The Hindu : Why should children die?

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Thursday, Sep 12, 2002

Opinion

Opinion - Leader Page Articles

Why should children die?

By Kalpana Sharma

It is strange that in this day and age, those who make laws and implement them cannot or will not see the link between nutrition and disease.

THIRTY CHILDREN die in a Kolkata hospital, 22 children die in an Adivasi area not far from Mumbai. Not our fault, say the authorities in West Bengal. Not ours, say the Ministers in Maharashtra. They must have been on the verge of death anyway, they say in Kolkata. They did not die of malnutrition, assert the Mantris of Maharashtra. They died because of superstition. It is a social problem, not an administrative problem, they insist.

It is strange that in this day and age, those who make laws and implement them cannot or will not see the link between nutrition and disease. Stranger still that denials, instead of honest inquiry or introspection, are the automatic reflex of all authorities, regardless of their political colour.

Every year during the monsoon, almost without fail, newspapers in Maharashtra report the deaths of Adivasi children. Inquiries, studies and reports by activists working in these areas for decades have confirmed the obvious — that underage, under-weight mothers are giving birth to low birth-weight babies who barely survive their first year in the world. If they get past this milestone, they die a few years down the line because their parents cannot get to a doctor in time. Nor can they give them adequate nutrition.

They do this not because they are superstitious, or stupid, but because they just do not have the food to feed their children, or even themselves. They also cannot find a doctor, even if they think of going to one in desperation.

So, if their children do not die from lack of food, they succumb to the first infection. In areas where even today there is no guaranteed or safe source of water and sanitation is non-existent, the simplest of infections is the same as a complicated disease.

The relentless cycle of poverty, deprivation and hunger has never been broken in all these years that India is supposed to have progressed. Large swathes of our Adivasi population will vouch for this. On the contrary, this deadly combination has been consolidated over time as more Adivasis are alienated from land, have fewer sources of livelihood and no money to buy food, even if it is available at subsidised rates.

In Maharashtra, what is even more shocking is that often these deaths, as in the current instance, take place just two hours away from the booming metropolis of Mumbai. The latest spate of deaths took place in Ambhiste village, which is in Thane district, on the outskirts of Mumbai.

Thane district is one of the better-off districts in the State because of its industrial belt. Yet, out of its population of 9.5 lakhs, 18 per cent are Adivasis. The majority of these live in rural and Adivasi pockets that remain a picture of developmental neglect. They become visible when a tragedy occurs, like the death of children. Otherwise they are largely forgotten.

In fact, if children do die of malnutrition in Maharashtra, it should not surprise the authorities. According to the Maharashtra Human Development Report 2002 (MHDR), around 76 per cent of children under three years suffer from anaemia and nearly half of all married women between the ages of 15 and 49 are anaemic.

Also, as high as 57.4 per cent of rural households in the State consume less than the standard 2,700 calories per day. And the per capita foodgrain production has been steadily declining — from 172 per kg in 1986 to 140 per kg in 1999. Add up all this data and stir — and you get the picture of a State where many people are hungry. Furthermore, a good percentage of the hungry people are also landless and almost certainly Adivasis.

Another indicator of the state of affairs is the availability of healthcare. While 42.4 per cent of the State's population lives in urban areas, it has the benefit of 80 per cent of all hospital beds. In cities, there are 139.8 doctors for every one lakh people while in the villages there are only 23.7 doctors for every one lakh people.

Look more closely at Thane district. Over 18 per cent of its population (1991) is Adivasi. Over half its population was registered as being below the poverty line (1997-98). The literacy rate among the Adivasi population (1991) was just 20.5 per cent.

And as far as the data on child health indicators goes (1998-99), 36.6 per cent of children had diarrhoea and 48.1 per cent suffered from breathing problems.

If we assume that a large proportion of the poor population is also the Adivasi population, we see from the figures of the availability of healthcare, that once again they would be the most deprived. The distribution of hospital beds in Thane district follows the same pattern as in the rest of the State: 90.9 per cent of hospital beds and 97.1 per cent of hospitals are in the urban areas of the district. What happens when a villager falls ill? Should we be surprised at the regularity with which children die in the Adivasi pockets of this district?

None of these facts is a secret. But each time there is news about the deaths of children from a common disease or malnutrition, we are shocked because it should not happen in Maharashtra, one of the better-off States in India. It has the second highest per capita State Domestic Product among 15 major States, according to the MHDR. Of course, distribution of this is uneven not just between districts, but within districts.

Like other States, Maharashtra also has a Bihar and a Kerala located within it and each district displays similar contrasts.

It is unfortunate that a State that has pioneered many progressive measures, such as the employment guarantee scheme, continues to respond bureaucratically when tragedy strikes. Would it not be more honest to admit that people are getting poorer in some parts of the State, that they do not have the money to buy grain, that healthcare does not reach these pockets of deprivation, and that they need specific and detailed attention from the state machinery?

In 1984, this writer met Medha Patkar of the Narmada Bachao Andolan (NBA) for the first time when she came to Mumbai to alert the State Health Department about the terrible condition of Adivasi children in Akkalkuwa tehsil, which lies within the submergence area of the Sardar Sarovar Project. Today, 18 years later, the children of similar Adivasi pockets continue to live and die in practically the same conditions.

And Ms. Patkar also continues to fight the same battle, as she stands neck deep in the rising waters of the Narmada at Domkhedi to register her protest against unequal development.

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