Despite a booming economy, India's record of preventing unnecessary deaths of children is indeed shameful. India can boast of the second fastest growing economy in the world after China but something is clearly wrong with our government's strategy of tackling child malnutrition. It is shocking to know that as many as 125 children have died due to severe malnutrition across Madhya Pradesh, while 65 tribal children lost their lives in the Eastern district of Satna alone since April, as reported by an NGO. And this despite the various special schemes such as "Bal Shakthi Yojana, "Shakthimaan Yojana" and "Bal Sanjeevani Abhiyan", that have been introduced to fight malnutrition among children. The awful truth is that these deaths have closely followed the implementation of the 12th phase of the Bal Sanjeevani Abhiyan, an initiative of the Madhya Pradesh government's women and child development department. This clearly highlights the fact that child health has not received the kind of state attention it deserves.

That India has a shameful track record in reducing malnutrition is revealed by the National Family Health Survey Data which says that there are 33,000 malnourished children in the state of Madhya Pradesh in the 0-5 age group which constitutes about 60 per cent of the total child population of the state. That the rest of the country fares no better is a damning indictment on the UPA government that continues to fumble in addressing this specific issue. National Statistics is indeed a telling reflection of the unusual challenge India faces regarding child survival even as it joins the league of fastest growing economics. The very fact that, India has the highest percentage of undernourished children in the world should be a sobering thought. UNESCO's 2008 report on the state of world's children paints a very dismal picture of infant and child mortality in the country. Everyday, more than 6,000 Indian children below 5 years of age die due to malnutrition. The country accounts for nearly 40 per cent of the world's malnourished children. While it would appear that the prevalence of malnutrition has fallen dramatically throughout the world, the situation has remained fairly constant for India. This has been reiterated by the UNESCO officials also who have indicated that notwithstanding India's spectacular success, it needs to do more to prevent unnecessary deaths of children in the country. Nevertheless, the report also points out that the Indian planners have attained some degree of success by halving the annual child mortality number from 20 million in 1960 to about 9.7 million in 2006.

Among the reasons cited for the poor show of child health in India, the major ones include inadequate neonatal care, insufficient breast feeding, malnutrition, low immunity and a host of communicable diseases. But sadly enough, local authorities working in the field of child and infant and child nutrition in Madhya Pradesh continue to argue that these entirely preventable deaths are due to diseases like Malaria and Encephalitis. They seem to ignore the fact that though disease remains a tremendous obstacle in a perceptible improvement of child mortality rates, the underlying cause of these diseases itself is the destruction of immune systems due to severe malnutrition. Malnutrition is the premium risk factor leading to disease and death. Poor nourishment in children results in compromised immune system which is the contributing cause of the high incidence of communicable diseases. Scientific evidence suggests that compared with the risks a well nourished child faces the risk of death from common childhood diseases is doubled for a mildly malnourished child and may be even as high as 8 times for a severely malnourished child. Nevertheless, the authorities choose to ignore these glaring statistics and fail to realise that these lives could actually be saved with better child care facilities.

Why are the levels of child malnutrition exceptionally high in India? There are many inherent causes that can be ascribed to the problem at hand. For instance, the linkages between child malnutrition with women's well-being and education are strong. The country's high levels of malnutrition amply reflect neglect in such important areas like neonatal care, insufficient breastfeeding and nutrition supplementation, disease control and prevention, education to improve domestic child care and feeding practice, and last but not the least, micronutrient supplementation. Figures reveal that 70 per cent of Indian children suffer from anemia and more than 50 per cent suffer from Vitamin A deficiency. It needs no reiteration that most childhood deaths result from unsafe and inadequate drinking water, poor sanitation, air pollution, limited accessibility to health care facilities and poor vaccination coverage. Therefore, the state needs to ensure safe drinking water, easy access to primary health care besides a clean environment to effectively fight child malnutrition. These simple and low cost interventions are sure to prevent many avoidable deaths in the vulnerable sections of the population.

At the same time, any plan directed at reducing malnutrition among children will not be a success unless it covers the health of mothers to be also. One of the prime factors of low birth weight and the consequent malnutrition is that the mothers cannot properly breastfeed their children due to the lack of adequate nutrition themselves. Besides, the women from the lower stratus of the society are unable to space births due to non-accessibility of contraceptive methods. This invariably leads to unwanted pregnancies and consequently extended families placing an additional burden to their already meager family resources. All these factors help to perpetuate the devastating cycle of impoverishment, disease and death which continues to plague states like Madhya Pradesh, Jharkhand, Bihar, Gujarat, Orissa, Chattisgarh, Uttar Pradesh, Meghalaya and many others. So any nutrition policy directed at reducing malnutrition has to give equal thought to ensure the health of the mothers to be.

Furthermore, the widening disparities in the availability of health care facilities often leaves the poorest with limited access to food, water, sanitation, medication and shelter. While there is a need to provide affordable food and basic amenities to all, in reality the country has failed to provide basic health care to the poor children. Sadly enough, even after 61 years of independence, the poor continue to suffer the most. Consequently, there are many avoidable deaths which is the major cause of high mortality rates among children.

India's incidence of undernourishment among rural children at an alarming high of 47.7 per cent reflects the continuing neglect of health, administrative failure of the government to adequately provide health and child care services and the serious mismatch between the ICDS intentions and implementation. While there is an urgent need to overcome the persistent malnutrition in the country, the present day policy response to this crisis is at best skewed and inadequate. Though there have been various policies and programmes for targeting malnutrition in place for many years and we can justifiably boast of the world's largest Development services like ICDS, but then again, not enough attention is being paid to their actual implementation. However, for any of these programmes to have a desired impact, effort needs to be stepped up to bridge the gap between implementation and accountability. The problem has been further compounded by the rampart corruption in health sector projects which adds to the current crisis.

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