Falling short

Large numbers of stunted children diminish the India story

Politicians and businessmen often take pride in India being one of the world’s few fast-growing economies, a fact that holds all the promise of a linear growth in prosperity and well-being. But a recent report from the international development charity, Water Aid, offers a grim reality check to this optimistic picture. It shows that, at 48 million, the country has the largest number of children under the age of five suffering from stunted growth. India alone accounts for a third of the 159 million children under five, who suffer from stunted growth globally, and the country enjoys the dubious distinction of leading Nigeria and Pakistan, ranked second and third, respectively, on this parameter. The causes for this dire situation in a critical health indicator should come as no surprise. Water Aid’s report underlines what study after study has shown for some years now — this malnourishment is primarily the result of poor sanitation and the lack of access to clean water and personal hygiene.

India accounts for 60 per cent of open defecation in the world, which has a direct impact on child health. The presence of faeces contaminates the surrounding environment including the air, water and hands. This results in the spread of diseases such as dysentery, diarrhoea, and a range of other water- and vector-borne diseases among children, who remain most at risk in the first two years of their lives. It is crucial to note that stunted growth in this phase is impossible to reverse. It also has longer-term socio-economic implications, since stunted infants tend to have lower cognitive growth and physical well-being in adulthood. A large number of stunted children raises questions about the so-called demographic dividend since a considerable proportion of India’s future youth will likely grow up to be less than optimally healthy. The Water Aid report points to the urgent need to address a problem that Prime Minister Narendra Modi has regularly highlighted since 2014. But Swachh Bharat, his government’s flagship sanitation programme, has been less than successful both in its toilet-building programme as well as in convincing more people to use toilets. This is not to say that the problem is intractable. Preliminary data from the National Family Health Survey-IV, covering 13 states and two Union Territories, indicate a fall in childhood stunting between 2005-06 and 2015-16, though the intra-state variations are wide.

Clearly, something is working in terms of public health policy, though it is not clear what. The explanation that faster economic growth has had an impact on falling childhood malnutrition does not hold because there was no significant reduction in childhood stunting between 1998-99 and 2005-06, one of the fastest periods of growth in the country. Moreover, countries with lower per capita incomes such as Bangladesh and Nepal, too, have lower levels of stunting. The pointer to the need for concerted public policy interventions – of the same intensity as improving India’s ease of doing business ranking – is hard to ignore. This, however, is not just a question of throwing money at the problem, as governments often tend to do, but in designing smart policies that impact outcomes more meaningfully. At a time when developed nations are rapidly ageing, India, as one of the world’s youngest countries, can ill afford an unhealthy outlook for its future population.