PVCR Research Study Report:

PVCR was able to positively impact several child rights issues in the state by successfully advocating for the same through its partners in the districts.  In the course of its several interventions on different child rights issues – be it right to education, right to adequate nutrition, right to protection and so on, PVCR had realized that persistent malnutrition among below 6 years children is one of the major causes of concern in the state.  Various secondary data sources and experiences from the field proved beyond doubt that malnutrition continue to exist among young children thereby affecting their mental and physical growth.

Though several reasons could be attributed to malnutrition among children, PVCR wanted to focus on the institutional factors that were responsible for this situation among children.  It may be noted that Integrated Child Development Services (ICDS) centres play an important role in ensuring proper nutrition among children through its supplementary nutrition programme.  Often, for poor children, the supplementary nutrition given at ICDS centres becomes main nutrition of the day.

Being sensible to the above fact, PVCR wanted to get first hand information on the extent of malnutrition among ICDS-centre-going children in the state and hence conducted a study on the levels of malnutrition among 6 months – 5 years children attending the ICDS centres.  The study was carried out in 240 ICDS centres across 12 districts in the unified state.  A study report was prepared by PVCR on the status of malnutrition among children and the findings clearly state that large number of children are still suffering with malnutrition and that there is no progress in reduction of malnourished children in the last 10 years.

The main findings of the report are as follows:

• The percent of severe acute malnourished children in the state has almost doubled in the last 10 years.
• There is only a marginal decrease of about 1.5% in the malnourished children in the last almost 10 years.
• Out of 5568 children, only 3318 (60%) are normal whereas the remaining 40% (ie.2250) are undernourished. Then again, 23% among the undernourished are moderately underweight and the remaining 18% are severely underweight. The percentages among the SC children are 60% normal, 40% undernourished, 23% moderately underweight and 17% severely underweight. Among the ST children, however, there is some variation. The values for them are 52%, 48%, 21% and 27% respectively. Similarly for the BC segment, the values are 61%, 39%, 24% and 15% respectively whereas among the OC children the normal are 70%, the undernourished 30%, the moderately underweight are 20% and severely underweight are 10%.  Finally, the values for the minority children are 64%, 36%, 25% and 11% respectively.
• There are only 61(26%) ICDS centers that have own building out of a total of 233 surveyed. Then again, only 65% of the ICDS centers are in concrete structures. The remaining 35% under asbestos sheets or are thatched ones. In other words, 35% are still not all-weather centers.
• 118(51%) centers are in rented building.
• 154 centers (66%) do not have electricity connection.
• The records at the ICDS centers show the pathetic condition of the availability of toilets. 174 (75%) out of 234 centers have no toilets and out of the remaining 60, only 19 are in usable condition.
• 78% (182) out of 233 ICDS centers do not have normal drinking water and this is a state where most of the children suffer from very many water borne diseases annually. There are no provision to filter the water and the water is fetched from outside.
• 51% (119) of the ICDS centers do the cooking outside in the open and often in unhygienic surroundings. The seriousness of the government in implementing the ICDS is questionable as the above graph clearly says there is no supply of cooking gas to the centers which means the food provided for the children is not hygienic.
• 62% (144) of the centers lack proper storage facilities. It means rats and insects eat the food rendering it unfit for human consumption.
• The government has started privatizing the services of ICDS programme and though only 16% are outside agencies in the present survey yet its growth can be dangerous as the government can conveniently wash off its hands from its constitutional responsibility. We have enough experience with the baneful effects of privatization.
• Only 147 (63%) out of 234 centers have weighing machines and 39 (21%) centers have height measuring instruments which clearly proves the non-serious attitude of the government and its monitoring systems.
• 40% of children dislike the food given in the ICDS centers. Strong advocacy for making food tastier and healthier for the children has not had any impact on this aspect.
• 43% (100) of the ICDS centers are not well-kept.
• Nearly 50% (125) of the ICDS centers do not have sufficient space for cooking, storage and children’s play.
• Eating plates and glasses are in short supply in most of the ICDS centers. 50% (125) centers are asking the children to get their own plates.
• While a good proportion of the mothers work as house maids, the fathers work in mainly agriculture and other daily wage works like painting, carpentry etc.
• It is universal knowledge that marriage age has a direct impact on malnutrition as the children born of such marriages are pre-mature and anemic. The survey found most of the women got married are below the age of 20.
•  58% of 1848 families do not have sufficient employment or workdays.
• 25% of 1848 families still migrate in search of livelihood.
• 97% out of 1848 families surveyed show less than Rs. 1,00,000 annual income.
• 53% out of 1517 families have no food security.
• 63% out of 1848 families do not have agricultural land.
• 21% mothers have pre-mature deliveries.

The Recommendations given to Government are as follows:

Based on the findings and analysis there are a few non-negotiables that are listed below for the effective implementation of ICDS program in order to reduce malnutrition among the children. The following recommendations are made with a hope that the policy makers and the government institutions will take the lead and address the problem with all the seriousness that it deserves. For the purpose of priority the recommendations are grouped under two headings, viz., immediate and long-term.

Immediate Measures

• Right to food and free from malnutrition to be given constitutional guarantee for all the children from 0-6 years.
• Weighing machines, toys, utensils must be provided immediately.
• Proper Infrastructure facilities on war footing.
• Immediate filling up of all vacancies of AWWs and Helpers.
• Immediate filling up of all vacancies of Supervisors, CDPOs.
• New posts of AWWs, Helpers and supervisors have to be created and filled.
• Competent, well-trained AWWs and Helpers must be employed and they must be given reasonably adequate financial compensation for their services and their roles must be accordingly redefined. Use of key and achievable indicators with incentives may be introduced. 
• Proper food transport, storage and distribution have to be ensured.
• Proper measuring of weights and heights every month and if need be doctor’s intervention should be sought.
• Monthly surveys have to be done and for every three months correctional steps like double ration to the needy children should be given.
• Nutrition education must be carried with all seriousness, and in this regard a nutritionist’s services must be used if need be.
• Convergence with other departments like Medical & Health, Rural Development, Social Welfare, etc. must be ensured in order to effectively check the incidence of malnutrition.

• The supplementary nutrition given to children should be nutrient, diversified and attractive. The menu should be prepared keeping the local customs and eating habits without in any way compromising on the nutrient values. For this allocation of funds must be accordingly made.

Long-Term Measures

• People’s committees with representation from mothers, SHGs, teachers, other citizens to be formed for the purposes of monitoring.
• Permanent training cum resource center for AWW/AWTs.
• Social auditing (public accountability) of the ICDS program is not a bad idea. The modalities for it need to be chalked out.
• Crèches must be made available at the ICDS centers as most of the mothers go for work in the informal sector.
• Proper and full utilization of allocated funds. PDS-instead of being diluted must be further strengthened and more essential commodities need to be brought under its vortex.
  • Education plays a vital role in arresting the child malnutrition. Universal Elementary Education should be implemented in letter and spirit.
  • Food Security needs to be drastically improved for all the parents of the children who come to Anganwadi Centers.
  • Employment days need to be increased and livelihood must be ensured for the poor.
    • Best practices in other states, particularly the better-performing states like Tamilnadu, Kerala where local specific nutritious food is provided must be recorded and emulated.