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Malnutrition and marginalized in Kerala A note

The recent report about childrens death1 due to malnutrition in Attappady of Palakkad district, Kerala is depressing. There are 46 such incidents reported from Attapady in last 18 months2. The media reports and interventions trigger off discussions on nutritious status of Adivasies and other marginalized communities in Kerala. However the government and the departments concerned are trying to portray it as an isolated incident happening only in Attappady. They also come up with theories and expert opinions ranging from genetical and alcoholism to cultural practices of Adivasies, all of them essentially implicating Adivasies themselves are responsible for such tragic incidents and announcing packages after packages3 for Attappady What is happening in Attapady is grave and gross violation of all notions of Human rights and needs urgent and meaningful intervention of the state. Nevertheless, we also should not forget that what is unfolding in Attapady is just a tip of the iceberg. In addition, there are media reports coming from different parts of Kerala citing similar incidents.4 In this note, we are mainly looking in to the issue of malnutrition in Kerala, focusing marginalized communities namely dalit, Adivasies and Fishing communities.

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39 such deaths reported in the media from March onwards Reporter TV 3 http://www.keralacm.gov.in/index.php/homenewtopnew/34-frontslider/1723-attapady 4 http://www.indiavisiontv.com/2013/05/18/205475.html http://www.mediaonetv.in/news/7141/mon-05202013-0749

Malnutrition among children in Kerala

Children at the age group of 0-6 constitute 9.95% of states total population.2 Surveys including National Family Health survey (NFHS) and National Nutrition Monitoring Bureau give a critical picture of malnutrition among children in kerala. NFHS -3 data reveal that Onequarter of children under the age of five years in the State are either stunted or growth reflects a process of failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions3. 16 per cent are wasted or thinness indicates in most cases a recent and severe process of weight loss, which is often associated with acute starvation and/or severe disease. 23 percent are underweight indicating too thin for their height and 23 per cent are underweight, indicating chronic and acute under-nutrition. The rate of severely malnourished children is higher in Kerala than that of Tamil Nadu and Andhra Pradesh.4
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Source: National Nutrition Monitoring bureau1

National Institution Monitoring Bureau http://www.censusindia.gov.in/2011-prov-results/paper2/prov_results_paper2_kerala.html 3 http://www.who.int/nutgrowthdb/about/introduction/en/index2.html 4 Government of Kerala economic Review 2012

Astonishingly the data tells us that between NFHS -2 and NFHS -3 there is no significant progress has been made even though state policy on children adopted in 2004 talks about in length on combating the problem of malnutrition! It is also suggesting that the state institutions that are designed to address the issue failed miserably. The infrastructure facilities available with 32115 AWC are pathetic. A study conducted by RIGHTS during the year 20121 found that 41% of ICDS centers do not have their own buildings. (Those centers which work in their own buildings are congested and not enough have space with any standard!!) 85% ICDS centers do not have electricity connection, 73 % No drinking water facilities, No gas connection for 72%, No toilets for 55% , No play ground for 94% and 43% do not have separate kitchen. What is alarming is that the ICDS service provided only to 25.1%2 children in the state between the age group 0-6, in other words state does not have any clue about the health or nutritious status of 75 % children in Kerala! The pattern of budget allocation in the state budget is also a sign of state apathy towards the issue. ICDS expenditure as a percentage of total revenue expenditure of state is just around 0.6 percent during the entire tenth and eleventh plan period. It needs to be seen how the increase in number of beneficiaries can be managed with a static allocation of financial resources to ICDS.3

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ICDS and Panchayath Budgets http://wcd.nic.in/icdsdatatables.htm

( state reports)

Mid Term Appraisal of the XI Plan of Kerala - Planning commission of India

In addition, all most 80-85 % of the ICDS budget spent on salaries alone and the government was able to provide service to AWCs by using funds of other nutritional programs. More over the Auditor General tabled its report on ICDS in the Kerala Legislative assembly during the budget session 2013, gave dismal picture and the report was literally blasts the government by following comments1: The department was not preparing any long term perspective plan. In the absence of the plan, there were deficiencies in creation of new AWCs and insufficiencies in the delivery of services to beneficiaries in various components in ICDS . There was a shortage of 8,619 Anganwadi Centres (21 per cent) in the State. Fourteen additional Anganwadi Centres (AWCs), sanctioned in 2005 by GOI, were yet to be operationalized. Many functional AWCs in the test checked ICDS projects were functioning in rented premises and lacked basic infrastructure facilities like safe drinking water, toilets, etc.

http://agker.cag.gov.in/images/Audrep2012/Civil/ch2.pdf

The percentage of child population who were not immunized against Polio and DPT in Palakkad and Malappuram districts were respectively 36 and 31. The objective of universalization of Supplementary Nutrition Programme was not achieved as 56 to 66 per cent of the identified beneficiaries were not covered under the Scheme. The percentage of malnourished children below the age of six years in the State ranged between 27 and 39. Test check of records in Idukki, Malappuram, Palakkad and Thiruvananthapuram districts indicated that 110 out of 1180 children who died during 2011-12, were severely malnourished. GOI guidelines stipulating periodical weighment of child beneficiaries under Supplementary Nutrition Programme to assess their nutritional status was not adhered to during 2007-12.

