Hidden Hunger in Indian Women: An Evident Gender Disparity

Women’s Day- the day when we celebrate success that women have achieved. On this day, we should also confront the challenges faced by women. Hidden hunger is an important one faced by large number of women in day-to-day life.

Hunger has three broad dimensions- first, inadequate food (energy) intake; second, deficient protein intake and third, deficiency of micro-nutrients also known as hidden hunger. Deficiency of micro-nutrients intake may not be felt as hunger, as quantity of food consumed might be enough. However, insufficiency of micro-nutrients affects individuals’ health and productivity to a great extent. Iron is an essential micro-nutrient and a component of haemoglobin that carries oxygen throughout the body.

Deficiency of haemoglobin in human body is called Anaemia (precisely, iron deficiency Anaemia). Fig 1 shows prevalence of Anaemia among children, women and men in major states of India. The states are arranged in decreasing order of prevalence of Anaemia in children; Chhattisgarh has the highest prevalence of Anaemia (71%) and Manipur has the lowest (23%). Women in West-Bengal and Haryana are the worst affected and face highest prevalence of Anaemia (63%). According to the recently published reports under the National Family Health Survey, the national level prevalence of Anaemia among men is 23 per cent, while for women the prevalence is more than double at 53 per cent. This gender disparity is reiterated by huge difference in state level prevalence between men and women; even in states like Kerala with lower incidence of Anaemia the difference is huge.

Measures like fortification of food and administration of Iron-folic acid tables are one way out for reducing prevalence of Anaemia. Studies have also suggested importance of diversity in diets for reduction in prevalence of Anaemia. Leveraging Agriculture for Nutrition in South Asia (LANSA) is taking up action research— Farming System for Nutrition (FSN) to increase dietary-diversity in few villages of Koraput (South Odisha) and Wardha (Maharashtra) by increasing consumption and production of nutrient dense food (pulses, millet, green leafy vegetables, vegetables and fruits). A study undertaken by the National Institute of Nutrition (NIN, Hyderabad) recommends us to eat Vitamin-C rich food along with the regular meals as it increases iron absorption (conversion of iron source in plants to iron required by human body). This restates the importance of diets-diversity.

Multiple approaches like fortification, supplementation, dietary-diversity, hygiene, behavioural changes have to be pursued for reducing prevalence of Anaemia. Most important is regular monitoring/surveys for measuring the prevalence that shows our failure or success towards improving health of individual in India. 

The huge difference in prevalence of Anaemia between men and women is a great cause of concern for gender disparity. In general, Anaemia causes low-productivity, dizziness and weakness. However, Anaemia  in pregnant women also hinders with development of child to be born and results in low birth-weight. Consequently, this may cause a life-long cycle of low productive individuals, hence low income and undernutrition. Therefore, Anaemia in women does not end with women’s well-being but is also a foundation of unequal beginning for many children to be born. Hence this gender disparity is a major challenge face by India.

#Anaemia #NFHS #gender

Mainstreaming Nutrition in Politics

In the 2016 Kerala Assembly Election, Prime Minister Modi compared child mortality (death) rate in a Scheduled Tribe of Kerala with Somalia. Keralites found it objectionable and were outraged on different social media platforms. I don’t know how many of these netizens belonged to the Scheduled Tribe community. In my opinion no child of any community or of any country should die at this young age. However, I was glad to see nutrition and child health being debated in Indian Politics. Since then I wondered if this would be the case in the forthcoming elections, especially in Uttar Pradesh (UP).

Before I am asked ‘why UP?’ let us see the status of undernutrition in UP and other states where Govt of India administered the Annual Heath Survey in 2012-13. But first, let me draw your attention towards hunger in India as defined by The Global Hunger Index (GHI). India ranks 97th out of 118 countries, greater the rank, worse is the condition. India stands better than its western neighbours- Pakistan and Afghanistan but worse than eastern neighbours -Nepal, Sri Lanka and Bangladesh. GHI is based on three factors—i) mortality in children below 5 years, ii) prevalence of undernutrition in children below 5 and iii) per cent of population eating less than a standard energy requirement.

The first parameter- Under 5 mortality rate i.e., out of hundred how many children die before attaining the age for 5 years. Fig. 1 shows that UP has the highest child mortality rate, about 10 out of 100 children in rural UP. On an average, about 5 children die below the age of 5 in India. Except Uttarakhand, all states shown in the figure have more number of children dying than the Indian average. 

Figure 1: Under 5 Mortality Rate  

Source: Annual Health Survey 2012-13 (for States) and Global Hunger Index (for Indian Average)

Prevalence of stunting is used as one of the components in GHI to measure undernutrition in children. Children unable to attain the height according to their age are stunted. UP has the highest proportion of stunted children, 6 out of 10 children. Studies have shown stunting negatively impacts a child’s cognitive capabilities and is associated with lower economic wellbeing in the longer run.

Figure 2: Under-nutrition in Children below 5 years.

Source: Annual Health Survey 2012-13 (for States) and Global Hunger Index (for Indian Average)

None of the political parties brought the dismal rate of mortality and undernutrition to their discourse for the forthcoming election (else media did not cover it). Are political parties afraid of raising these issues, as they lack to envisage the solution? Or the Kerala troll experience is a lesson to all parties to not to talk about it. Or political parties don’t see this as an issue that will connect with people? Well, mortality rate and rate of undernutrition may sound similar like some economic indicators however it is about life and death of budding lives. These rate of child mortality and the undernutrion raises question on India's aspiration of being economic power and shows insensitivity of Indian politics.

