WAYS AND MEANS TO PREVENT POVERTY AND HUNGER IN INDIA

Socio-Political Issues of Nutritional Disorders in India – Paths yet to Define.

Prof.  SRIMANTA   KUMAR   PAL

 

 

 

 

M.B.B.S., D.G.O., F.I.C.S., F.I.C.O.G., F.A.C.S.

Professor, Deptt. of Obstetrics & Gynecology,

Kishanganj Medical College, Bihar, Pin- 855 107

India, Contact No. : +91-9333315050

WHY SO MUCH MALNUTRITION IN INDIA ???
 IN FACT  MOST OF THE  HINDRANCES TO IMPROVEMENT OF NUTRITIONAL STATUS OF  OUR RURAL CITIZEN   IS WELL KNOWN  TO US :    BUT WE KEEP SILENT.   BECAUSE WE CONSIDER THAT  ‘ IT IS NOT MY PROBLEM!

What UN did in year 2000?

What India has achieved after implementation of MDG 2000? Looking back; looking forward

Threadbare discussion of SECC, 2011.

How many households have been declared as underprivileged by the Socio Economic and Caste Census

How many households have been declared as underprivileged by the Socio Economic and Caste Census

How many households have been declared as underprivileged by the Socio Economic and Caste Census

Threadbare discussion of SECC, 2011.

The real picture of Rural India!!

Like to know the real picture of Rural India? Have you time to spend?

How many percentages of Rural families pay Income Tax?

Advancements achieved in India in last two decades.

Like to know about West Bengal (Rural only)?

What we fail to achieve?

 ARE WE  REALLY UNAWARE OF FACTOTRS   LEADING    TO MALNUTRITION    AMONGST  RURAL INDIANS ? CERTAINLY NOT.

What PREVALENCE     AND  ILL EFFECTS    OF   ‘ POVERTY ‘   AND  THEREFORE   ‘HUNGER   BURDEN ‘   & ‘MALNUTRITION’   OF   OUR   RURAL   PEOPLE

The recognized problems are

OVERPOPULATION

 

 

že)   C O R R U P T I O N  IS  AN BIG ISSUE IN REMOVAL OF HUNGER BURDEN PARTICULARLY IN OUR COUNTRY

žF )  ECONOMIC DEVELOPMENT HAVE IMPROVED CONSIDERABLY     BUT WHAT ABOUT    HUMAN DEVELOPMENT INDICES IN OUR COUNTRY WHERE WE TAKE ACCOUNT ALL CITIZEN (COMBINED URBAN & RURAL) ?

THIS PRESENTATION COMPRISES OF FOLLOWINGS

ž 1)Prevalence  of hunger burden   in  India

ž 2) Constitutional Commitments   and Role of politicians in removing the burden of hunger.    Are the  Politicia FAILING in thier duties so far as removal of hunger burden  in India?

ž 3) What is meant by the word DEVELOPMENT  ? Are we really  paying due importance on the esssential  daily needs of our countrumen while evaluating progress of  India ? OR we , like economists ,  are considering only hard  statistical figures like GDP, Foreign debts etc. etc. which , however do not carry any meaning to average  RURAL INDIANS.

PART  1 OF THE DELIBERATION

ž    

žPREVALENCE, DIAGONSOIS & ILL EFFECTS OF MALNUTRITION 

žARE  INDIAN PEOPLE STARVING- REALLY ? 

Part   2  of DELIBERATION

Role of politicians in removal of Malnutrition in Indfia.

Are we aiming for Economic Development or Social Development?.What is meant by Quality of People? ?

PART 3, 4, 5. & 6

žPart 3:  Poverty, Hunger and Malnutrition  are interrelated.

žPart 4 : Identifying Different Problems hindering poverty reduction including corruption.

žPart 5. The burden of ever increasing population

žPart 6: Different Paths to minimise malnutrition including the role of  RURAL FOOD COUNSELOR

PART  1

žHUNGER BURDEN IN INDIA &   PRVALENCE OF MALNUTRITION IN INDIA

'Global hunger index'
(Place of India)

       One-sixth of global population are hungry !!!.  India is home to the world's largest food insecure population and more than 200 million people are hungry in India.

      According to 2008 Global Hunger Index, India scored 66^th place in the 2008 global Hunger list of 88 countries.

      Surprisingly the state of Pubjab, the pride of India and the best-performing State, is below Gabon, Honduras and Vietnam!!

 Why an old topic like

Malnutriton? - Is it relevant for discussion?

 

Magnitude of Malnutrition amongst Indian Children and Women.

 a) Below three years of age: 38% are stunted, 46% are underweight and 79.2% are anaemic.

 b) About 70% of pregnant women are anaemic & 36% of Indian women have BMI less 18.5.

 Why an old topic like Malnutriton?
Is it relevant for discussion ? (Contd.)

 

ž Nutritional Disorders are worth discussing because it is a TREATABLE  condition.

ž  Additionally if many a people of a given country  do suffer from  Nutritional  Disorder then WORK FORCE and  PRODUCTIVITY  will be zeopardisesd.

Why not any modern topic? Why an old subject like Nutrition?

ž One may ask why not something on Stem cell / Cloning / Mol. Biology / Genetic disorders or any  new agents  like-  Drugs on HIV or Cancer?  

ž Nutrition is equal to Physical & Mental health of every individual--- Male / Female,        Adult /  Child.

ž Additionally a good Nutrition prevent from many Diseases & Disabilities.

Many Indian Doctors come across such children daily in their clinical practice.

 

Thus it is the  doctors  who

have to approach to

Politicians about the

magnitude and severity

of undenutrition amongst

Indian children

However, Govt. is not sitting idle on the issue of Malnutrition

 

   There are several Poverty & Hunger Alleviation Programmes in India.
 ( Govt. of India Schemes )

Part  2
of the Deliberation

   Why the politicians should  be at all involved in the improvement of nutrition of our countrymen?

Why the term Socio-Political ?

•                      Role of politicians are immense when the problem is vast.

•                      The concept of relevance of Economic Development is now fading.

•                      Instead the concept of social development has become more relevant for the wellbing of countrymen.

•                       For social development  politicians help is less  essential.

Why  an  uncommon  term   like  'Socio-Political'  issue? What is the role of Politicians in improving malnutrition?

 

    The first article published in British Journal of Obstetric and Gynaecology 2007; 114:785-790 had the following title- "The state of political priority for safe motherhood in India". An foreign

This  lead aricle was wriitten by  a foreign Author. It is this article  which prompted the author to prepare this deliberation.

It is this article published in British Journal which initiated the author to think of role of political commitment  in removal of undernutrition in India

The political will force is very important to fight  any disease  which is rampant in a given country – This relialisation should stem from physicians

Political will in Nigeria has been able to curtail maternal death rate in that country which doctors could not achieve (Shiffman J, Okonofua F. The state of political priority for safe motherhood in Nigeria. BJOG 2007;114:127-33.

Politicians have to solve many problems to solve. What are the most “Pressing International Problems now”?

 

The most pressing   International Problems are-

•   Hunger.

•   Poverty  (civil war , Famine & Flood).

•    Disease  burden  including  HIV.

•    Environmental  degradation .

•    Political Instability / Militancy ( Mumbai Nov’08, Lalgarh,2009 , Jharkhand 2010 and many others).

•    Overpopulation  (Demographic momentum).

Malnutrition is interrelated with several   other  current  National / International Problems which politicians have to solve.

 

       The other pressing   OLD  National Problems  with which malnutrition is interrelated are :-

•   Unemployment.

•   Corruption.

•   War , Famine & Flood.

 

 

 

Malnutrition is interrelated with several   other  current  National / International Problems which politicians have to solve.

•                                                                    Disease burden  including HIV.

•                                                                    Political Instability / Militancy (Mumbai, India, Nov, ’08).

•                                                                   ↑ Problems of  nuclear family & Corruption.

•                                                                    More Urban migration ( problems of urban poor – slum )

The other pressing problem that Politicians are dealing with …

       Overpopulation (Demographic momentum).

