135 and counting: The sorry state of Bihar's nutritional status of children

Blame the litchi fruit or the intense heat waves, it's high time Bihar fights the scourge of malnutrition. The state is the home to the highest percentage of children under the age of five with a low height-for-age (stunting) amongst all the states--at 48.3 per cent. This is almost 10 percentage points above the national average of 38.4 per cent for children under-five who are stunted, as per the National Family Health Survey (NFHS)-4 (2015-16). In fact, Bihar also has the highest share of severely stunted children under-five at 23.1 per cent.

As per the NFHS-4, 43.9 per cent of under-five children in Bihar are underweight, 15.2 per cent severely underweight and 20.8 per cent wasted, next only to its unfortunate highest scoring neighbouring state, Jharkhand, on these parameters. The sad state of nutritional imbalance assessed from indicators such as stunting (height-for-age), wasting (weight-for-height), and underweight (weight-for-age) among children can be gauged from its national average. While the overall prevalence of stunting has gone down, in terms of absolute values, it continues to remain high in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh and Dadra & Nagar Haveli, where more than 40 per cent of the children remain stunted.

Child-under nutrition or malnutrition is linked to higher mortality and morbidity. The current deaths toll due to Acute Encephalitis Syndrome rose to 135 in Bihar, out of which 117 children died in Muzaffarpur while 12 died in Motihari and six in Begusarai. The occurrence of stunting, children under five years who are wasted and underweight is more than 40 per cent in all the three districts except for Begusarai district, where 39.1 per cent are underweight.

The main programme for addressing the issue of malnutrition is the Integrated Child Development Scheme (ICDS), which is implemented by the Ministry of Women and Child Development, under the National Health Mission (NHM). The Minister of Health and Family Welfare, Harsh Vardhan said in a reply in Lok Sabha on Friday that the ministry is strengthening the health system, which includes various programs to reduce under-nutrition in the vulnerable population across the life cycle, such as micronutrients supplementation program, management of sick children with severe acute malnutrition in health facilities, improvement of appropriate infant and young child feeding practices, vitamin A supplementation, National Deworming Day etc.

But woefully inadequate spending on such programmes in Bihar makes the matter worse. The funds spent in micronutrient supplementation programmes, infant and young child feeding (IYCF) practices, nutrition rehabilitation centres (NRCs) and diarrhoea control activities in Bihar has seen a continuous decline since 2013/14, except for two consecutive years of growth in 2017 and 2018. Overall funds spent by ten high focus states such as Jharkhand, Orissa, Madhya Pradesh and Uttar Pradesh have been increasing steadily from 39.73 crore in 2014/15 to 68.26 crore in 2018/19.     

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