A NY Times article published today highlights an interesting, though depressing, paradox in India – a decade of steadfast economic growth and one of the worst child malnutrition rates in the world. As the article notes: “China, that other Asian economic powerhouse, sharply reduced child malnutrition, and now just 7 percent of its children under 5 are underweight, a critical gauge for malnutrition. In India…the comparable number is 42.5 percent”. According to the Global Hunger Index (which measures three criteria with equal weight; the proportion of undernourished as a percentage of the population; the prevalence of underweight children under the age of five; the mortality rate of children under the age of five), India is worse than two-dozen Sub-Saharan African nations and other neighbouring nations such as Pakistan.
There are obviously a multitude of reasons given for the paradox. One mentioned is the ‘democracy versus authoritarianism’ debate, in the context of growth and development. And it probably has some explanatory power. The state-led authoritarian model followed by China makes it easier to pass health legislation to intervene when necessary. Despite some shortfalls, there is evidence to support this as China’s low child malnutrition rates continue to decline. In contrast, India finds it more difficult to intervene and direct funds towards particular problems. It is the world’s largest democracy that has a ton of special-interest groups guiding politician’s legislative agendas, and it could be argued government itself is a formidable gird-locked bureaucracy.
Further, despite the democratic incentive for politicians to cater to voters, the majority of whom do not have access to healthcare, public expenditure on health is low. According to WHO data on public and private expenditure, per capita health spending is probably slightly lower compared to nations that India has outpaced in economic growth. However, as seems to be the case in many debates about Aid and Growth, maybe the issue is more about the allocation of money and resources. The article explains, “most experts agree that providing adequate nutrition to pregnant women and children under 2 years old is crucial – and the Indian program (the Integrated Child Development Services program – network of soup kitchens in urban slums and villages) has not homed in on them adequately”.
While a call to more effective health interventions is central, it seems that microfinance should have some role to play – especially if aggregate economic growth is not going rapidly mitigate child malnutrition. Intuitively, given that the majority of credit is held by women, greater access to credit should help in some way to reduce malnutrition among children.
So I guess the big question is, since India and Bangladesh (below India in the Global Hunger Index) have been the examples of microfinance proliferation and innovation, why has child malnutrition persisted at levels worse than a number of war-ravaged sub-Saharan nations who don’t have a microfinance sectors? So more to the point, in India, has microfinance had a role in reducing this problem?
Any thoughts?
8 comments:
This is an extremely important issue and a massive developmental challenge for India, with as is well known- complex and multiple determinants. It is indeed worrying and unfortunate that India has experienced virtually no improvements in nutritional status over the past two decades, and that child malnutrition remains such a widespread reality. Between the second National Family and Health Survey (1998-99) and the third (2005-06) Child Undernutriton (measured by Underweight for Age for children under 3), reduced negligibly from 47% to 46%. This stagnation is further corroborated by time series data from NMMB from 10 southern states. The indicators are expectedly worse when disaggregated by socio-economic criteria. Some reflections on aspects of the discussion:
• On the South Asia- Sub-Sahran Africa Comparisons- An important argument in explaining child nutritional status being far worse in India (and South Asia overall, therefore including Bangladesh) when compared to Sub-Saharan Africa, is that the inequality between men and women is a central determinant (first put forth by V Ramalingaswamy et al, Malnutrition: a South Asian Enigma, 1997), and by far the most important contributor to the regional gap. It argues for a thrust towards improving womens social status and equal freedoms, opportunities and rights for women to participate in decision-making.
Osmani and Sen (The Hidden Penalties of Gender Inequality- The Fetal Origins of Ill Health, 1993) have further brought out the interconnections between gender inequality and maternal deprivation and its societal implications for undernutrition, health and development in both short and long-term. Further, research also points that improvements in womens status relative to men are likely to have greater positive improvements on child nutrition when compared to Sub-Saharan Africa.
It might be useful to build some of these questions into microfinance research.
• Experience shows that aggregate economic growth is not necessarily leading to adequate improvements in child undernutrition (Gujarat as a case in point actually experienced an increase in percentage of children underweight for age over the two NFHS rounds between 1998-99 and 2006-07!). There are also limits to how far income growth can take us, and evidence does point to a central role for direct interventions in this area.
• Further, Childhood Stunting (also Underweight for Age especially when it is not Severe Acute Malnutriton, but in mild and moderate categores) is often ‘invisible’ to the community- given that it is such a widespread problem, and at the community level- the average heights are low. This possibly affects expressed demand from the community- influencing political will and allocations- unlike an issue such as education, where the benefits are more visible and established, and hence lead to greater public demand.
It's interesting that you should mention that Gujarat actually became worse off.
I would imagine there has been a shift towards storable commodities in Gujarat -- which are often, but not necessarily, inedible -- with the promotion of spot and futures exchanges, and hedging and speculative practices in agriculture more generally.