       World leaders have now realized that most of these problem can be solved by securing women’s education, employment, their empowerment and thus establishing their ‘Sexual and Reproductive Rights.’   Is that true?

 

It is the doctors who has to voice to the politicians that 'ALL is not well'. Politicians have to deal many problems  in the country and as such they may not be aware of the severity of malnutrition in India.

    

     The topic of Nutrition is worth discussing because this scenario is not uncommon in 'Rural India' & particularly in 'Urban Slums'  

    

     For all these reasons the topic of NUTRITION and role of politicians in improving nutrition of people are worth discussing.

Difernet 'Poverty & Hunger Alleviation Programmes ' already implemented in our country.
 ( Govt. of India Schemes ) (Contd.)

 

ž    Swarnajoyanti Gram Swarozgar Jojana (SGSY)

ž    Scheme for self employment for Educated Unemployed Youth (SEEUY)

ž    Prime Minister’s Rojgar Yojona (PMRY)

ž    Etc. etc.

        Did  these  yield  any  good  effect ???

        How far these schemes have been successful in removal of Hunger?    Millions of  Indian  are  still Hungry.

 

What are the other different National Programmes in India carried out under  the auspicious by Govt. of India

   Programmes :-

   i) Vitamin A prophylaxis programme

    ii) Prophylaxis against nutritional anemia

    iii) Iodine deficiency disorders control programme

    iv) Special nutrition programme

    

What are the different national Programmes in India carried out by Govt. of India (Contd.)

   

    v)    Balwadi nutrition pragramme

    vi)   ICDS programme

    vii)  Midday meal programme

    viii) Guarenteed job for hundred days

 

Coming back to Political commitment - Why strongly political will is so relevant in allievating malnutrition in India

 

     (1) Political priority refers to the degree to which political leders consider an issue to be worthy of sustained attention and back up that attention with the provision of financial, human and technical resources commensurate with the serverity of the problem. We know that priority is meaningful when (1) national political leaders publicly and privately express sustained concern for the issue;

Why strongly political will is so relevant in allievating malnutrition in India (Contd.)

 

     (2) The government, throught an authoritative dicision-making process, enacts policies that offer widely embraced strategies to address the problem and (3) the government then allocates and releases public budgets commensurate with the problem's gravity.

 

     (Source: J Shiffman, RR Ved)

 

Why strongly political will is so relevant in allievating malnutrition in India (Contd.)

 

    (4)  SELECTION BIAS AMONGST GOVT. OFFICIALS : Examining political priority is critical because even if policy makers are aware of the sverity of the problem and know of potential solutions, there is no guarantee they will act, as they have thousands of issues to confront and scarce resources at their disposal.

Govt. of India is trying hard. Investment in different plan periods (in Rs. Crores)

Investment in different plan periods (in Rs. Crores) (Contd.)

N. R. E. G.  PROGRAMME

žTotal  Number of  Families in West Bengal  who have been benefited  under this pogramme is 28,38,487 ( in the year 2009 )  but   still B. P. L. per centage is 39% !

Role of politicians in improving Nutrition.
What The Constitution of India says?

     The Constitution of India guarantees that alleviating poverty is . primary responsibility of GOVT. OF India,  where the people elect the Government democratically.

Ensuring the welfare of the people  rest with the Govermnments of any country. It is the Government's responsibility to take measures to erradicate malnutrition which is responsible for many a diseases.

 

     (Source: Prof. Rajaram Pagadala, President, Academy of Safe Motherhood)

It is the doctors   who has to voice that all is not well

Who else is                                   So malnutrition

facing the                                is a topic for

challenge of                                  discussion.

malnutrition

daily ??

Part  3 of the deliberation

Multisectoral concept of malnutrition

   Poverty, Hunger and Malnutrition are interrelated and alleviation of any one of them will improve the other

Malnutrition is a Multisectoral Problem not just  a Medical issue. Thus malnutrition is more a Political issue than Medical problem

 

     Nutritional problems are not just medical problems but are “multifactorial” with roots in many  other sectors of development such as education, demography, agriculture and  rural development in particular. It has now become apparent that lasting improvement in the health and nutritional status of people can be brought about only through a successful attack on the basic problems of  poverty and injustice. Understandably  if one has to tackle the problem of malnutrition effectively then Role of politicians can not be denied.

Interrelation between of Poverty, Hunger and Malnutrition

     The old concept that the health sector alone is responsible for all nutritional ills of the community has faded away. It is now realized that a broad intersectoral and integrated approach of many sectors of development is needed to tackle today’s nutritional problems. (Source: K. Park, PREVENTIVE AND SOCIAL MEDICINE, Published by M/s BANARSIDAS BHANOT 2002).

If one intends to alleviate Malnutrition multi-sectorally one must at first identify the list of most “Pressing National Problems of India as on 2009”.

     

      ‘Poverty – Hunger – Nutrition’ are nowadays viewed as a single problem, at least in India. In fact these are   essential indices of DEVELOPMENTAL PROCESS so far as India is concerned.

    

Relevance of safe drinking water – often a forgotten advice by doctors and possibly by Politicians too

 

     Nutritional  Disorders are not limited to protein, calorie, vitamin or mineral deficiency. Additioally one has to consider scarcity of safe drinking  water  which is responsible for so many WATER-BORNE Diseases which does affect nutrition particularly in rural areas. This is often not considered when we counsel on undernutrition. Policy makers too possiby pay less importance on this when frormulating  different plans for impovement of  NUTRITION

We  Doctors  already  know  the  relation between  the  undermentioned  three  issues. It is Politicians who should now realise this to formulate different plans and policies.

Previously coated all the 6 international problems eventually lead do  – poverty - more so in underdeveloped countries     

                  POVERTY                HUNGER

                 

                            These 3 are Interrelated

                        MALNUTRITION                         

Poverty and Malnutrition are Interrelated

 

     Removal of ‘poverty’ will automatically remove  ‘hunger’ and improve ‘nutrition’. If we are able to identify and take appropriate steps for removal of poverty  the incidence of malnutrition will automatically decrease ---provided adequate steps are taken to improve equal development of all sectors of citizen   i.e. urban and rural. BUT,  unfortunately, equal development is a very difficult proposition in Indian context.

 

Nutritional Status is INTERRELATED WITH:

      Overall development of  a country depends on many factors – and we are yet to define which factor / index is  more relevant in reduction of  malnutrition. Possibly all the following indices have to be considered for overall reduction of burden of malnutrition. 

  

Malnutrition depends on following factors too

•                                                              Demography : Specially population size (hence the role of contraceptive)

•                                            Land size.

•                                            Culture, Attitudinal  factors of the community.

•                                            G.D.P, B.P.L & other common economic indices.

Malnutrition depends on following factors (Contd.)

 

•                                                                  H.D.I (Including MMR & IMR)

•                                                                    Education, Road, Electricity , Drinking water , Sanitation and other  Health care facilities.

•                                                                    Industry

         Thus to improve Nutrition the policy makers have to take into account of all these factors or indices. Officers of National Institute of Nutrition also should take a note of these factors. Prescribing only good diets will not be able to remove malnutrition in India.

It is the 'poverty' and 'hunger' burden  which is the major causes of Malnutrition amongst Indians (Etiological causes of under nutrition)

 

a) Poverty related malnutrition: (About 97% of under nourished men / women / children).

 b) Poverty independent malnutriton: i.e. disease related  under nutrition is attributable to  Kochs, Cancer, Diseases of Pancreas, Liver & Gut. In these cases the person may possibly able to afford to purchase adequate nutrituous food (2%).

 

Major Ill-Effects of
Improper Nutrition

 

Malnutrition is basically of two types : -

A) Underweight:   where BMI is less than 18.5

    (Thin, moderately thin and very thin). The BMI is defined as weight in Kg. divided by height in metres squared (kg/m²).

 

B) Overweight:      where BMI is >25 (overweight = BMI of 25.1 to 30.0 and obesity means BMI above 30)

 

      N.B. : Obesity is fast increasing in India.

        

Part  4
of the Deliberation

  What is meant by the most commonly used word  Development in recent times? Is it relevant to know the basic aspects of development to formulate effective plans to eradicate malnutrition. Understandably, development of a country improves the nutritional status of citizen.

