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Jean Dreze on Malnutrition and Child Mortality in India

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Jean Dreze on Malnutrition and Child Mortality in India

Jean Dreze discusses diet, poverty, and development in India.

Jean Dreze on Malnutrition and Child Mortality in India
Credit: CC0 image via Pixabay

While the Indian government is aiming at a 5 trillion dollar economy by 2024, a recent report by UNICEF reveals that nearly a million children under five years old died in this South Asian country last year, the highest number of child deaths in the world. Experts believe that had the Indian government not heeded the word of vegetarian activists, the lives of many children could have been saved.

On nutrition, India also ranked 102nd among 117 countries on the Global Hunger Index 2019. And according to the Indian government’s own National Family Health Survey, more than 35 percent of children under five years of age are underweight, over 38 percent are stunted, and more than half of all children are anemic.

To make sense of these statistics, The Diplomat spoke to a Belgian-born Indian economist and activist, Jean Dreze.

The Diplomat: According to government data, the budget for women and child development increases every year. For example, this year’s budget for anganwadis, or government sponsored childcare centers, increased by 11 percent. However, a recent report suggests that there was little improvement in combating malnutrition. So what’s wrong with the government’s efforts?

Jean Dreze: The central government has shown very little interest in child development during the last five years. Large cuts in the Integrated Child Development Services (ICDS) and midday meal (school lunch) budgets in 2015-16 inflicted lasting damage. At constant prices, the ICDS budget is more or less the same today as in 2013-14. Another telling fact is the central government’s inertia on maternity benefits. In violation of the National Food Security Act, benefits have been reduced to 5,000 rupees and restricted to one child per family.

Just to give one more example, the government could easily make it a national policy to provide eggs in school meals and anganwadis. Eggs are an excellent source of protein and other nutrients for growing children. But the central government is resisting this, under the influence of upper-caste vegetarian lobbies. So coming to your question, what is wrong with the government’s efforts is that they are not serious.

Do you think India’s public distribution system (PDS) has anything to do with malnutrition?

I think of the PDS more as a social security measure than as a nutrition intervention. As long as the PDS is restricted to food grains, it cannot be expected to have a major nutrition impact. Still, it has some value as a nutrition intervention, because the first step towards good nutrition is to avoid hunger, and the PDS is quite helpful in that respect.

Do you think India has enough resources to eradicate malnutrition among children and their breastfeeding mothers?

Eradicating malnutrition is bound to take time, because it has an intergenerational aspect. When children are underweight at birth because their mothers are undernourished, it is difficult to make up for that deficit later on. Similarly, it is difficult for young mothers today to overcome the accumulated burden of malnutrition. Breaking this vicious cycle takes time, but it could be done much faster than is happening today. There is an extensive and functional infrastructure in place to reach young children and pregnant or breastfeeding women, in the form of village anganwadis. This infrastructure could be used much better to provide essential health and nutrition services. More active public health measures, related for instance to sanitation, immunization, and water supply, would also help.

Do you think the civil society is doing enough to help fight malnutrition and child mortality?

Nongovernment initiatives in the social sector tend to be very helpful as far as they go, because the market mechanism has severe limitations in this field. But in a vast country like India, there is only so much nongovernment actors can do in terms of direct intervention. Perhaps a more important role is to expose the government’s inertia and help people to demand better public services. Unfortunately, the political climate today is such that many nongovernment actors hesitate to antagonize or criticize the government. This is one major reason why the movement for socioeconomic rights has lost some steam in recent years.

On the one hand, the Indian government is aiming at a 5 trillion dollar economy by 2024, but on the other, a report by the Bill and Melinda Gates Foundation suggests that 68.2 percent of deaths of children under the age of 5 occur due to malnutrition. What does this say about the government’s priorities?

The obsession with trillions of dollars is symptomatic of the superpower aspirations of the Indian elite. Of course, a more prosperous economy can help, in principle, to remove malnutrition. But that does not seem to be the intention of this 5 trillion goal. The intention is to enhance the country’s power and prestige in the world. If malnutrition and people’s wellbeing were the real objective, we would be concerned not only with the country’s GDP but also with the quality of public services, the reach of basic education, the health of the environment, and so on. All this gets lost in the fixation with size.

India’s middle class, which is the main news consumer, is not directly affected by the high rate of child mortality or malnutrition. Why should they care about it? Why do you personally care about it?

Let’s put it this way, someone who doesn’t care about a starving child strikes me as a kind of monster. Of course, you could just rephrase your question, and ask what stops anyone from being a monster. That’s a good question for a debating society, but I don’t see why we need to get into it. Kindness to children is a widely-shared social norm that seems to serve us well, and it is also reflected in various provisions of the constitution. I think that we have a good reason to hang on to these values, instead of playing monster to see what happens.