By Louis-Georges Arsenault *
Despite constitutional protection, positive discrimination policies and earmarked budgets, India’s 104 million tribal people continue to remain among the poorest and most nutritionally deprived social groups in the country.
In 2005-06, 54 per cent of India’s tribal children under five years of age were stunted (too short for their age), which is a measure of chronic undernutrition; this is well above the national average of 48 per cent estimated by the same survey. Studies carried out between 2006 and 2013 in different states of rural India reveal that the percentage of tribal children who are stunted remains stubbornly high at above 50 per cent. Though deaths due to severe forms of undernutrition among these children are hardly uncommon, only a few catch the headlines.
It is evident that this grim situation is a reflection of multiple deprivations that the tribal population has continued to face over the years. Poverty rates among India’s tribals are still unacceptably high (at 47 per cent in rural areas and 30 per cent in urban areas) and nearly every second tribal family in rural India is food-insecure – with low caloric and protein consumption which is 25 per cent to 53 per cent below the recommended dietary allowance (National Nutrition Monitoring Bureau report 2009). Most consume a diet with negligible amounts of dairy products, fresh fruits and vegetables – important sources of essential vitamins, minerals and fatty acids. Less than 20 per cent tribal households have access to safe drinking water source or a toilet facility in their premises, which is quite low.
There is also strong government commitment to address the existing inequites, which is reflected in the dedicated budget allocation to support development programmes targeting tribal areas. Starting from the fifth five year plan (1974-75), a separate tribal sub-plan (TSP) within the umbrella of the overall state plan is drawn up providing need-based funds for welfare and development in tribal dominated administrative blocks. However, most TSP items are focused on infrastructure with limited attention to specific interventions that address nutrition directly or indirectly. Furthermore, most state and central ministries plans do not apportion funds for TSP as per the schedule tribe proportion. Importantly, even when it is done, the apportioning often lacks prioritization, purpose or a system of tracking the allocation usage. To this end, there remains a question on whether these investments are leading to improvements in nutrition status of tribal children.
Latest evidence from developing countries across the world shows that stunting occurs early in life from conception up to two years of age. This is most likely to apply for tribal children though it needs to be established by further analysis of the existing data. This means that the likelihood of the child being born with low birth weight is increased if the mother is undernourished before and during pregnancy. In other words, nutritional deprivations before and during pregnancy can contribute to poor nutrition status of the newborn, with poor caring and feeding practices further exacerbating the situation.
The underlying reasons for high maternal and child undernutrition, especially in resource poor settings, include poor access to health and environmental services, food insecurity, poor maternal education and caring capacity. The risk of severe stunting was three times higher among children that belong to the poorest as compared to those from the two richest wealth quintiles.
It is now well established that the consequences of chronic under-nutrition are profound, irreversible and life-long. At least 45 per cent of child mortality is attributable to poor nutrition; those children who survive under-nutrition face a diminished life. Their physical and mental development is likely to be impaired, hence they are less likely to perform well in school, less economically productive in adulthood, and at risk of nutrition related chronic illnesses such as obesity, diabetes and cardiovascular diseases.
At the national level, poor countries can lose as much as 6 per cent of GDP as a result of under-nutrition. This points to the importance of raising the nutrition agenda at the highest political level. Furthermore, a multi-sector approach is required to address both the immediate and the underlying causes, with particular focus on population groups that face multiple deprivations, such as the tribals. This means including nutrition promotion in livelihood and food security programmes or in social protection schemes.
What is the way forward?
It is clear that improving the ‘nutrition of tribal children’ needs to become the heart of the equity agenda cutting across key line Departments so as to address both the immediate and underlying issues for significant and sustained impact.
Second, civil society and faith-based organizations with established grassroots presence and credibility, as well as increased outreach, should be involved to generate community demand to reach out to mothers with timely information, counselling and support on a periodic basis, especially in inaccessible hilly and rugged terrain.
Third, countrywide statistical profile of scheduled tribes in India needs to be widely available and used, as to inform policy programme decisions and scope of the National Nutrition Monitoring Bureau tribal nutrition surveys should be extended to all states.
Fourth, addressing undernutrition in tribal children should focus on scaling-up proven nutrition interventions during the first 1,000 days of life, from conception until two years of age, for preventing chronic undernutrition, that aimed at both improving livelihoods, access to essential nutrition services, as well as enhancing tribal leadership and empowerment for sustained results.
Finally, vigilance against limited legislative enforcement is paramount for addressing the core reasons fuelling persisting poverty and hunger.
Accelerating multi-sectoral commitments for improving nutrition of India’s tribal children is a moral imperative and right in principle and practice. This calls for a rethinking on differential programming strategies, budget and government accountability mechanisms and new rules, new optics and where tribal communities are not just informants but partners and influencers of change.
* Louis-Georges Arsenault is the Country Representative, UNICEF India, New Delhi