Let us define ‘Development’   of a particular Nation.

    What is exactly meant by the term ‘development’?    In the eye of a  “DOCTOR” -- What are the  main indices to be considered while  evaluating the degree of  development in his / her country ? Is it akin to economists or some other factors  that play in the minds of doctors or even amongst common people while understansding degree of developmentin the eye of a  “DOCTOR”? Is  'economic surge' synonymous with 'development'? The opinion is fast changing.

Different indices to assess degree of development of any  country

 

•                                                                   Foreign debt. …main index ? (Removal of International Trade Deficit or repayment of debt.

•                                                                   Industrialization …..  as an index?

•                                                                   Civilization …. as an index?

•                                                                   GDP (Agrl, Industry, Tour & Travel and Income from Mines)

•                                                                   HDI ( does this reflect  real per capita income ? )

Other Different indices of development of a country (Contd.)

 

•                                                                    Capital Formation

•                                                                    Capital Account (Share Market & Capital Market )

•                                                                    Inflation- … as an Index

•                                                                    Foreign Investment

•                                                                    Employment Generation

•                                                                  Removal of poverty

•                                                                    PQLI …Physical Quality Life Index- Edu, Health, Nutrition

 

 

 

Part 4 of deliberation

  The concept of 'Quality of  people'  has now become the main index or criteria of development as it should be .

Earlier  most of us used to  express or define  Developmente  in terms of GDP / Industrial Growth/ Export  etc. without paying much importance of qyuality of lives of countrymen including  malnutrition and  prevalence of  starving people.

“Population" : "Quality of people" : "It is the Social  and  not the Economic Development of a country which matters most"

•                                                                   The definitions of the above quoted three indices (Population, QOL, and Economic Development) have changed  recently.

•                                                                   If we intend to improve Malnutrition in our mothrland  then we should understand what  the above mentioned terms  exactly mean.

•                                                                   No more literal meaning of above three words  please.  And we have to remember that the old indices of 'population', 'quality of people' and 'development' have changed in recent times.

The recent and possibly relevant indices of development – partly relevant so far as Quality of people is concerned

 

  Quality of People is primarily related to Demographic Indicators :-

        a) Total population (in thousands)

     b) Surface area (thousands of sq. km) -  land size of a country

     c) Population density (persons per sq km)

     d) Population growth rate (%)

     e) Crude birth rate (per 1000 population)

    

Development is now considered both on the issue of number of people as well as  wellbeing  of the people

 

    Quality of people is more important index of Development.

    Thus, Human Development Index as I said is now the appropriate indicator of development of any country.

 

How population size is related to ‘Social Development’ & ‘Economic Surge’?

ž Development now concerns the individual as much as the nation. Development now spans the social, economic and political context of the individual and her / his ability to participate, as an equal, in the development process. To measure and compare the extent of development across different states and nations, new indices have been designed – like the Human Development Index (HDI) or the Human Poverty Index.

Have we ever tried to realise  who is the real beneficiary so far as improvement of Malnutrition is concerned?

   

•                                                                   We have to understand that it is the people who are the beneficiary. If that be show then quite  logically we should understand what is meant by PEOPLE and Quality of People? Now-a-days it is the Quality of the people that counts rather than total number of people in a given country

•                                                                   Now let us now discuss what is meant by People and ‘Social Development’

Should we then , redefine the very popular and commonly used term ‘Development’?

 

    DEVELOPMENT is a very broad term  and Indices for development varies  while assessing   Country / Community /  Individual and even in  Family.
The followings are the  different indices of development. ( old  and new ) :-

 Socio economic Indicators ( OLD INDICES) :-

       a) GNP per capita (US Dollar)

      b) Average annual growth rate of GNP (%)

      c) Average annual rate of inflation (%)

What is meant by population
in recent times

    The term population, derived from the word ‘people’, is not limited to numbers alone. Population is as much concerned with peoples quality of life it is with their numbers. The health and well being of the people, the situation of different kinds of people (adolescents, elderly, tribal's, and other marginalized groups) are also matters of concern, as is their absolute numbers. – (UNFPA)

What is meant  by   Quality of  Population ? How to define it ? What are the different indices to assess Quality of Population?

      Nutritional Disorders do affect Quality of Population and  now quality of population is the KEY INDEX OF DEVELOPMENT of any country.

     There are now five Parameters of Quality of People.  QUALITY of People is now judged by following five parameters:- A)  The level of health enjoyed by the people. B) Proneness  to suffer from ill health, diseases, and epidemics C) Life expectancy at birth D) Technical skill and Productivity of the citizen  E) Level of Literacy and  above all E) Maternal  and  Infant Mortality.

Patient is a cosumer and Doctor is service-provider

ž The area of health is intimately  related to her/his sense of wellbeing ,puposefulness, and place in society, modesty, guilt and shame.

ž For instance in voiding disoders which are nonfatal/nonlife threatening anorectal dysfunction, pains in lower urinry tract/Pelvic pain (CPP), urinary incontinence ,bladder storage dysfunction, postmicturition scalding, POP(pelvic organ prolapse) Sexual dysfunction, Urinary frequency, Nocturia, Urinary hesistancy,

BEST HANDS FOR THE JOB

Dedicated Patient centered Consultation is Expected by Indian People.

ž For instance in URO-Gynaecology a) Continence Nurse b) OPD awake cystoscopy C) Specialist Sonologist= Pelvi//anorectal/Pelvic floor bladder ultrasound  are essential.

ž So also Pelvic floor physiotherapists, behavioural /Lifestyle modification, Bladder retraining, Supervised pelvic floor muscle training  biofedback , Pharmocotherapy, Intravesical therapy, Csto-distension, sacral Nerve stimulation, POP surgery, -Mesh use;Abd route repairs/Rbot Assisted repair of pop, , TOT Tapes(Trans Obturator Tapes),Colpo suspension, Urethral Injection with bulking agents,  All operative procedures - Mostly on day care basis.

Quality of People - Redefined

 

•       Freedom from    want.

•       Freedom from     hunger.

•       Freedom from     fear.

•       Freedom from     diseases.

Quality of People redefined

•                                                                  Adequate housing   and   basic sanitation

•                                                                  Quality Health Service

•                                                                  Schooling   with  novel   ideas  to prevent dropouts

•                                                                  Avoid Energy-Protein-Calorie-Malnutrition

Quality of People redefined (Contd.)

•                                                                                    Avoiding  violence  and  torture agianst women

•                                                                  Preventing  enviornmental  degradation

•                                                                  Dealing   with   problems   of migration and facilities   for   Urban poor

•                                                                 REMOVING RURAL INEQUALITY

 

Understanding the  linkage  between ‘Population’, ‘Social Development’

 

ž ‘Economic Spur’, ‘Poverty’, ‘Hunger’, and ‘Malnutrition’ are interrelated.

ž And   these   issues  including  development  share  a  single concern – the well being of people.

ž India, along with 180 countries agreed to the common Program of Action of the ICPD, which set the agenda of action for the next 20 years. The title of the 13 days long-lasting International conference was on ‘Population & Development’.

PART  5  of the Deliberation

žHUMAN   DEVELOPMENT   INDEX  ( H. D. I )

H U M A N   D E V E L O P M E N T   I N D E X

ž   NOT THE  ECONOMIC   DEVELOPMENT    OF COUNTRY .

žBut

žTHE QUESTION  IS  ‘ARE WE  or  THE POLITICIANS  REALLY BOTHERED ABOUT          HUMAN          DEVELOPMENT  INDEX (H D I ) .

ž Indices of Development of   Country and   its  citizen   are   not  same  mostly  because  of    rural    inequality.  

-Therefore   there   is   continued    high   incidence of POVERTY  ALSO    HUNGER  &  MALNUTRITION.

H.D.I.

   Details of Human Development Index in India is detailed.  In fact statistics which are quoted in the slides that follow is the main reflection of Social development of our country (H.D.I. is not to be confused with Economic Surge, because there can be unequal economic surge in a given country) .

