India must rise to the challenge of stunting

The Centre must provide healthier school meals, start milk stations and make nutritious food more affordable

In India, more than 4.8 crore children suffer from stunting, which means they are below the normal height range for their age group. The consequences of stunting are immediate and lifelong for them, ranging from learning disabilities, reduced earning opportunities, and increased disease risks in adulthood.

The causes of stunting are well known: Lack of adequate nutrition; contaminated drinking water and poor sanitation; inadequate access to health care facilities; delayed treatment of infections; low parental socioeconomic and educational status (especially of the mother).

A comparison of data from India’s National Family Health Survey 1 and 4 shows a reduction in stunting from 52% in 1992-93 to 38% in 2015-16. The single biggest factor behind this has been improved access to primary health facilities, focusing on maternal and child health including immunisation.

To increase the pace of change, first, the government needs to make nutritious food more affordable and accessible to poor families. As per the latest National Nutrition Monitoring Bureau, which has been collecting data on diet and nutritional status of rural, tribal and urban populations for almost four decades, the calorie intake of children (1-3 years) in rural areas was only about 70% of their requirement due to shortages.

For example, milk is a vital source of nutrition for physical and brain development in young children. While the country is a global leader in milk production, substantial shortfalls in consumption persist, especially in poor communities.

This shortfall could be tackled by establishing “milk stations”. This was a key strategy in the United States in the early 20th century to improve the nutritional status of its population.

Further, the intake of good quality protein and micronutrients are missing in the diet of the poor, which is largely cereal based. This deficiency could be addressed by adding pulses and millets and milk, eggs, fruits and vegetables in the food basket of the poor communities.

A clean India will also be critical for a healthy India. Access to clean drinking water and sanitation facilities reduces risks of water-borne infectious diseases, and thus enables children to absorb their food better. While building a functional toilet for every household and motivating them to use these toilets are crucial, what is equally important is the safe disposal and treatment of human excreta. Currently, less than 20% of the human waste in India is treated before it enters the water bodies, which is again recycled for human consumption.

The situation in the country may look dismal but a study done in 1992 by researchers at the Uppsala University in Sweden shows that the window to eliminate stunting is far wider than that was thought earlier. Between 1969 and 1987, 27,000 children were adopted by Swedish foster parents from across the world, including 114 Indian children (aged three months to six-years) who moved to the country in 1985. The study followed these 114 and found that at the time of their arrival in Sweden, 47% were stunted, but the move brought a striking change in them. In less than two years, this figure dropped to 4%. Even children beyond two years saw increases in their height when they moved to Sweden. This means that even as sustained efforts must be made to prevent stunting among all children, it is also possible to help older children who are suffering from stunting.

This can done through creating a stimulating educational environment till their adolescent years and improving the nutritional content of school meals. Almost half of the 400 million adults entering the workforce over the next 15 years would be experiencing stunting in childhood and we must do all we can to ensure that they live healthy and productive lives. The stories of the 114 children who overcame stunting in a short time must be scrutinised. Can we give the millions of children living in India, who have suffered stunting, a similar chance to grow and thrive? It appears that we can.