The stubborn persistence of child malnutrition in India is truly one of the tragedies of our time. Many of us have long agonised over this preventable problem, and we continue to ask, why do half our children not get either enough or the right food or adequate care? Even in sub-Saharan Africa only thirty percent of the children are malnourished versus fifty percent in South Asia. And this 20-point gap exists despite our much higher levels of per capita income, education and even safer water access. One-third of the babies in India are born with low birth weight compared to one-sixth in sub-Saharan Africa. This is heartbreaking given the dramatic improvements in our agriculture, advances in literacy, and great strides in economic growth. For more than 20 years, India has even “sustained the greatest effort in history to improve nutritional standards,” according to UNICEF, through its Integrated Child Development Services Programme. So, it is not for lack of effort. Nor is it due to poverty, which has been steadily declining by one percent a year for two decades. What then accounts for this puzzle? In 1996, India's famous physician-nutritionist, the late Professor V. Ramalingaswami (with others) wrote a groundbreaking article on this anomaly called “The Asian Enigma.” After considering different factors, including access to food and income and our vegetarianism, he concluded that the lower status of women in South Asia might be the reason. The link between women's position and child nutrition seems plausible. In many Indian homes men eat first; women have to make do with leftovers. And this is perhaps why 83 percent of women in India suffer from iron deficiency anemia versus 40 percent in sub-Saharan Africa. A malnourished mother will give birth to a baby with low birth weight--the single most important predictor of child survival. Moreover, the pressure of domestic work often forces a mother to delegate to older siblings the irritating chore of feeding solid food to her baby. If women had more control over family income and decisions they would devote them to better pre and post natal care and to their children's needs. So far this was the theory. But now an extensive empirical study by the International Food Policy Research Institute and Emory University seems to confirm Ramalingaswami's hypothesis. The study brought together data from 36 developing countries, spanning over one hundred thousand children under the age of three and an equal number of women. It measured a woman's position in the home in various ways--whether the woman works for cash, her age at marriage, and the difference in age and education between husband and wife. The study concludes that the lowly position of women in the family compared to men is the single most important reason for the gap between South Asia and sub-Saharan Africa in children's nutrition, followed by sanitation (e.g. the lack of latrines) and urbanization (slum living). A woman's low place in society also prevents the active use of health services by women and children. While reading this report I wondered why is the position of women in India so much worse than that of women in other societies? The report seemed to suggest that the South Asian women were not so far behind African women as the way their inferior status limited their ability to nurture their children. I also questioned whether the tragedy of children's well being is only a woman's issue, or is it a family concern where men play a crucial role. I suspect there are no easy answers, but they are worthy subjects for further research. Women everywhere suffer from a lower status, but in India it appears to have devastating consequences. The policy implications are clear: if we want to reduce child malnutrition, we must combine our child programs with efforts to improve the situation of women in our society. To succeed in the knowledge-based economy, we need healthy children who will become tomorrow's innovative adults. If we ignore gender inequality, we will continue to produce stunted children, wasted lives, and untold misery.
Jul 29th 2002