Human Development Index in India – THE NAKED  TRUTH IN OUR COUNTRY

•                                                                   IN INDIA :   Before becoming 28 days old (Neonatal Deaths) : Annual death is one million ! Simply unbelievable .

•                                                                   A child born in India is 14 times more likely to die during first 28 days than one born at USA or UK !

•                                                                   Most  deaths occur at Orrisa (52 deaths per 1,000 live births), MP (51), UP (46), Rajasthan (45) and  Chhattishgarh (43)

          (Source: State of the World’s Children, 2009)

 

Human   Development   index of India – as   published by UNICEF on 15^th July 2008

 

4) An Indian woman  is at 300 times more likely to die during pregnancy  and child birth  in comparison to women of UK /  USA. Most the deaths occur at Bihar, MP, Assam, Rajasthan and  UP  i.e. BIMARU  states.  Death Rate is also high  in Jharkhand a nd  Chhattisgarh  and  Uttaranchal .

5) Home Delivery Rate: still  60% ; Institutional  40% only !

 

Where  do  we  stand now (2009)? Human Development index of India – as published by UNICEF on 15^th January, 2009

     On 15^th January, 2009, UNICEF published the Human Development Index of Indian mothers and children which read as follows (Source : State of the World’s Children, 2009)

     6) One woman dies every 7 minutes (78,000  annual deaths in India  which were preventable deaths!)

    

Not only H.D.I. but also India is lagging in Economics aspects too.

ž Very  high  power  cost  (Electricity / Petrol / Disel)

ž Bank  interest  rate  is  high

ž Red  tape  &  Corruption – Delay  in  implementation  of  different  Economic  plans even after approval by Planing Commission / Pariamentary Committee/ Dudget sesssion.

ž Escaleting  Sale  Tax  and  Local  Taxes

ž Slow  and  Expensive  transport  system

ž Inflexible  labor  market

India is lagging behind in the ladder of Human Development index (Now India is in 128 position out of 175 countries surveyed !!!

FACTS & FIGURES ON HUMAN DEVELOPMENT  INDICES

ž  UN has published a  detailed description on H.D.I. of different countries on 5^th October , 2009 and some of the figures have been briefly mentioned  in Anandabazar Daily , on 14 th October, 2009.

ž   Interested Readers may kindly go through that editorial

‘ INDICES    OF    SOCIAL DEVELOPMENT’  is  different from indices expressed to denote economic development as is usually expressed by Economists.

 

Doctors are very rightly interested more  in  social indices  of  Development  rather  than Economic indices.

    Social indices, however are not bounded by the mathematical figures expressed by economists e.g. G.D.P. (Gross Domestic Production) or GNP (Gross National Production).

INDICES     OF
SOCIAL DEVELOPMENT

   

    It has wide spread meaning and more esasily understandable by general people and Health Care Providrs. However, over  the years the use of narrow economic approach as a measure of development is now being rejected and a broader concept of human development  is  proposed.

 

The recent and possibly relevant indices of development – partly relevant so far as Quality of people is concerned

 

 Demographic Indicators are primary indicators of social development  :-

        a) Total population (in thousands)

     b) Surface area (thousands of sq. km) -  land size of a country

     c) Population density (persons per sq km)

     d) Population growth rate (%)

     e) Crude birth rate (per 1000 population)

    

RECENT  REVELANT INDICES  for development of any country

  

Human Development Index

 A)  Basic Indices of HDI.

           i)  Dependency Ratio total (young/Adult Ratio)              

          ii) Adult literacy ratio ( Total = Male + Female).

          iii) Gross primary school enrolment ratio (M+F).

          iv) Gross secondary may enrollment ration (M+F).

The   old   indices  of  development – not so relevant so far as Quality of people is concerned (Contd.)

 

    B)   DEMOGRAPHIC  INDICATORS (Contd.)

     a) Crude death rate (per 1000 population)

    b) Urban population (%) – possible partly relevant to quality of people.

    c) Average annual growth rate of the urban population (%)

 

 

 

 

 

But following two  indices are important  indicators of development as these very much reflect quality of population i.e. to what extent a country is developed

   

g)  Population with access to safe water (%)

            i)   Total,  ii)  Urban,   iii) Rural

      h)   Population with access to adequate sanitation (%)

            i)   Total,  ii)  Urban,   iii) Rural

 

Part  6  of the Deliberation

  Identifying the

key problems

of malnutrition.

Malnutrition can not be alleviated by taking foods only

    
Problems and issues of  malnutrition should be discussed under the following broad headings. All are relevant so far as correction of malnutrition is concerned. Simply advising on good foods will not improve nutrition of all Indians. One should keep in mind that 'good nutrition' and health of the citizen is a congleramated effect of -

One has to consider the relevancy of total health of the citizen, not only on supply of adequate food

    

     a) General Nutrition b) Hunger Burden, c) Economic Status of the citizen, d) Poverty Load, e) Food Production in our country and above all f) Total Population size in India. To eradicate malnutrition and to counteract its ill effects on the society policymakers have to improve all the above quoted issues.
Author discusses the improvement of malnutrition in India under following broad headings.

M A L N U T R I T I O N
Identifying  the   problems  and evolving different paths for solution of Malnutrition

The deliberation now follows under following headings (Contd.)

 

•                                                                     Analysing the different issues which govern Developmental process – the old and new.

•                                                                     Where do we stand now –   Balance Sheet of India.

•                                                                     Socio Political Solutions for malnutrition is still on search, so also the Paths for improvement of nutrition.

Issues in overall improvement of Nutrition

   

    Part 1 :  Present Nutritional Status of Indian people

Part 2 :   Hunger Burden in India
Part 3 :   Current Economic Spur in India

Issues which have an impact on the incidence and severity of malnutriton

      Part 4 :  Poverty Burden
Part 5 :  Rate of Domestic Food Production And             Balance Between Production & Demand            of  Food
Part 6 :  Population Size
All these six issues are relevant so far as malnutrition is concerned (Contd.)

Part  : 7

DETAILS OF NUTRITION

 

(  DEFINITION   &    PREVALENCE   IN   INDIA    )

 MALNUTRITION -  DEFINATION, HOW TO DIAGONOSE , ILL EFFECTS  &PREVALENCE –PROBLEMS  OF OBESSITY , the another form of nmalnutrition, role of ICDS  SCHEMES & pattern of breast feeding and cooking habits

 

•                                                                    What does the term Nutrition encompasses? Definition, Etiology, Prevalence, Classification and Diagnosis  of  Malnutrition  in  India.

•                                                                    To what extent – Malnutriton is interrelated to the overall  DEVELOPMENT  (Social & Economic) of a country.

Etiological causes of under nutrition: (Contd.)

a) Poverty related malnutrition: (About 97% of under nourished men / women / children).

 b) Poverty independent malnutriton: i.e. disease related  under nutrition is attributable to  Kochs, Cancer, Diseases of Pancreas, Liver & Gut. In these cases the person may possibly able to afford to purchase adequate nutrituous food (2%).

•                       Bad selection of food stuff : Poor cooking habits, unscientific storage of foods (1%)

N.B.: These habits are community – acquired and difficult to change particularly in remote areas and amongst tribal persons.

The National Institute of Nutrition (NIN)

     The National Institute of Nutrition (NIN) in India since its inception in 1918 ---- is playing a great role in formulating different National Nutrition Policies in  India. It is constantly keeping vigilance on the impact of different policies it was formulating.  It act as a watch dog on diff. Govt. Policies too.

      Based on the recommendations of NIN, the Govt. of India laid down its different  nutrition policies from time to time.

How do we assess Nutritional Status
(Definition and Diagnosis)

1) ABCD method :-

ž Anthropometric:   height, weight, etc

ž Biochemical:        like Hb / HCT, TLC, albumin etc

ž Clinical:         Observation of clinical signs for beri-beri, angular stomatitis, pellagra, etc

     These methods can be very valuable and effective, due to low cost, and resource availability in India, probably more so in a rural or low-income setting.

 

How do we assess Nutritional Status
(Definition and Diagnosis) (Contd.)