It would be interesting to look at how the composition of 'for sale' vs. 'for home consumption' crops have changed over time with growth and export market promotion and the impact that has on childhood, or, for that matter, adult nutrition in rural areas.
The relative merits of political, social, and economic systems aside, presumably when thinking about nutrition it would seem reasonable to consider what goes in to a diet.
However, Sri Lanka (and, I would imagine, Kerala) seems to provide a strong case for the gender inequality argument.
It would indeed be interesting to look at what has happened to nutritional status with changing crop patterns towards cash crops.
I have observed that in several cases, changed cropping patterns from traditional cerials to cash crops such as soya in tribal belts (of Maharashtra for instance) have been accompanied with a shift to highly subsidised Rs. 3/kg rice/wheat from the PDS. It would be very useful to understand what this did to nutritional status.
In certain geographies (many Tribal belts in central India) where historically there has been inadequate (while perhaps more diverse- traditional subsistance) diets, what does this income from cash crops, and subsidised access to PDS do for nutritional status and overall wellbeing.
And further how does this transition pan out in other relatively food secure geographies such as in the North East?
China and India are not comparable because of their different family planning regimes.
Nor is evidence from areas with high female literacy of relevance because of its association with higher marriage age and reduced family size.
A quite different point has to do with Indian religious and cultural taboos about what can be eaten- what qualifies as food. This affects young mothers- even from affluent backgrounds or who are first generation immigrants to western countries- and leads to child malnutrition. In the U.K, health workers in areas with large concentrations of women from Asian backgrounds ran educational programs to this end. Even now, Asian women who continue to feed the child with milk rather than encourage a switch to solid food are counselled by the Community nurse who has been taught to look out for such things.
Irrational and religious taboo systems are also responsible for a lower proportion of biomass being processable for human nutrition.
Market failures arising from externalities as well as distortions arising out of subsidies to vested interest groups compound the problem.
However, at bottom, there is a lot of ignorance of what constitutes good child nutrition.
It may be, in the past, there was more nutritional diversity even on a basic diet. Monocultures in cereals have unanticipated nutritional effects.
The affluent can compensate for irrational food choice by dietary supplements.
As things stand, Child malnutrition in India is heavily associated with low marriage age, high fertility, lack of nutritional diversity and reduced availability of perishable protein and vitamin sources.
The answer is to rethink nutrition from an Indian perspective. There are all sorts of workarounds for Religious taboos and Gandhian silliness.
This blog post rather surprised me. Although I have heard of India's malnutrition troubles on various reports of the BBC, I don't think I quite got the full picture. To think that the poster child of third world development through micro finance and multi-national corporation contribution is much, much worse off than I thought (and probably many other Americans know of), makes me wonder if the techniques used in India to procure this rapid development don't actually work as well as we would like to believe. The "invention" of micro-finance and the belief that giving small loans to women in particular is the best way to increase overall health of children in developing countries, will have to be reassessed in my opinion. If we cannot help one of the world's poorest and most populous nations, then we must take a step back and rethink what we are doing. We cannot stay by micro-finance because of a false hope and belief that it works, when in reality it might not. I am no expert on third world development and especially not micro-finance. I am just an intern at a non-profit humanitarian known as Ascend, but I hope that all organizations, companies, and nations take a look at India and try to fix this problem.
Micro-finance initiatives are not designed to tackle child malnutrition. The official approach focuses on an integrated district level 'Child care and Well mother' program which gives attention to both mother's health and nutrition as well as that of the child. In addition there is 'aanganvadi' scheme for providing meals to younger children. Free school meal schemes are also run with some degree of effectiveness in some States.
However, a basic problem is that high caste Hindus in many states don't know the nutritional value of traditional lower caste staples. Popular culture is pushing a false idea of what constitutes 'good food' as against 'impure food'.
Fall in nutritional awareness of mothers is inevitable during industrialization. In U.K working class mothers, in some parts of the country, were still mis-feeding kids until recently.
In U.K, and other Western countries, the Govt. sponsored an expensive 'domestic science' programme in all schools to teach girls about this.
During Wartime, Govts. sponsored information campaigns aimed at young mothers and implemented a rationing program.
All such initiatives are expensive and take a big commitment of Govt. time and monitoring.
In India, there is increasing geographical mobility, language problems, religious taboos, failures in public provision of merit goods and so forth.
In this context, Govt. does not have the necessary legitimacy to act. Why? Since it has no history of mobilising the human resources of the country for a particular purpose, any sums it might allocate for this purpose would be regarded as 'fair game' for rent-seeking politicians. Indeed, the nightmare of tax payers subsiding a Malthusian horror story on their door-steps- simply for vote bank politics- would be enough to vitiate the scheme.
However, it is comforting to note, highlighting this issue will not result in it being tackled but should succeed in getting funding for some particularly oxymoronic research scheme, or add a branch to some existing PhD factory mill.
However, this will not tackle basic problem of childish and malnourished brains of the holier than thou academic working in this field.
very useful blog.
I am impressed.
I like it very much.
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