The problem is likely to be less severe than UN statics
indicate, given faulty yardsticks. To end on a positive note, however, even the
flawed methodology allows us to reasonable track progress over time within the
same population. So have the reforms and growth in India indeed failed to
improve child nutrition as widely alleged by the reform critics and growth.
According to the CAG report, in just four years, the proportion of underweight
children in India has declined from 50% in 2006-2007 to 41%. If asked to name the state with the lowest
incidence of child malnutrition in India, readers will overwhelmingly pick one
of Kerala, Goa, Himachal Pradesh, Tamil Nadu, Maharashtra, Punjab or West
Bengal. But they will all be wrong by a wide margin: none of these states
appears among even the top five performers. The recent report by the general
(CAG) of India, Arunachal Pradesh won the good position. Based on 2010-2011
data, Nagaland, Sikkim, Manipur and Mizoram, in that order, follow on the top
five lists. Maharashtra ranks a close sixth but the next four slots again go to
the northern and North-eastern states. Arunachal Pradesh, the star performer in
child nutrition, had IMR of 32 in 2011 compared with 11 in Goa and 12 in
Kerala. But the CAG reports places 34% children in Goa, 37% in Kerala and just
two percent in Arunachal Pradesh in the underweight category. Assam does worse
than even the Indian average in life expectancy and IMR but beats Goa and
Kerala in child nutrition.
These puzzling inter-state rankings mirror some
international rankings. In 2009, 33 countries in Sub-Saharan Africa (SSA) had lower
per-capital incomes than India. The same year, India ranked ahead of the vast of
the majority of these countries in life expectancy, IMR, child mortality and
maternal mortality.
The World Health Organisation (WHO) has aggressively pushed
to give substance to one of the key United Nation Millennium development goals.
This methodology prescribes a single worldwide weight norm for children age and
gender to determine whether they are underweight.
But populations greatly differ height and weight even absent
nutritional difference, Assumption is that regardless of race, ethnicity,
culture and geography. Japanese adults remain 12 to 13 centimeters shorter than
their Dutch counterparts after many generations of healthy diet. American adults
have been having as good a diet as the Dutch for decades but they began falling
behind the latter in height during the 1950's. African adults are much taller
than their South Asian counterparts despite poorer diets for decades.
Using a single weight or height norm to determine
malnutrition when populations of different races and ethnicities differ in
these attributes is bound to result in measured outcomes defy commonsense.
The government of India carefully needs to carefully review
whether the WHO approach to measuring underweight children, adopted
uncritically, rests on a sound methodology. If not, it should work with its
best paediatricians and nutritionists toward devising a better methodology.