 

2) Dietary methods: 24 hour diet recall, diet history, etc

    This method can quickly point out the adequate intakes of macronutrients and important micronutrients like Calcium, Iron, Vitamin C and A etc.

 

 3) Diagnosis of malnutrition: Other Simple Clinical METHODS Diagnosis of Malnutrition

 

• Height for age: it is an important indicator of PEM (Protein-energy-malnutrition) in children. It gives a picture of past nutritional history of the child.

• Weight for height: Is regarded as an index of current nutritional status. It helps to classify children as follows:

           

Other simple Clinical Diagnosis of Malnutrition (Contd.)

4)        W E I G H T  W I S E   C L A S S I F I C A T I O N

•                                                                                 Normal

•                                                                                 Acute malnutrition alone (starving but no stunting)

•                                                                                 Chronic malnutrition alone (stunting but no starving)

•                                                                                 Acute upon chronic malnutrition (stunting + starving)

 

5) What is the Mid-Arm Circumference (MAC)

ž This is measured sing a tape around the mid-point of the left upper arm. It is particularly useful when a weighing machine is not available. When measured properly, it is said to be more sensitive than weight in monitoring nutritional status. The MAC is unique in that it does not change much in normal children between ages of 12 to 60 months. It is 11cm at birth, 16 cm at 12 months, and 17 cm at 60 months. The gradation of malnutrition on the basis of MAC is similar to the weight for age classification.

6) Skin fold thickness

 

    Skin fold thickness: using a skin calipers over the triceps and sub-scapular region is of considerable le value in assessing the amount of fat and reserve calories in the body.

 

7) One can now   Grade the  Malnutrition

Major Ill-Effects of
Improper Nutrition

 

Malnutrition is basically of two types : -

A) Underweight where BMI is less than 18.5

    (Thin, moderately thin and very thin). The BMI is defined as weight in Kg. divided by height in metres squared (kg/m²).

 

B) Overweight where BMI is >25 (overweight = BMI of 25.1 to 30.0 and obesity means BMI above 30)

 

      N.B. : Obesity is fast increasing in India.

        

Clinical Expression of Different types of Nutritional Diseases

ž'Protein-Energy malnutrition' (PEM): Insuffieicncy of food – the so-called "food-gap" appears to be the chief cause of PEM.

žNutritional Anaemia:  India has the highest prevalence of Nutritional Anaemia in women and children.

žLow birth weight babies: This is one of the major public health problem in many countries including India. In fact about 30% percent of Indian babies are born with birth weight < 2.5 kg.

ž Xerophthalmia (Nutritional blindness): About 0.04% of total blindness in India is attributed to nutritional deficiency of vitamin A.

ž Other Deficiencies:   e.g. Iodine & other trce elements.

Prevalence of Improper Nutrition amongst Indian Women

PREVALENCE OF MALNUTRITION :-

ž  When BMI is less than 18.5 then we usually suspect Chronic Energy  deprivation.

ž  Unfortunately 36% of Indian women have a BMI below 18.5. This shows a very high incidence of Nutritional deficiency in our country.

ž  Those who are thin among them as many as 45% are moderately or severely thin.

ž   NFHS-3 data shows the nutritional problem is serious for rural woman  &  illiterate Men and Women.

Problems of over weight and Obesity

    

     Overweight is also harmful as it invites complicated physical illness decreased capacity to Work, Hypertension , Coronary Heart Disease, Cancer etc. etc.

 

     Thus Nutritional disorders are the problem both for the "The Best" and "The Rest".

 

PREVALENCE OF
OVER NUTRITION

 

ž 13-15% of Indian women are either overweight or obese. This is the other side of malnutrition. Obesity amongst Indian women are more common in urban, well educated women and from households with high standard of living.

 

ž This is a growing problem in India. The percentage of woman aged 15-49 who are overweight or obese has  increased from11% in NFHS-2 to 15% in NFHS-3.

 

In India too - Obesity is a  great   militant

 

 

ž Thus Indian women suffer from a dual burden of malnutrition, with nearly 49% (36%+13%) being either too thin or overweight (NFHS: i.e. National Family Health Survey of India – 3, Study period 2005 – 06, India).

ž Courtsey: Internationa Institute for Population Sciences, Deonar, Mumbai – 400 088 and Macro International.

Diabetes – A major militant in India !!!

Children's Health in Rural India!

What about Indian children? Are they well nourished?

Many  Indian  children

below the age of three

years suffer from

Protein-Energy

Malnutrition

Let us know the recommendation of Govt. of India about standard feeding practices of infants.

ž The Government of India recommends that children should be exclusively breastfed for the first six months of life(that is, the child should breast milk and nothing else, not even water) and that children should be given appropriate and adequate complementary feeding in addition to continued breastfeeding from six months of age (Ministry of Women and Child Development, 2006).

How many months the Indian childrens are  Exclusively  breastfeed  ???

     The poor nutritional standard of Indian children is chiefly related to poor breastfeeding knowledge and technique.

     Only 69 percent of children under two months of age are exclusively breastfed. Exclusive breastfeeding drops to 51 percent at 2-3 months of age and 28 percent at 4-5 months of age.

How many months the Indian childrens are Exclusively breastfeed ???

 

     Overall, slightly less than half of children under six months of age are exclusively breastfed. Only Twenty-two percent of children under six months of age  received   breast  milk  and  plain water and 15 percent drank both breast milk and other milk. Rest 63 % are denied of breast milk before 6 months of age. Thus in absence of proper information and counseling it is the Indian children who  suffer.

Imprecise Breast Feeding Practice in India . Who is going to teach millions of mothers annually ? To whom this duty should be entrusted???

 

ž Who is going to counsel the mothers during antenatal and / or postnatal visits about Exculsive Breastfeeding and details of the right technique of breastfeeding?  Who will do?  Any N.G.O.?

ž The purpose of complementary feeding is to complement the breast milk and sustain the growth and development of the child. Information on supplementary feeds  was obtained by asking mothers about the current breastfeeding status of all children under five years of age

Unfortunate Indian infants – they are half fed since infancy !!!

     Feeding recommendations are even less likely to be followed for nonbreastfeeding children age 6-23 months. More than four out of five children in this group were given mild or milk products the day before the survey, but only 31 percent consumed food from four or more food groups, as recommended.  Even fewer children (27 percent) are fed four or more times a day. Only 12 percent of nonbreastfed children are fed with all three as per Infant and Young Child  Feeding (IYCF) Practices.

     (Source: NFHS-3 and Macro International; Indian Institute of Population Sciences, Mumbai)

 

 

Nutritional status of Indian Children (Contd.)

ž70% of Indian children are anemic including 26% who are mildly, 40% moderately & 4% severely anemic.

ž  For Women however the percentage of anemia are respectively 33%,16%& 2%.

ž The percentage of anemia has increased from 52% to 56% from NFHS-2 to NFHS-3. Are Health Care Providers (Dr / Nurses) and Policy makers are doing justice to Indian Women? (Source: International Institute for Population/Science, Deonar , Mumbad and Macro international, 2007).

 

How many times and types of different foods an infant ( 6-23 months ) should ideally be fed per day? Poverty and thus shortage of complementary foods suitable for infant is lacking in most Indian families

 A) If breast feeding is contuinued:-  It  is recommended that breastfeeding children aged 6-23 months should be fed from three or more different food groups. Moreover, infants age 6-8 months should be fed at least twice a day and children age 9-23 months should be fed at least three times a day.

    

Malnutrition and Poor Indian infants

    B) Nonbreastfeeding children:-  aged 6-23 months should be fed milk or milk products every day. In  addition, they should be fed from at least four food groups and they should be fed four or more times a day.

     Sadly only 44 percent of breastfed children are fed at least the minimum number of times recommended, but only half of them also consume food from three or more food groups.

Indian Children and Prevalence of Malnutrition

     What is the Nutritional status of Children ? What Laboratory people  reports?

      70 percent of Indian children are anaemic, including 26 percent who are mildly anaemic (10.0-10.9 g/dl), 40 percent who are moderately anaemic (7.0-9.9 g/dl), and 3 percent who are severely anaemic (less that 7.0 g/dl). Appropriate adjustments in these cutoff points have been made for children living at altitudes above 1,000 metres because these children require more haemoglobin in their blood

     Hard to believe in a Country which have got Metrorail sattelite!!!