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2016 के असेंबली चुनाव में प्रधानमंत्री मोदी ने केरल के एक अनूसूचित जनजाति में शिशुओं के मृत्यु दर (मोर्टेलिटी) की तुलना सोमालिया से की थी. केरल के कुछ लोगों को ये तुलना नागवार गुज़ारा और अपनी नाराज़गी social media पे ज़ाहिर की. अब ये तो मालूम नहीं की नाराज़ लोगों में से कितने उस अनूसूचित जनजाति के थे. मेरी राय में किसी भी देश या समाज के बच्चों की छोटी उम्र में मौत दुखद है. खैर, भारतीय राजनीति में कुपोषण और स्वस्थ की चर्चा से मैं उत्साहित था. मैंने सोचा, क्या ऐसी चर्चा अब आने वाले सभी चुनाव में होंगी, क्या सुपर पॉवर का दंभ भरने वाले इस देश में कुपोषण चुनावी मुद्दा बन सकेगी? खासकर उत्तर प्रदेश (UP) के चुनाव में जहां ये आंकड़ा भारतीय समाज की कड़वी सच्चाई है ?

चलें, UP में कुपोषण की समस्या को समझने की कोशिश करते हैं. भारत सरकार ने 2012-13 में UP और कुछ राज्यों में एनुअ्ल हेल्थ सर्वे (AHS) करवाए थे. राज्यों के बारे में जानने से पेहले आइये हम भारत की स्थिति टटोल लें. ग्लोबल हंगर इंडेक्स (GHI) देशों  में भूखमरी को मापने का एक मान्य तरीका है. एक सो अठारह देशों में भारत सत्तानवे स्थान पर है. अपने पश्चिमी पड़ोसी पाकिस्तान और अफगानिस्थान से भारत बेहतर स्थान पर है, लेकिन अपने पूर्वी पड़ोसी नेपाल, श्रीलंका और बांग्लादेश से पीछे है. GHI के तीन पैमाने हैं i) पांच साल से काम उम्र के बच्चों में मृत्यु दर (मॉर्टेलिटी रेट), ii) पांच साल से काम उम्र के बच्चों में कुपोषण का दर और iii)  कितनी प्रतिशत लोग भोजन से मिनिमम ऊर्जा कि ज़रूरत भी पूरी नहीं कर पाते हैं 

Fig. 1 दर्शाता है UP में मॉर्टेलिटी सब से ज्यादा है. ग्रामीण UP में करीब सौ में से १० बच्चे अपनी पाँच साल की उम्र पूरी नहीं कर पाते हैं. ये भारत के मौजूदा औसत से लगभग दो गुना है. सिर्फ उत्तराखंड को छोड़ कर सभी दिखाए गए प्रदेश का हाल भारत के औसत से बुरा ही है.

Figure 1: पांच साल से काम उम्र के बच्चों में मृत्यु दर

स्टनटिंग (stunting) यानि बच्चों का अपनी उम्र के मुताबिक कम कद का होना; कुपोषण को दर्शाता है. GHI भी स्टनटिंग कि दर को कुपोषण के एक मापदंड की तरह इस्तेमाल करता है. UP में स्टनटिंग की दर बांकी दिखाए गए राज्यों अधिक है (Fig.2). कुछ शोध बताते हैं की स्टनटिंग का सम्बन्ध बच्चों के कम लिखने-पढ़ने की क्षमता से हैं और साथ ही दीर्घकाल में इसका आर्थिक दुष्प्रभाव भी हो सकता है.

Figure 2: पांच साल से कम उम्र के बच्चों में कुपोषण दर

UP के इस इलेक्शन में अभी तक किसी राजनैतिक पार्टी ने कुपोषण पे कोई चर्चा नहीं छेड़ी है, ना ही मीडिया में इस मुद्दें को कवरेज़ मिल पाई है. क्या हमारे नेता समाधानों की कमी के वजह से ऐसी समस्या से कतराते हैं? या केरल की नाराज़गी से सबक सीख सभी पार्टियां ऐसे मुद्दों को उठाने से गुरेज़ कर रहीं हैं ? या पॉलिटिकल पार्टियां सोचती हैं की ये मुद्दों लोगों से जोड़ने में कारगर नहीं हैं ? वैसे सुनने में मोर्टेलिटी और कुपोषण दर किसी आर्थिक सूचक जैसा भी सुनाई पड़ता है, लेकिन ये याद रहें कि ये महज आंकड़े नहीं हैं बल्कि ये उन अनगितन फूलों की दास्तान हैं जो खिलने से पहले मुरझाने को मजबूर हैं। कुपोषण से मर रहे मासूमों या उस कमतर ज़िन्दगी को जीने के लिए मजबूर बच्चों का रुदन उस ठहाके लगाते भारत को तमाचा है जो अपनी अंधी तरक्की की होड़ में हमारी संवेदनशीलता को भी कुपोषित कर रही है।

Tags: #nutrition #India #UP #election