Interview

Saba Mebrahtu, Chief, Child Development and Nutrition Section, Unicef India country office in New Delhi speaks to Seminar.¹

 

Why is it important to address the challenges of nutrition in tribal children of central India?

India is a major contributor to the global child stunting burden, having 40% of all the world’s affected children. The latest Rapid Survey on Children (RSOC) 2013-14 data indicates that 38% of Indian children are chronically undernourished or stunted. This rate is higher (42%) among children from tribal population groups, which are among the most marginalized and poorest social groups in the country. Chronic under-nutrition indicates linear growth failure and is a result of cumulative nutrition deficiency, starting from conception until the age of two years. It also has an intergenerational dimension, because women who were stunted during childhood are more likely to be small and give birth to low birth babies, who are in turn likely to be stunted by the age of two especially more so if they are not provided with optimal breastfeeding and complementary feeding. The consequences are serious, lifelong and largely irreversible. The significant losses in physical growth and brain development that occur by the age of two years due to undernutrition can never be regained. Children are likely to be undernourished when they remain in an environment marked by poverty – often a situation rural tribal children live in, which further perpetuates poor child nutrition status. In terms of numbers, out of the 11.5 million tribal children in the country, 4.88 million are stunted (calculation is based on the 2013-14 RSOC survey). Nine central Indian states – Rajasthan, Gujarat, Maharashtra, Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha, Telangana and Andhra Pradesh – house 75% of all tribal children in the country. Hence, it becomes pivotal to concentrate on tribal children of the central Indian belt.

 

What do you feel are the major causes and solutions of undernutrition in tribal children?

It is evident that chronic undernutrition among tribal children is influenced by a complex web of factors. At the immediate causal level this includes inadequate dietary intake and bouts of infection. While, at the underlying level, the causes range from chronic poverty and food insecurity, poor reach and quality of essential food security, nutrition, and environmental health services during critical periods of life, such as early childhood, adolescence, pregnancy and lactation. These poor conditions are further exacerbated by physical remoteness, weak governance and inadequate accountability mechanisms. Therefore, it is clear that efforts to prevent stunting in tribal children should take a holistic approach addressing issues related to nutrition, health, family planning, water and sanitation, poverty alleviation and women empowerment simultaneously. This means that the concerned ministries should join hands to plan and implement effective multi-sectoral interventions. The Ministry of Tribal Affairs (MoTA), the nodal ministry for India’s tribal people, has in principle the power to convene various ministries for policy, planning and programme coordination for tribal welfare, and is thus well positioned to take a proactive role in this regard.

 

What has been UNICEF’s response thus far?

At UNICEF, we believe that all children worldwide have the same growth and development potential. We also firmly believe that India is obligated to support every child in the country and the government is taking steps in that direction, so that the children can realize their nutrition and development right, especially those children that are the most deprived.

UNICEF India, in partnership with the government and civil society, is thus marshalling a series of efforts to highlight gaps and help address existing nutrition disparities among India’s tribal children. These efforts are in the direction of generating evidence and, on this basis, working to influence policy and programmes through advocacy, helping design multi-sectoral programmes towards demonstrating change in selected poorest tribal pockets of India.

After comparing levels and determinants of stunting between tribal and non-tribal children using the third National Family Survey’s raw data, we synthesized affirmative nutrition actions for these children and suggested a way forward. The UNICEF publication entitled ‘Nourishing India’s Tribal Children’, was the first of its kind. It helped pull together evidence on promising practices that have worked for influencing multi-sector nutrition programmes and policies for tribal children.

We found that severe stunting was nine percentage points higher among tribal children compared to non-tribal children (29% vs. 20%). This was the main reason for the nine percentage point difference in stunting between both population groups (54% vs. 45%). Significant predictors of severe stunting included child’s characteristics, in terms of birth order and gender, maternal factors (undernutrition, young age, less pregnancy spacing and illiteracy), and household poverty. We also found that nutrition programmes for tribal people were constrained by ‘budgeting for nutrition’ in tribal/allied plans, weak inter-sectoral coordination, and scarcity of disaggregated tribal nutrition data. The findings pointed to the need to improve coverage of nutrition interventions in tribal pockets, by working with state governments to improve inter-ministerial coordination and set up accountability mechanisms. We coupled livelihood measures with nutrition information and communication, and promoted partnerships with grassroots organizations and community collectives, while laying equal emphasis on the need for disaggregated tribal nutrition data to be made available.

