplement)14-16,
2002.
Letus trainherwellforthe
responsibilities.
4 NutritionEducationand InfantGrowthin Rural
jobs she is supposedto do in the ICDS
Indian Infants, by S Ghosh, A Kilaru and S
retainwhatis essentialin the
programme,
Ganapathy, Journal of India Medical
forimprovinggrowth,nutrition Association, Vol 100, pp 483-90, 2002.
programme
5 The RelationshipbetweenChildAnthropometry
and developmentof children,andget rid
andMortalityin DevelopingCountries:ImplicationsforPolicy, ProgrammeandFutureResearch
of the rest.We need to convertthe ICDS
intoatruehealth,nutrition
anddevelopment by DL Pelletier,JNutr, 124, 2047S-81S, 1994.
6 NutritionalProblemsin UrbanSlum Children,
programmeandnot limitit to a food dole
by S Ghosh and D Shah, Indian Pediatrics 41,
pp 682-96, 2004.
programme.For nutritionto improve,we

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