CAUSES  OF  MALNUTRITION AMONGST  INDIAN  CHILDREN :

 

ž The nutritional status of children is strongly related to maternal nutrition status. Under nutrition is much more common for children of mother whose BMI is below 18.5 than for children whose mother are not underweight. Children from households with a low standard of living are twice as likely as to be undernourished as children from households with a high standard of living.

ž (Source: International Institute for Population sciences (IIPS), DEONOR, MUMBAI, INDIA and Macro International, 2007).

 

 

 

 

     There are 3 standard indices of physical growth that describe the nutritional status of children : a) Height for age (Stunting - 50%)  b) Weight for Height (Wasting- 20%)  c) Weight for age (Underweight – 43%). Figures in brackets indicates present status amongst Indian Children as  on 2005-06 !!!

 

     (Source : National Family Health Survey – 3, Study period 2005 – 06, India).

Relationship between Nutritional Status of children with education of their Mothers

     Indian children make up one-third of the world's malnourished children. Most striking features are theat every second young children in India is a malnourished. A staggering 38.4% under the age of three are stunted and 46% are underweight.

      Only 4 out of 10 girls who enroll in primary section complete eight years of schooloing. Thus when the become mothers they have got little idea about care of infant and hygine.

Poor Health of children born to uneducated Indian Mothers

 

    Girls and boys are about equally likely to be undernourished and this is correlated with the level of maternal education. Most children under age three are anemic (79.2%), higher in rural areas and among non-eucated mothers. Anemia thus is primarily linked to poor diet and poor hygienic condicions. All these are illeffects of  illiteracy and poor knowledge of their mothers.

 

Integrated  Child  Development Scheme (I C D S) and its beneficial effects  on Indian children

     Govt. of India started the ICDS, Program in 1975 and the program was expected to play a major role in improving the health and welbeing of mothers and children under 6. This program aim at improving health, nutrition and education. The program offers basic health services, supplementary food, and pre-school education.

      Our ICDS program is one of the largest in the world; reaches more than 34 million children aged 0-6 years  and  7  million pregnant and lactating mothers.

     (Source: Prof. Rajaram Pagadala)

But the benefits of ICDS is being covered by other Govt. programs as well – so unnecessary expences by implementing many policies for the same beneficiaries

 

 

     We know that in ICDS Program the beneficiaries are children below 6 years, pregnant and lactating mothers, and women aged 15-44 years, who are provided supplementary nutrition, immunization, health check-ups, referral services, treatment of minor illnesses and pre-school education to children aged 3-6 years.

Unnecessary expences by implementing too many policies for the same beneficiaries (Contd.)

     "It is ironical as to how the bureaucrats and efficient policy makers with the help of committed professionals and philanthropic international aid agencies who have come together to fight poverty, hunger and diseases have duplicated the programs where the beneficiaries are the same leading to wastage."

     (Source: Prof. Rajaram Pagadala)

Amartya Sen laments on 26/02/09

     A  survey  conducted  under  the  leadershop of  Dr. A. Sen on the children of  West  Bengal  revealed  that  fair number of children living in West Bengal is not being covered by ICDS program.

      As such Dr. Sen was unhappy with the performance of ICDS personel in West Bengal as it could not cover most of the children  in West Bengal. Such may be the state of affair in remaining states of India.

Indian Children and  Micronutrient  Deficiency

      Micronutrient deficiency is a serious contributor to childhood morbidity and mortality. Children can receive micronutrients from food, food fortification, and direct supplementation. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage. VAD can also increase the severity of infections such as measles and diarrhoeal disease  in children  and  slow  recovery  from  illness.

Indian Children and Micronutrient  Deficiency

      The human liver can store an adequate amount of the vitamin for four to six months. Periodic dosing with vitamin A supplements (usually every six months) is one method of ensuring that children at risk do not develop VAD. The Government of India recommends that children should be given vitamin A supplements every six months until they reach three years of age, starting at age 9 months. Some states have decided to extend that period to include children until they reach age five years, as recommended by the World Health Organization.

Part - 8

 

HUNGER BURDEN

 

(QUANTUM  OF  PEOPLE  LIVING  WITH  HUNGER)

 

Global hunger index
(Place of India)

     According to 2008 Global Hunger Index, India scored 66^th place in the 2008 global Hunger list of 88 countries.

      Surprisingly the state of Pubjab, the pride of India and the best-performing State, is below Gabon, Honduras and Vietnam!!

      India is home to the world's largest food insecure population and more than 200 million people are hungry India.

Global hunger index
(Place of India) (Contd.)

    The three indicators taken for indexing hunger are: prevalence of  child malnurtition,  child mortality, and the proportion of people who are calorie deficient. The other two components of the Global Hunger Index – child underweight and child mortality – India ranks below Bnagladesh.

    (Source: Prof. Rajaram Pagadala)

 

Role of UN in reducing Hunger Burden

     The United Nation's has framed a special sub-committee on Nutrition which is a part of Administrative Committee on Coordination of Nutritional Standards (ACC / SCN) of various countries. This sub-committee reviews 'The National Nutritional Policies of all the Nations' and guide them accordingly. They also offer financial assistance to different countries. All the major UN constituent members like, FAO, IAEA, IFAD, ILO, UN, UNDP, UNEP, UNESCO, UNFPA, UNHCR, UNICEF, UNRISD, UNU, WFC, WFP, WHO and the World Bank are the founder members of the same committee.

     (Courtsey: Prof. Rajam Pagadala)

What prevents the practicing doctors to tell that 'king you are naked' (Rabindranath)

 

      This depicts real India like the film SLUMDOG Millionare which has righly depicted the true nutrtional sttus of Indian children living in slum areas of Mumbai, India

Alias ! Of all the States of India - the burden of hunger is maximum in West Bengal, India

WE ALL WANT  ERADICATION OF HUNGER FROM OUR COUNTRY (“GOROBI  HATOA”)

But what is the Right Path to remove hunger?

    Removal of hunger and poverty (Garibi hatao) was the manifesto of  a major political party of India in late seventies. Long thirty five years have passed . Still there are millions of Indian people hungry & living B.P.L.(22.15% as on 31-12-06). There are many indices of BPL of which common  parameter  is   if one is unable to procure  less than 2400nkcal per adult member of the family in rural areas where persons are acively engaged iphysical work and less than 2100 kcal in urban areas where people relatively pass sedentary lives thus there is minimal calorie expenditure.

Percentage of people who suffer from hunger in villages per thousand, India. (State wise Breakup)

Percentage of people who suffer from hunger in villages per thousand, India

     (This Table details the % of people who are underfed a) few months in a year b) all the months of a year and c) food gains alloted per person per year.

Percentage of people who suffer from hunger in villages per thousand people, India

 

     The following states of India suffer from the burden of Hunger most

•Prevalence of hunger in rural India:  11.9% (10% of People do not get adequate food for some months in a year and as many as 1.9% remain almost half-fed during the entire year).

• However such figures for Orissa, Chhattisgarh, Bihar and Assam is 6.1%, 2.6%, 2.8% and 5.3% respectively.

Govt. of West Bengal, India admits the  burden  of  hunger in State Assembly

Prevalence of hunger in rural people of people of  West Bengal – a state in India- -as many as 2,00,00,000 people do not get adequate food – an example of rural inquitable development. As many as 10.5% of Rural people are half fed throughout the year !!!

Rural unemployment – A great challenge for the policy makers of India

Unequal income between urban and rural people

West Bengal ranks first in the burden of hunger amongst all the States of India

What are the Common Causes of  Hunger Poverty and thus Malnutrition in India?

 

•   Ownership of industries in the hands of a few small businessmen.

•   “Gross unequal distribution of assets.”  So skewed distribution of the ownership of income yielding assets.”

•   Rural Inequitable  - chronic unemployment and under employment.

Any attempt to remove malnutrition should tackle the following problems as well.

•                                                      Regressive tax structure of the country leading to tax evasion & growth of black money in a reckless speed.