UNICEF is engaging with the Ministry of Tribal Affairs to enhance inter-ministerial coordination for nutrition of tribal children. It has been encouraging to see that nutrition is for the first time being featured as a key point of agenda for discussion with other ministries. Furthermore, in collaboration with MoTA, the first of its kind national conclave – Nourishing India’s Tribal Children – was organized with five ministries, prime minister’s office, academia, civil society, and the media on 15-16 January 2015. The conclave focused on tribal children from across nine states of central India where child stunting numbers are the highest. The notably two specific commitments for tribal children aimed to address major determining factors of child stunting among tribal children: Commitment #1: universalization of crèches in tribal areas to alleviate the burden on women’s heavy workload, limiting their ability to provide optimal child care and feeding, and for enhancing access to optimal child nutritional care; and Commitment #2: focusing on programmes for improving women’s nutrition before and after pregnancy for preventing low birth weight at birth.

Second, using existing evidence and as a follow-up to the conclave, we have started marshalling efforts to nourish central India’s tribal children through the #ICOMMIT campaign which comprised a series of efforts including advocacy, programme interventions and building partnerships as of 2015.

The #ICommit campaign has received a buoyancy with the engagement of the parliamentarians’ group for children, wherein a sub-group was constituted to push multi-sectoral nutrition actions for tribal children in their constituencies under the leadership of Ninny Ering.

Four states have held a state level dialogue on the recommendations of the tribal nutrition conclave – Jharkhand, Madhya Pradesh, Chhattisgarh and Maharashtra – with Jharkhand announcing a nutrition mission with a special focus on tribal children. In addition, the Maharashtra Nutrition Mission has designed its programme intervention with a focus on tribal children in its Phase III. Madhya Pradesh has announced three new state schemes for tribal children and Chhattisgarh has held a high level discussion to take the recommendations forward in its tribal blocks. It is envisaged that all participating states will prepare and start executing their multi-sectoral nutrition plans for tribal children by the end of 2016.

Given that household poverty was the key predictor of stunting in tribal children, a new partnership has been formed between UNICEF and the Ministry of Rural Development’s poverty alleviation programme to link nutrition promotion with livelihood and to pilot a multi-sectoral programme, with a focus on improving maternal nutrition in the tribal areas of Jharkhand, Chhattisgarh and Odisha.

The need to overcome media blackout on tribal nutrition has been one of the findings of the research. For this, efforts have been made to reach out to journalists to report stories from tribal areas and disseminate these widely through print, social and electronic media. Like-minded persons and grassroots organizations working on these issues have been approached to write articles about their interventions, which have been captured through eleven short documentary films on promising practices. These films are available in the public domain (Unicef’s channel on Youtube); also included are the viewpoints of think tanks that work exclusively on tribal issues towards effecting solutions to reduce stunting prevalence among the children.

 

What are your suggestions to address tribal undernutrition?

For addressing stunting among tribal children, focus on scaling-up proven essential nutrition interventions during the first two years of life and maternal nutrition is critical. Programmatically, emphasis on ‘nutrition of tribal people’ needs to continue to be made a political and bureaucratic priority. UNICEF will work closely with MOTA to enhance inter-ministerial coordination and accountability. This will help make nutrition programmes sensitive to the context, geographical location and needs of communities, women and children. My suggestion would be to revitalize the tribal discourse by engaging with the media as key partners to take this agenda forward and to keep this discourse alive in the public domain, investing in tribal leadership to lead nutrition service delivery. Investing in low-cost high quality and high impact essential nutrition interventions would give a very high return and dividend.

It is important to ensure that tribal nutrition indicators are discussed during state performance reviews. It would be useful to form a tribal nutrition task force within existing task forces/missions and appoint designated officers exclusively for tribal issues at the state level to enable inter-sectoral liaising, and have formal tie-ups with NGOs for increasing outreach to tribal communities.

 

Footnote:

1. The opinions expressed are those of the author and do not necessarily reflect the views of UNICEF.