Why Mumbai is losing the battle against child malnutrition

MumbaisColaba is well known for its art deco buildings, the Gateway of India, swish pubs and restaurants, and the pleasant promenade of Marine Drive. It houses the state assembly, the VidhanBhavan, and the state secretariat, Mantralaya.However, this high-profile ward recorded the third-highest incidence of malnourishment (69 per cent) among government school children in Mumbai in 2015-16, according to a report by the non-profit Praja Foundation.

How can such a dire situation exist in one of the poshest parts of a city that generates more money than any other in India, ranking 17th among the 20 richest cities of the world? Slums are not easy to spot in Colaba, where real estate prices go up to Rs 100,000 per square foot. However, towards the tapering edge of the island city, bordering the defence forces' area of Navy Nagar, lies Geeta Nagar, with a population of 6,000. Between the ramshackle houses, one can glimpse the sea, and the high tide brings seawater into people's homes.

"Most of the community here is of migrants from Maharashtra and Uttar Pradesh. Most mothers work as domestic help in homes nearby and fathers work as security men or drivers," Velankani Joseph, a social worker who lives here, told IndiaSpend. "Since mothers can cook only one meal [at home] in a day, the kids here eat biscuits, chips and fried snacks between meals."As many as 49 per cent boys and 59 per cent girls were malnourished in Colaba Ward, in which Geeta Nagar lies, in 2015-16, according the Praja Foundation report.

The total number of malnourished children rose from 244 in 2014-15 to 2,768 in 2015-16, the report found.The Mumbai civic body, Brihanmumbai Municipal Corporation (BMC), conducts a yearly health assessment of all children studying in its schools. Praja accessed this data through Right to Information filings, and concluded from analysing this data that younger children were more likely to be malnourished - 73 per cent of malnourished children in 2015-16 studied between Grades I to V.Mumbai's high malnutrition figures are despite the fact that 83 per cent of government and aided schools in Mumbai city and 95.1 per cent in its suburbs, respectively, have a mid-day meal programme.

The BMC, the richest municipal corporation in the country, denies Praja's contention that malnutrition has increased four-fold. "There has been a misunderstanding by Praja Foundation. Before 2014, we only measured weight for age. Since 2014, we also measure height, weight for age and also waist circumference," Padmaja Keskar, Executive Health Officer, BMC, told IndiaSpend. "Also, underweight does not mean malnourished."Praja Foundation terms these "excuses," emphasising that the BMC should be trying to find solutions instead.

"If the BMC had not been measuring height along with weight of the child before 2014, it is gross negligence on their part because even a basic body mass index, requires height measurement," said Milind Mhaske, Project Coordinator, Praja Foundation. Even accounting for the BMC's argument about change of methodology of assessment after 2014, the data shows that 36 per cent of children studying in BMC schools are malnourished.

Mhaske says this points to failure of the Integrated Child Development Scheme, which seeks to provide nutrition and pre-school education to children under six; the public distribution system of the central government which aims to make available food and non-food items to the poor; and the mid-day meal programme run by respective state governments to provide free meals to primary and upper primary school children.

The WHO considers malnourishment to cover two kinds of conditions: Under-nutrition which leads to stunting (low height for age), wasting (low weight for height), low weight (for age), and micronutrient deficiencies on the one hand, and obesity and related problems on the other.Government data has also shown up worrying statistics pertaining to childhood malnutrition.

Among children under the age of five, 21.3 per cent are stunted, 20.3 per cent wasted, and a total of 28.9 per cent children are underweight, according to the National Family Health Survey-4 (2015-16) for Mumbai Suburban, which has thrice the size and population of Mumbai city and extends up to Dahisar in the north and Mulund in the east.

NFHS-4 numbers are worse for Mumbai city (which consists of South Bombay from Colaba to Sion and is also known as the Island City), with one among four children under five years of age being stunted (25.5 per cent), wasted (25.8 per cent) and underweight (22.7 per cent).Mumbai's glittering skyline hides inequities that impact people's access to healthcare, sanitation and government services.

Nowhere is this more visible in Mumbai's slums, where 41.3 per cent of its population lives.Nearly 60 per cent of Mumbai's slum population lives on eight per cent of land in the city, jostling not just for space but also basic facilities -- fewer slum households have access to a drinking water source within the premises than other urban areas, a bathroom, covered drainage, clean cooking fuel such as LPG or a latrine, according to the 2015 Save the Children report "Forgotten Voices: The World of Urban Children in India."

Mumbai's problem is emblematic of the challenge facing the entire country in the years to come. Yet, the Indian government allocates to its urban citizens only one-sixth the per capita spending allocated for rural citizens and one-tenth of what is allocated for the rural poor."The urban health system is still evolving, there is an urgent need for decentralisation of health services and in its current state perhaps it [urban health system] is not at par with this increasing demand of health care among the urban poor," said Suvarna Ghosh Jerath, Additional Professor, Public Health Foundation of India, Delhi. "Perhaps due to their low visibility among general urban population, the magnitude of the problems of the urban poor isn't well known." (IANS in arrangement with IndiaSpend.org)

By Swagata Yadavar