•                                                      High rate of population growth India (Here contraceptives play an imp. role)

•                                                      Continuous hike in procurement prices of food grains.

•                                                      And many other factors….

 

Steps to fight hunger

The aims are:-

•                                                                    Feeding a future world – seeking practical solutions for food deficit countries and moving towards food security.

•                                                                    Food for all in 21^st Century (Food security) – Eradicatring Hunger.

•                                                                    Plans and policies to improve Indian finances : Time for redesign

What is the unspoken and undiscussed success path for removal of poverty in India?

     It is difficult to define which factor is most relevant for reduction of poverty in a particular country. Experience shows one can’t generalize the importance of any particular path so far as improvement of Nutrition Is concerned.

     But one thing is certain i.e. Corruption & Wrong agrl. Policies are the two main detrimental factors in Indian Economy so far as reduction of hunger burden is concerned.

PART : 9 


CORRUPTION
&
HUNGER BURDEN

Corruption and Bribe are new indices of development !!!

•        Corruption  is  a  silent  sting

•        There  are  many  bribe  paying  countries  and  unfortunately India  is  one  of  them.

          Transperancy International (a N.G.O.) has statistically evaluated the magnitude of bribe received by different Govt. officials / other  persons  in  India  and  they  have  quantified the severity of bribe as follows:-

                  a. B.P.I. – Bribe Payers Index

                  b. C.P.I. – Corruption Perception Index

Corruption and Bribe

 

    The is no point in denying that Bribe and thus corruptions have finally become part of  policy makers and aid-granting authorities in some countries.

    Additionally the size of the black or underground economy is enormous in India.

Corruption in multinational company located in India – Eroding the Indian Economy?

    Corruption in a multinational house! World Bank has declared Wipro as a Black Listed Company.

Corruption in  a highly reputed company – Eroding the name and fame of  Indian Foreign Trade?

 

    Corruption also prevails in "SATYAM" – a famous Indian Company

 

 

    Several persons have been arrested

Malnutrition – a direct effect of corruption – this has happened in Govt. – aided organization too

 

     Baruipur Home, West Bengal, India. The money received from Govt. of West Bengal, India as an aid  has  been  spent  for some other purpose. But this was allocated for Care of Children. As a result several children died due to malnutrition.

Corruption in Indian medicine – Spurious drugs affecting foreign trade

     Spurious drugs manufacture in India is preventing the export of drugs to other countries. Thus there is less foreign trade.

PART : 10

ECONOMIC DEVELOPMENT

a)  Economic  Development  and  its  impact  on  nutrition

b) Unequal Benefits of economic development in different areas of a same country e.g. Lalgarh, Darjeeling, Cooach-Bihar districts, (West Bengal, India).

Malnutrition is not only a problem limited to have nots. Malnutrition amongst rich people too !

•                                                                    Rich persons usually indulge  on costly food but many of them are simply ignorant on the BALANCED  DIET.

•                                                                    Often the marketing part i.e. purchasing of food particularly fresh and leafy vegetables is left to servants so also the cooking part. The servents are illiterate and have no idea on  protein, fat, carbohydrate  not  to speak of balanced diet.

SIMPLY to have MONEY is not sufficient to maintain adequate nutrition
Malnutrition amongst rich persons !

•                                                                    Even if head  of the family goes to market  he is hesitant to purchase  green leafy vegetables which are commonly purchased by people of low income group.

•                                                                    Fast food and late night dinner and taking beverages has become rampant amongst  rich men and women of India.

Economics of Food

 

   This deliberations highlight mainly ECONOMICS of FOOD -  which is seldom discussed in medical fraternity

Has HUNGER Declined Since Economic Reforms of 1991?

      The urban sector seems to have continued its ‘march of poverty reduction’ in the process of growth. But ‘rural poverty reduction’ was choked off  buy lack of rural growth. Stagnation in rural growth is the basic cause of slow down in poverty reduction.

      This naturally puts a question mark on the very nature of the reform process in terms or rural welfare. The inverse relationship observed between poverty reduction and GDP growth becomes even more prominent if one obtains the trends over the recent years. Thus rise of GDP do not guarantee ‘adequate food intake’.

Analysis of Economic status of India (2006)
(By a Gynecologist!!!)

GOOD NEWS:

Foreign Reserve   -172 billion dollar  as on 31/12/2006

GDP               -9.2% (2007)

Share Market       -↑ ↑ ↑( bull)

 

BAD NEWS:

     But the dark side is that 22.15% INDIANS are still BPL (26 crore to 29 Crore). Of this 22.15%. ‘Rural Poverty Ratio’ is about 26%  &  Urban poverty Ratio  is about 20%

What about Human Dev Index in rural area? How far corruption is impeding development in rural India?

   

    Village persons are less developed economically. If  Rs.1/- is sanctioned  by centre only 15 paisee actually reaches to rural people.

    Similarly reservation for SC/ST ! Any real benefit to them???

    To what extent? We don’t know.

 

Unemployment  is  a  Big  issue  in solving the problem of Malnutrition

Want to Solve Malnutrition?
It is like:

 

"Pay up

&

Play the game"

 

 

You  pay  the  money  and  purchase  food  –  avail nutrition.  If  you  are  unemployed  how  you  are  going  to  solve the  problem  of  hunger  and  malnutrition ?

China Syndrome

•        The Republic of China gets 10 times more foreign investment

•        China exports five times more than the merchantise Indian firms

        Why India is lagging behind???

Part : 11

Poverty – ‘Definition’ & ‘Quantum’ in India

Why many Indian people are becoming poorer?

Dimensions of Poverty

    Definition: Poverty is a multidimensional socio- economic condition, and any attempt to define it by using a multipurpose data is bound to yield only an approximate representation. Poor People have to live with HUNGER! Malnutrition is bound to follow. Thus any discussion or malnutrition is bound to be incomplete If we do not discuss the ABC of POVERTY!

 

Magnitude of B.P.L. persons in India as on 2008 (as per N.F.H.S. – 27% of Indians are B.P.L.

WE  ALL  WANT  POVERTY  &  HUNGER  ERADICATION   FROM  OUR  COUNTRY  ( GOROBI   HATOA)  (Contd.)

    Then , what is the ROAD or magic bullet of ‘poverty eradication & removal of  Hunger ‘ in India? Will the microcredit  policy or installing  thousands  of  GRAMIN  BANK – as Nobel Laureate Md. Yunus has done in Bangladesh will work in India too? Or any other new policy will be appropriate for India to eradicate the burden of poverty,?

      Right answer is possibly still unknown.

How one should define persons living Below Poverty Line (B.P.L.) ?

(CONCEPT OF BPL    and  INDICES OF B.P.L.)

Definations or different indices of B.P.L.

     Not only calories, but also ‘amount of protein intake’ should also be considers as the criterion. Generally for simplicity, calorie intake norms are accepted as an indicator of poverty.

    

     Thus the official definition of ‘poverty line’ goes like this: ‘expenditure required for daily calorie intake of 2400 KCal per person in rural areas and 2,100 KCal in urban areas.’

 

Criteria of B.P.L varies in different countries and possibly in the states of a same country !!!

      There is some controversy about the percentage of population living below the poverty line in India since measurement of B.P.L involves decisions relating to indicators time trends, interpretation of data etc. Whether one should use ‘income’ or ‘consumption’ as the criterion, whether to use indicators which are ‘distribution- sensitive’, whether to place emphasis on ‘non-income indicators’ are all important questions to address the problem of poverty.

Criteria of B.P.L varies in different countries and possibly in the states of a same country !!!

   

    Inequality and poverty  are interrelated. Poverty usually is a  reflection of inequality.

In general, a person is considered to live on poverty if this (her) income and other means of support are insufficient.

 

 What is the Quantum of B.P.L. in W.B and India?

In West Bengal (One of the state of Eastern India) the number of BPL is two crores !!! Unbelievable

Part : 12

RATE OF FOOD PRODUCTION AND ADVANCEMENT OF AGRICULTURAL SCIENCE  IN  INDIA

    (Balance between production & demand of food grain in India).

