PRAGOTI

Saqib Khan from TISS, Mumbai writes on the malnutrition situation in Madhya Pradesh. 

Introduction

Forget Palamu and Kalahandi in Jharkhand and Orissa, respectively. Over the years, persisting hunger and malnutrition has added another name to its kitty- Madhya Pradesh (MP). In recent times, there has been a spate of hunger-related deaths of children, mostly from tribal communities, in a number of districts of the state. Added to this is the fact that districts that have seen such deaths and the districts with significant tribal population also fare quite low on overall developmental indicators in the state. The report on Human Development Index (HDI) as mentioned in Madhya Pradesh’s annual plan document presented to the Planning Commission in August last year also highlighted the status of hunger and nutritional health which has assumed alarming proportions in the state. Though the judiciary has taken a serious note of hunger deaths in the state, the response of administration, officials and the government to a large extent remains lukewarm and that of denial at times. There is an urgent need to recognise the existing situation in a number of districts in the state and work towards improving the overall development levels of such districts.

The Report on HDI

Last year’s report on Human Development Index (HDI) revealed the issue of persisting hunger in MP. The report said that MP has descended to a state similar to that of Ethiopia- the global yardstick for hunger and malnutrition. This revelation which was covered by both English as well as Hindi dailies on their front pages¹, came as a “shocker” for many and in some ways gave a jolt to the leading political party in the state. However, the report in more than one way highlighted the situation of hunger and malnutrition that has been worsening in recent times, especially in tribal hamlets in the state.

The report on HDI in Madhya Pradesh held that Madhya Pradesh has descended to a state similar to that of Ethiopia. It has not only surpassed its neighbouring states like Chhattisgarh, but has outdone even Ethiopia in some indicators related to hunger and malnutrition. The report revealed that the nutritional levels of women and children in MP have been steadily declining over the past decade². This comes out after taking into consideration a number of health and nutritional aspects particularly for women and children. As per the report, the percentage of underweight children less than 3 years old has increased from 53.5 per cent in NFHS 2 concluded in 1996 to 60.3 per cent in the latest NFHS 3. Similarly, the percentage of anaemic children has increased from 71.3 per cent to 82.6 per cent between the two surveys. The percentage of anaemic pregnant mothers, too, has increased from 49.9 per cent to 57.9 per cent. Though the infant mortality rate has decreased from 88 per cent to 57 per cent, it is higher than the national average of 55 per cent³. Table 1 below shows some hunger, health and nutritional indicators for Madhya Pradesh and Ethiopia as brought out by the above report.

Table 1

Some hunger and nutritional indicators for Madhya Pradesh and Ethiopia

Sources⁴: For MP: NFHS 3 and Indian State Hunger Index.

For Ethiopia: WHO reports and International Index.

 Hunger situation in MP

The poor nutritional and health standard of MP is often attributed to increasing hunger in the state. In fact MP’s tryst with hunger and malnutrition has been long and over the years has come to light time and again. Districts like Sheopur- home to Sahariya tribal community- tell the picture of hunger and malnutrition in the state. According to the data provided by the Regional Medical Research Institute of Tribals in Jabalpur, 93 per cent of Sahariya children are victims of severe malnourishment and 15 per cent of them are almost on the verge of death due to malnourishment. According to a report filed by State Commissioners appointed by the Supreme Court, there were no fewer than 50 hunger-related deaths in Shivpuri district during 2004-05 (Zaidi 2005). Same can be said about Satna district- home to Kol and Mawasi tribes- that has seen death of malnourished tribal children in recent times. In fact in 2008 the Right to Food campaign identified that at least 163 children died of malnutrition within a span of four months during 2008 in four districts of Madhya Pradesh- Satna, Khandwa, Shivpuri and Sheopur. And all the children belonged to tribal/indigenous communities– Kol, Mawasi, Saheriya and Korku (Mahaprashasta 2008).