There are number of other statistical reports and information are now available with the government and in the public domain to prove that malnutrition is a serious threat in the state. However, state still refuse to accept the fact and tend to believe and make the society to believe that malnutrition is a phenomenon remains only in some Adivasi pockets in the state. As we have discussed earlier, most of the child population in Kerala did not came under the monitoring net of the state, then who are these children in the data? In spite of the existence of low income rates, the incredible achievements in the life index is said to be the core of Kerala development1. One of the points highlighted as specific to Kerala model development is that the distribution of economic services based on equality and social justice has been obtained. The statistical data of achievements in health and educational sectors have been constantly evoked as the signs of victory of the model. While Kerala development model gained national and international appreciation as an adaptable development ideal, the experiences of the marginalized of Kerala was entirely excluded from the much acclaimed statistical information and academic studies. The troubled realities of the marginalized were hidden in the much-hyped statistical wonders produced in time to time by the defenders of the model. ... When a Malayali who compares health care in kerala that in developed countries chooses, when it comes to dalits, to llok towards Bhihar, it is offensive in two ways. First, by establishing the notorious and appalling massacres of dalits in Bihar as the sole forms of oppression that Dalits face.2
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kerala Padanagal, Kerala Shastha Sahithya Parishath Sunny M Kapikadu- No alphabet in sight

While discussing Horizontal Inequalities that persist in Kerala among Dalits, Adivasies and fishing communities Human development report 2005 pointed out .There is no denying ones location within the network of social affiliation substantially affects ones access to resources. The defining factor of malnutrition is the Socioeconomic inequality, as explained by different WHO1 documents, is the degree to which childhood malnutrition rates differ between more and less socially and economically advantaged groups and their access to the resources. It is very clear that the Dalit Adivasi and fishing communities the out layers of Kerala Development and their social economic deprivation made children of these communities become most vulnerable when it comes to the question of malnutrition.

Dallit

Dalits constitute around 10% total population of the state. 81% of scheduled caste population lives in villages, 95.6% are agricultural labors and wage labors1. The 60% of scheduled caste live in 25906 scheduled caste colonies in Kerala 2 . Children compose 12% to total dalit population3. Exclusion of dalits from socio economic field of the state is a reality in Kerala. At least, those who defend Kerala model now accept the fact that there are excluded communities from the so-called development. There is nothing to be surprised about a community, in which 70% are wage labors and 83% hold less than 10 cents of land, more than 60% living in ghettos, lag behind over all development4.
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http://www.who.int/bulletin/volumes/86/4/07-044800/en/ Census data 2001 2 Kerala Institute of local administration under RTI 3 Economic review 2011 4 RIGHTS report- lessons of discrimination in development

Percentage of children under 5 year classified as malnourished according to anthropometric of nutritional status, Kerala

The chart above exemplifies the miserable malnutrition status of Dalits in Kerala. In different stages of malnutrition, State average is 24.5 (Height for age) 15.9 (Weight for height) 22.9 (weight for age) while Dalits lags behind 33.7, 16.5 and 25.4 respectively. In addition, different development indices devised by the planning board and other government departments such as poverty, and district variance in progress etc, the districts that have large concentration of dalits and advisees far below the state average.

Adivasi
At national level, population of Adivasies is above 8% to the total population; while in Kerala Adivasies constitute just 1.4 1 percent to total population. The Adivasies in Kerala are not only geographically concentrated, but are overwhelmingly rural. Highest concentration of Scheduled Tribes is seen in Wayanad district (37.36 %) followed by Idukki (14 %) and
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Census data 2011

Palakkad (10.8 %) and these three districts together account for over 60 per cent of STs in the State. The costal district of Alappuzha has the lowest percentage2 (0.15%). Children constitute about 14 % of Total Adivasi population.

Above chart is a survey conducted by national nutrition monitoring bureau on Tribal children up to the age of 12 months. Among Adivasi children in Kerala presence Severe under weight (9.1%), severe stunting (32.2) and severe wasting (7%). In all other age groups, the results are more or less the same. Planning commission of India in its Kerala development report1 place it straight rural poverty among adivasis in Kerala persists and comes to more than two-and-half times that of the rural population of kerala in general. Adivasis constitute only around one per cent of the states population, nearly one-fouth of them still live below the official poverty line; the actual incidence of poverty among them could be even higher, this high incidence of poverty among adivsies points to the various dimensions of social inequalities prevalent in the state . What is unfolding in Attapadi today is manifestation acute hunger and poverty among adivasies in kerala.

Kerala Government Economic review 2011

Fishing communities
..Fishermen community still remains underprivileged in Kerala. Nine districts of Kerala have coastal areas. The Kerala coastline running to about 600 kms forms 10% of Indias coastline. The number of fishermen of Kerala is estimated at 189200, one-fifth of traditional fishermen in India. People living in the long coastal belt have all the disadvantage of environmental mismanagement. Congested living, lack of safe drinking water and sanitation, high prevalence of water borne diseases, low immunization status and family planning achievements1... The statistical information about fish that has been caught and the foreign currency earned by the country and its share to GDP and SDP are available with the government even with weekly breakup! Sadly the government has or conducted any surveys so far to review the socio-economic profile of fishing communities. In real terms, the health indices of fishing communities are more or less same as Dalits and Asdivasies. Theeradesha Samrakashna Samithi a grassroots organization working among costal people conducted survey in 2012 in Alapad Panchayath. Alappad panchayath contain 8 of the fishing village out 222 fishing village in the state. Survey found that 54 % children belw the age of 0-6 are malnourished!

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http://planningcommission.gov.in/plans/stateplan/index.php?state=b_sdrbody.htm Kerala Government Economic Review 2011

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It is evident from the chart that apart from poor delivery of service, infrastructure facilities available for marginalized communities also extremely pitiable and far bellow from the state average and yet another example of service to the poor is poor service .