Child MalnutritionAuthor(s): Shanti GhoshSource: Economic and Political Weekly, Vol. 39, No. 40 (Oct. 2-8, 2004), pp. 4412-4413Published by: Economic and Political WeeklyStable URL: http://www.jstor.org/stable/4415611 .

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from the Rajya Sabha. Thus, the Lok Sabha numerically dominates in this committee. The Estimate Committee is, however, a body completely made up of the members of the Lok Sabha and it exclusively decides how the financial estimates of different schemes should be kept at a minimum in order to prevent governmental extravagance. In other words, it shows the way in which the policy and objectives of the government could be carried out with the least expen- diture of public resources.15 Thus, it is a cardinal truth that in financial matters, the Lok Sabha enjoys almost exclusive author- ity. Obviously, in order to uphold the demo- cratic principle, the makers have not placed them at par.16 So, unlike the Rajya Sabha, the Lok Sabha can bring down the cabinet by throwing out the budget.

Then, from the point of view of the constitutional position, the Lok Sabha has, surely, a consequential advantage. The Rajya Sabha consists of 250 members - 12 of them are, under Article 80(1)(a), chosen by the president and others are, according to clause (a)(b), elected by the state legislatures. In other words, none of them is directly elected by the people's ballot. But, as Article 81(l)(a) indicates, almost all the members of the Lok Sabha are directly elected. 17 In a democratic set- up, such a popular chamber is sure to claim a superior position to that of the other House. This is why, M M Singh has commented, "The Lok Sabha is the heart of parliament".18

Thus, while the members of the Rajya Sabha represent either the president or the vidhayaks, the Lok Sabha directly stands for the people. So, it truly ventilates public grievances and authoritatively raises local demands so that the ruling authorities may pay heed to them.19 Naturally, its debates attract public notice in a far broader way and, more often than not, the luminaries of public life prefer it as the only forum for the advancement of their political career.

All these have made the Lok Sabha a much more important partner of the Rajya Sabha which is sometimes regarded as almost an ornamental superstructure or even an inessential adjunct.20 Though the founding fathers created a bicameral par- liament, they surely felt that as the Lok Sabha was an elected House, it must assume a special role in our administrative system. For this reason, they granted a limited role to the other House.21 On occasions, how- ever, a conflict between the two Houses has created a temporary confusion, but due to the constitutional advantage, the Lok

Sabha has ultimately consolidated its own

position. Once, the late Hiren Mukherjee, a member of the Lok Sabha, made some adverse comments about the other House, but he was not required to apologise, because the matter was amicably settled before it headed to a crisis.

For all these reasons, it can be claimed that our Constitution has adopted the English pattern in the distribution of power between the two Houses of parliament.22 In this scheme of affairs, the Lok Sabha really plays the key-role. [S1

Notes 1 M V Pylee - A Introduction to the Constitution

of India, p 181. 2 Our Constitution, p 182. 3 Pylee, Introduction to the Constitution of India,

p 201. 4 Democratic Constitution of India, p 149. 5 H H Das - India: Democratic Government and

Politics, p 207.

6 Op cit, p 171. 7 Op cit, p 200. 8 Pylee, op cit, p 181. 9 Indian Government and Politics, p 173.

10 Parliamentary Democracy of India, p 142. Significantly, Sikri writes, 'The Rajya Sabha Cannot Make or Unmake the Government, op cit, p 173.

11 As S C Kashyap has written, 'The Prime Minister is Usually a Member of the Lok Sabha', Our Parliament, p 25.

12 Ivor Jennings - The Queen's Government, pp 42-43.

13 B B Majumder - Rise and Development of the English Constitution, p 229.

14 B Bhagwan, V Bhushan - Indian Adminis- tration, p 349.

15 C P Bhamlbri - Public Administration: Theory and Practice, p 215.

16 J C Johari - Indian Politics, p 327. 17 G N Joshi - The Constitution of India, p 133. 18 The Constitution of Indian, p 884. 19 V D Mahajan - The Constitution of India,

p213. 20 Sachdev Gupta - Indian Constitution, p 120. 21 Kedia Pandey - The Essentials of the Indian

Constitution, 19. 22 G S Pandey - Constitutional Law in India,

p 244.

Child Malnutrition The Integrated Child Development Services (ICDS) programme was expected to prevent the incidence of severe malnutrition of the kind that has been reported in some parts of the country. However, after 30 years of operation, the ICDS is yet to have an impact on the poor nutritional status of children. The ICDS has to be converted into a true health, nutrition and development programme, and not limited to a food dole programme.

SHANTI GHOSH

here were distressing reports in the newspapers as well as on television earlier this year about severe mal-

nutrition among young children in some drought-affected areas of Maharashtra and Orissa. While children and elderly are the worst effected in any deprivation, we need to keep in mind the spectrum of mal- nutrition in India even in so-called normal times. Almost 30 per cent of newborns have a weight below 2.5 kg, among whom mortality is much higher than among better birth weight babies. According to the National Family Health Survey 1998-99 (NFHS-2), almost half the children (47 per cent) under four are malnourished (-2SD) and 18 per cent are severely malnourished (-3SD). The reasons are many, chief among them being poor living conditions and lack of awareness of the young child's food requirements. Even though nearly all mothers breastfeed the child, which is the

best food for the baby, most do it for 3-4 months only while the WHO recommends exclusive breastfeeding for six months.