The first-ever 2008 India State Hunger Index (ISHI)⁵ published by IFPRI⁶ noted that all Indian states have at least a “serious” level of hunger. Twelve states fall into the “alarming” category and one (Madhya Pradesh) is considered to have an “extremely alarming” level of hunger. India’s poor performance on the Global Hunger Index (66^th out of 88 countries) is primarily due to its relatively high levels of child malnutrition and undernourishment resulting from calorie deficient diets (2008 India State Hunger Index: Key Findings & Facts, IFPRI). The table below shows the hunger index of Indian states with global comparisons.  

Table 2

World Hunger Index- How India Compares

Source: IFPRI

The incidence of acute hunger and malnutrition in MP has also to be seen along with a changing expenditure and consumption pattern that points towards a deep crisis of food security in the state. This is reflected in the falling per capita food grain expenditure and consumption. The Human Development Report 2002 highlighted that MP has the lowest per capita expenditure on food amongst all Indian states (Highlights: Madhya Pradesh HDR 2002). In 2005-06, on an average, a person in rural Madhya Pradesh was consuming 11.48 kgs food grain per month and was spending Rs. 86.46 to acquire this amount of food. This food consumption has declined to the level of 9.718 kgs per month, while expenditure level is almost the same at Rs. 87.27 (Jain 2008).

Analysis of human development indicators in nine districts of MP

In the discussion on hunger and malnutrition in Madhya Pradesh, an important point must be taken note of. The fact that most of the districts where hunger-related deaths have occurred in recent times (Satna, Khandwa, Shivpuri, Sheopur) and districts with significant tribal population (Jhabua, Barwani, Dindori, Mandla, Dhar) in MP also figure at the bottom in human development indicators is not mere coincidence. While at the national level, human development indicators for MP aren’t very encouraging, these indictors for the districts mentioned above leave a lot to think about. Tables 3 and 4 below show some human development indicators for the above districts and MP:

Table 3

Some human development indicators for MP & districts with hunger deaths in the state in recent times

Source: Madhya Pradesh Human Development Report 2007

Table 4

Some human development indicators for MP & districts with significant tribal population in the state

Source: Madhya Pradesh Human Development Report 2007

Data from the above tables shows that the literacy rate of all the districts except Satna is less than the average for MP. Significantly, the literacy rate of tribals in the state is only 41.2 - much less than state’s 64.11 per cent. And besides Dindori and Mandla, in all other districts, the literacy rate for tribals is less than 38 per cent; Sheopur and Barwani being the districts where literacy rate for tribals is in the 20s. In terms of per capita availability of food, five districts- Satna, Khandwa, Jhabua, Dindori and Mandla- fall behind the average for the state (253.1 kgs.).

In seven districts, the percentage of households with access to electricity, drinking water and toilet (all three) is less than 13 per cent and thus, much less than the average for the state, with only Khandwa and Dhar districts slightly above the average.

Malnutrition among children is one indicator where all the districts are above the average for the state, with districts like Sheopur and Dhar having as much as 57.69 per cent and 56.17 per cent of child population suffering from total malnutrition. In fact according to NFHS-3 factsheet for MP, 60 per cent of children under 3 years in MP are stunted, wasted or underweight (NFHS-3, 2005-06).

Infant Mortality Rate (IMR) is also another indicator where all the nine districts are above the state average of 70, with districts like Dindori that have 64.5 per cent of population as tribals having IMR as high as 99.

Thus, it can be seen that all the districts where hunger-related deaths have occurred in recent times- Satna, Khandwa, Shivpuri and Sheopur- as well districts with significant tribal population like Jhabua and Barwani report a HDI that is lower than that of MP as a whole (0.560). It is then hardly surprising that these six districts- Satna, Khandwa, Shivpuri, Sheopur, Jhabua and Barwani- out of nine districts taken up above are among the bottom twelve districts in MP according to HDI.

If we take into account other indicators like life expectancy and per capita income (not taken up in the tables above), they also throw useful light on the overall pace of development in Madhya Pradesh. Life expectancy in MP shows two important features:

• Life expectancy at birth for MP (59 years for males and 58 years for females)⁷ is the lowest amongst all major states in India (MP Human Development Report 2007).

