Evolve a consensus to save our children

The government must soon come out with a national policy on nutrition, with the last child at the heart of it

Women and child development minister Maneka Gandhi set the cat among the pigeons recently at a meeting by calling to create a malnutrition-free India by 2022.

The minister came out in favour of precooked foods to replace hot cooked meals, given in India’s 1.4 million Anganwadi centres. And she spoke against cash transfers to replace the take-home-rations (THRs), given for children between the age of six months and three years, and for pregnant women. But what emerged out of the highprofile meeting was only confusion. For experts, NGOs, doctors, and the government were divided on both the points Gandhi touched upon.

One reason why the nutrition story has not gone forward in India as it should have is the sharp division that has existed in the nutrition community, and almost two out of five children under five still remain stunted, despite the improvements.

It is widely conceded that the THRs, procured through the PDS system, are of substandard quality, sometimes fed to animals or at times consumed by the family rather than the child. Malnutrition is known to peak and irreversible damage done in this group of children. Given this, the revelation— made by the government-conducted National Family Health Survey 2015-16 that only 10% of (6-24 month) children are adequately fed — was not surprising.

Some advocate cash transfers to the mother’s account as a way to mitigate the problem. Others, like Gandhi, made a case for packaged foods because the amount transferred per month is too small (₹180 a month at the rate of ₹6 per child) and will hardly enable the mother to get an adequate supply for the child’s needs in the open market.

Now to another contentious issue not touched by Gandhi. There is a controversy around the provision of Ready-to-Use Therapeutic Foods (RUTF) or energy dense foods, produced in India, which like medication, are given over a period of four-six weeks to pull the severely wasted child back from the brink, and there are nine million such children in India. This is different from the pre-packaged food but is often confused with it.

The NGOs campaigning against it make three points. It helps the MNCs and the suppliers’ lobby make profits, it has only a 50-55% efficacy rate with many children slumping back, and it is not worth the effort or money. Though the government of India has put this on hold in the absence of a clearly enunciated policy, it raises many questions.

If you have cancer and have even a 30% chance of survival, would you not pull out all the stops to give yourself that chance, and take the necessary medication, if available? Why must children, the most vulnerable and voiceless in our society, be denied that chance to live?

Of course, powerful lobbies are at work to promote it, and will work even harder with elections around the corner. But do we stop the availability of medicines because of corruption in the pharmaceutical industry? Do we shut the PD S system for the poor because it is riddled with leaks and corruption? Should we chop our nose to spite our face? The battle against corruption has to be fought, but it has to be fought separately and certainly not at the cost of children’s lives.

There was a small study done in Meerut not long ago by a group of paediatricians who concluded that even without the RUTF, only 2-3% of the severely wasted children died, and 25% went on to recover. But it was silent on what happened to the remaining 75%, who did not recover. Malnutrition, which is emerging as the most important issue, if India is to have a future, can lead to physical disabilities, mental challenges, cognitive disrepair, and loss in productivity.

This also raises the question: What in India do we consider as an acceptable rate of mortality? And, if the RUTF is not the way to go, what is the alternative we put in its place?

It is time the government came out with a national policy on nutrition, which addresses these, and other, questions expeditiously. But it must be an evidence-based policy, with that last child at the heart of it. If we fail to evolve a consensus, our children’s tomorrow could die today.

SHOULD WE CHOP OUR NOSE TO SPITE OUR FACE? THE BATTLE AGAINST CORRUPTION HAS TO BE FOUGHT, BUT IT HAS TO BE FOUGHT SEPARATELY AND CERTAINLY NOT AT THE COST OF CHILDREN’S LIVES