The Breastfeeding Promotion Network in India (BPNI)l conducted a study in 49 districts in 2003. The study revealed that only 39.7 per cent of infants were exclu- sively breastfed during the first six months. The role of artificial feeding was quite high. The situation regarding introducing semi-solids is even worse. Overall in India, only one-third of children were offered any semi-solid food between six and nine months and in Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan it varied between 15 per cent and 30 per cent. Even in prosperous Punjab, the figure was only 38.7 per cent and in Haryana 41.8 per cent. Overall for India, the figure was 33 per cent (NFHS-2). There is no concept of feeding the child modified family food. This is the beginning of malnutrition, which is worst between six months and one-and- a-half to two years, when the child is

4412 Economic and Political Weekly October 2, 2004

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dependent on a caretaker to feed him/her, after which it tends to improve because now the child is mobile and can access food whenever it is in the household.

We have a countrywide Integrated Child Development Services Programme (ICDS), whose main objective is the improvement of nutrition of pregnant and lactating women and young children. It operates at the village level and in urban slums through an anganwadi centre (AWC) manned by a anganwadi worker (AWW) who usually belongs to the village and dispenses services, including nutrition supplements to children, and pregnant and lactating women. The programme began in 1975 in 33 blocks and a few urban areas, and now after 30 years it covers most of the country. It is considered the biggest child welfare programme in Asia and probably in the world. The priority groups are low socio-economic group families, scheduled castes and scheduled tribes. The package of services consists of supplementary nutrition to children and to pregnant women during the last trimester of pregnancy and during lactation, as well as health and nutrition education and some activities for child development. However, the functioning of the programme leaves much to be desired and much of the AWW' s time is taken up by routine recording and reporting, and mindless weighing of children (growth monitoring) after which no action is taken oradvice given to the caretaker. Her main responsibility should be health and nutrition education, encouraging women to breastfeed exclusively for six months and add semi-solid family food three to four times a day in appropriate quantities after that, which alone can improve nutrition. Teamwork with the auxiliary nurse mid- wife (ANM) would result in better care of pregnant women, immunisation and man- agement of any illness. However, the way the programme functions is that, even after 30 years, it has not been able to make a dent in the poor nutritional status of young children.2' 3 However, in-depth nutrition education regarding feeding with foods within the family resources can help to improve nutrition.4 The Tenth Five-Year Plan has not been very ambitious in this regard. It postulates a reduction of mal- nutrition from 47 per cent to 40 per cent. It is time, therefore, to change the direc- tion of the programme and make it a true nutrition and child development programme.

Now a Nutrition Mission is proposed with more attention to 200-250 districts where the level of malnutrition is high. The Tenth Five-Year Plan proposed the prime minister's Gramudyog Yojana with an

allocation of Rs 452 crore. The total budget for nutrition in the Tenth Five-Year Plan is Rs 1,280 crore. Experience with food distribution has not been very positive so far. There are large gaps in distribution, often the food is not attractive or suitable and there is evidence of misappropriation.

The WHO estimates that malnutrition was associated with over half of all deaths in the developing countries. The risk of death for common childhood diseases is related to the degree of malnutrition. Pelletier5 has emphasised the relationship between child anthropometry and mortality.

AWW is a good resource who if properly trained and supervised, can achieve a great deal in collaboration with the health system. Instead of ensuring that the job she is assign- ed is done as stipulated, she is being pulled in different directions - for domiciliary care of the newborn, for integrated management of childhood illness and so on. She has become a handy frontline worker for every programme that the government starts rather than being left alone to carry out her own responsibilities. Let us train her well for the jobs she is supposed to do in the ICDS programme, retain what is essential in the programme for improving growth, nutrition and development of children, and get rid of the rest. We need to convert the ICDS into a true health, nutrition and development programme and not limit it to a food dole programme. For nutrition to improve, we

have to strengthen proper breastfeeding and complementary feeding, together with com- plete immunisation and prompt manage- ment of any illness. Nutrition of young children is no better in the urban areas where it should be easier to deliver services.6

The government, press and concerned citizens get energised suddenly when news- papers report deaths and diseases but what happened to the programmes that were sup- posed to prevent such situations? Some com- mittee or the other will be appointed to look into it. These are situations that happen frequ- ently and afterthe first publicity and concern, it fades from everyone's memory, and the programmes go on in the same way. IE3

Notes 1 Breastfeeding Promotion Network of India2003.

Status of infant and young child feeding in 49 districts 98 (blocks).

2 Integrated Child Development Services Programme: Need for Reappraisal by S Ghosh, Indian Pediatrics 34, 911-18, 1997.

3 Integrated Child Development Services Pro- gramme by S Ghosh, The National Medical Journal of India, 15, No 2 (Supplement)14-16, 2002.

4 Nutrition Education and Infant Growth in Rural Indian Infants, by S Ghosh, A Kilaru and S Ganapathy, Journal of India Medical Association, Vol 100, pp 483-90, 2002.

5 The Relationship between Child Anthropometry and Mortality in Developing Countries: Implica- tions for Policy, Programme and Future Research by DL Pelletier, JNutr, 124, 2047S-81S, 1994.

6 Nutritional Problems in Urban Slum Children, by S Ghosh and D Shah, Indian Pediatrics 41, pp 682-96, 2004.

NEW YORK UNIVERSITY FELLOWSHIPS 2005 - 2006 The Politics of the Unprivileged

The INTERNATIONAL CENTER FOR ADVANCED STUDIES (ICAS) at NYU brings together a community of scholars to pursue research, writing, and intellectual exchange around a common theme. The community is international in membership, interdisciplinary and comparative in intellectual strategy, and global in scope.

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Economic and Political Weekly October 2, 2004 4413

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