• MP is one of the few major states (along with Bihar and Orissa) where female life expectancy is lower than male life expectancy at birth⁸.

MP is also the state where the gap between national per capita income and that of the state is ever increasing. From 1993 to 1999-2000, at constant prices, per capita income of MP was on an average about 81 per cent of national average. From 2000-01 to 2004-05 this fell to an average of 68 per cent. And not only is the income in MP much lower than the national average, this gap is increasing- both with rest of India and especially with the more developed states (Ibid.).

Responses

The situation of hunger and malnutrition and the spate of huger-related deaths in the state have evoked a serious response from the judiciary. In September 2008, the Madhya Pradesh High Court ordered the Chief Secretary of the state to file a report on the malnutrition deaths in the State. It also asked the Collectors of Satna, Khandwa, Shivpuri and Sheopur districts to file affidavits regarding such deaths⁹. Almost at the same time, a Supreme Court panel also reprimanded the Madhya Pradesh government for such deaths and being negligent towards the health of children. In a letter written to the Chief Secretary, the panel also pointed out the state’s failure to implement food and employment related schemes, particularly in districts where malnutrition deaths were reported¹⁰. However, the response of district officials and also the government can be said to be lukewarm and even dismissive at times. In districts like Sheopur, officials have been known to deny any report of starvation deaths and blaming the media for creating a strange situation¹¹. In fact officials even go to the extent of blaming the tribal community for malnutrition in the villages, for neglecting their children and for lack of hygiene in their houses. In districts like Satna it has been reported that the administration saw the death of children in recent times not because of malnutrition, but because of diseases like diarrhoea, jaundice, etc. The extent of denial can be gauged from the fact that doctors in some of the blocks of these districts have reported that there is pressure from the district administration not to report such cases(Mahaprashasta 2008). Last year’s report on HDI in MP caught the ruling party (BJP) in a defensive mode and the government pointed instead to “another world of reality away from the world of statistics”, with the Chief Minister of the state attributing poor health and nutritional indicators to low industrialisation of the state¹².

Conclusion

Time and again various sources have brought to light hunger and nutritional status in MP. There is no denying the fact that hunger has assumed severe proportions in MP. Districts like Satna, Khandwa, Shivpuri, Sheopur, Jhabua, Barwani, Dindori, Mandla and Dhar while bearing the brunt of hunger and malnutrition, also show low overall human development indicators and most of them are at the bottom in terms of HDI in MP. And it is the tribal communities that are being hit the hardest. The irony is that issues of hunger, malnutrition, etc. hardly ever figure in the agendas of the two major political parties (BJP and Congress) in a state where tribals constitute 20.23 per cent of population¹³ and has been seeing continuing hunger-related deaths among these communities. The state needs to take a serious note of an issue as basic and fundamental as hunger and nothing short of a proactive and sustained response from it would help in addressing the situation as well as improving overall development levels of these districts.

REFERENCES

Factsheet: Madhya Pradesh. National Family Health Survey (NFHS-3). 2005-06. Ministry of

Health and Family Welfare, Government of India.

India State Hunger Index: Key Findings & Facts. 2008. IFPRI.

Jain, Sachin Kumar. December 2008. ‘Is society living with Hunger in Madhya Pradesh?’

Vikas Samvad, Bhopal, Madhya Pradesh.

Madhya Pradesh Human Development Report 2002: Highlights (http://www.undp.org.in/content/pub/HDR/Highlights-Madhya-Pradesh-HDR-2002.pdf)

Madhya Pradesh Human Development Report. 2007. Directorate of Institutional Finance,

Government of Madhya Pradesh (http://www.mp.gov.in/difmp/mphdr2007.htm)

Mahaprashasta, Ajoy Ashirwad. 2008. ‘Dying of hunger’, Frontline, Vol. 25, No. 22,

October 25- November 07.

Zaidi, Annie. 2005. ‘Death by Hunger’, Frontline, Vol. 22, No. 9, Apr. 23 – May 06.