Landless persons are the worst sufferers  of  malnutrition

    In the state of West Bengal, India as many as 50% rural people are landess where from they will produce food ?

Factors controlling Food Production?

 

     What are the Impediments to a good Nutritional Status of  Citizen of any Country. In fact these are also the barriers to  civilization / economic surge / development. The followings are the barriers:

Factors interfering with adequate Food Production

 

       Decreased food production and thus Poor Agricultural Output may be due to:

•   Wrong Agricultural Policies & Bad selection of Agrl. Plants; Choosing rain-dependent cultivation, Unscientific selection of Pesticides, insecticides, fertilizers & most importantly Poor utilization of rain & river water.

          Additionally  water  scarcity, Pollution and Continuous erotion of cultivation Land / Loss of Forest are the other causes for poor food production. These have to be tackled  socio-politically.

Food insecurity – who is to be blamed? Everyone is trying to avoid responsibility!

 

     Food scarecity in India; Govt. of India is blaming World Bank and  I.M.F.

Allocation of Cereals per Indian is reasonably acceptable  but what about daily intake of PULSES?

 

    There have been fourfould increase of food-grains in India in last 30 yrs. For instance per capita per day allocation of total food grains( cereals & pulses) was 334 gm (1950-51); 418 gm. (1970-71); 469 gm (1990-91) though it fell to 429 gm. in 1998-99.

 

New century: New challenges
Moving towards food security

Green and Growing

ž Brain takes only 0.01 seconds to send a message to one's finger. How many years India will take to erradicate hunger and poverty.

ž We can't direct the wind … But we can certainly adjust the sails. Why not to improve agricultural science and food production  if  population  growth in India can’t be checked.

ž Can't we be quicker to increase our domestic Food Production?

The  Bad  News and  the Good News
about agricultural research in India

New innovations in agriculture moving towards Food security?

Part: 13

  POPULATION SIZE AND UNDER NUTRITION

Population Growth Rate is still very high in West Bengal (India). Then how to solve the  problem of malnutrition?

    

     From 2001 to 2009 there has been an increase in population (90,00,000) in West Bengal – a state of India.

 

 

Population rise in India. Where from food will come?

 

 

Is it true that science of agriculture is advancing – as it should do can it keep pace with population rise.

    What about soil? What about good quality seeds, irrigation, soil – friendly - fertilizers? Have we arrived at end point?

CORRUPTION is also an impediment for rural development including procurement of food gains by middle man and so far as Govt. of India subsidies allotted to poor people (100 days guaranteed work).

Aiming for stable population in India and thus adequate food for all Indians ?
Is it at all possible ???

    In 2000, GOI- announced a new National Population Policy (NPP-2000). The principle policy was not bounded by numerical targets neighter by offering incentives for two children families. But it did plead for delaying marriage.

     The present policy, which follows an earlier, shift in ‘emphasis from demographic control’ to ‘health care and education of women’ aims to bring fertility rate down to replacement level by 2010 and achieve what it called stable population by 2045.

Aiming for stable population in India and thus adequate food for all Indians ?
Is it at all possible ???

  

   Note:-  In NPP-2000 there are total 14 socio demographic goals to be achieved by 2010. In the said policy contraceptive use has been considered as one of the most important step to achieve sustainable development of India.

 

DECENNIAL POP. GROWTH
(How  close  we  are  to  our  goal?)

Percent decadal Variation of Population Growth.

QUANTUM OF B.P.L.  IN WEST BENGAL

ž  In 2002 : 33%

 

ž  In 2009 : 43% !!!

ž  Source: Editorial BARTAMAN PATRIKA DAILY,

ž  28^th.  October , 2009

Removal of Hunger & Problem of Overpopulation

    Six problems were identified at the ICPD; 1994(International Conference on Population & Development, Cairo where representatives from 179 countries met.

     Delegates present in the said congress also agreed that  key solution for poverty reduction & removal of hunger is to establish Reproductive Rights. They also agreed that REPRODUCTIVE RIGHTS ARE HUMAN RIGHTS.

 

India is Overpopulated – How can there be  Food Security?

Then What is the root cause of poverty / hunger / malnutrition in WB, a state in eastern India?
Rise of population in WB:

1-3-2009                              =         8 Crore 89 Lakh 14,500

(Estimated Mid Year Population Size) 

31-3-2001                            =                 8 Crore 2 Lakh 21,171

(Census 2001)_________________________________________________________

So Rise in 8 Years in West Bengal            =         90,00,000

Has Agricultural Land / Rate of food production is keeping pace with the population rise? If not then hunger and under-nutrition is bound to follow. The idea of population stabilization in West Bengal is becoming a myth!

 

How overpopulated is our Motherland !!!

How overpopulated is our Motherland. Can we claim that we are developed ?

Part : 14
of the Deliberation

•                                                                                   Issues (problems) related to malnutrition in India  have been discussed at length i.e. Nutrition, Hunger, Indian Economy, Poverty Burden, Domestic Food  Production  and ever rising  Population Size.

•                                                                                   Now following are the PATHS that has been suggested to improve malnutrition in India.

Different Paths / Solutions for a Hunger free world

OLD  BATTLE

NEW STRATEGIES

Many promisess, different suggestions - But will we be able to remove rural poverty? Because most cases of malnutrition is observed amongst rural populstion

Paths  to  alleviate  hunger  in  India

 

    Problems related to hunger have been discussed .

    Now we come to find out the different paths / remedies to reduce the hunger burden and malnutrition

Different recognised Paths of Social Development and thus removal of malnutriton

    Six paths of development have been approved by different International Agencies (Cited later). But none of those paths have yielded poverty reduction in a sizeable way at least in India. What then is the most appropriate or effective path of removal of POVERTY / HUNGER / MALNUTRITION in India?

     We are aware that for every valid recommendation there is a valid exception.

     There are some good news and bad news for each six recognized paths of development.

Six  recognized paths of development

    Although no snigle path will work alone  one have to find the impact of each path and this mandates 'fairly radical programme changes from the present prevailing policies of Govt. of India including those which will yield social changes and at the same time acceptable to different religions and community (community acceptance).

Different Paths of Improvement of Nutrition & Poverty Reduction…

     Six internationally recognised paths for removal of hunger / improvement of nutrition have been suggested:-

    Path 1 : Liberal use of Contraceptives (Contraceptive-Dpendent  Poverty  Reduction Path )

    Path 2 : Industrialization (Job Oriented Poverty Eradication Path)

    Path 3: Women’s Education & Employment (Effective Planning in the family & grass root Implementation of most policies and adapted by Govt. of India).

Different Paths of Improvement of Nutrition & Poverty Reduction…

    Path 4 : RCH Care (Improving Health of Mothers & Child. This will drastically cut down of budgetary allocation of Govt. on curative medicines and hospital stay).

    Path 5 : Women’s Empowerment & Acceptance of their Decision making Power (Power in the family- food to choose)

    Path 6 : Care of Girl Child in most appropriate  way (Future  Backbone  of  our  Nation)

      But, But, But, where is the evaluation / Assessment of EACH PATH ? Morecver what about  Budgetary allocation for implementation of each path?

Who is going to pay differential importance on these six paths of developments?

 

    Pick and Choose any path you like:-

     As  budgetary limitations  are there    hence policy makers have to pay differential attention  i.e. they pay more attention on some specific path or paths which they   firmly believe will do good to cuntrymen.  Thier judgement  may be RIGHT or WRONG.

      It is impossible for any country to avail all the six paths identically i.e. with equal emphasis.

Path 1
Population control approach of development & Removal of under nutrition – by use of contraceptives and family planning. Though use of contraceptives does not mean control of population alone

 

 

     Experience since 1952 has witnessed that Judicious use of contraceptive though imply one of the method of limiting population size in a country or in a community but contraceptives are not the panacea for population control and thus limiting demand of foods. Limiting  the family size carry other important message e.g. good health of family members.

Path  :  1
Traditional  Population   Control  Approach of managing  Malnutrition,

         Path 1 claims :-

         Primarily  rely  on  liberal use of contraceptives "Lower ‘Total Fertility Rate per woman’ slow down pop growth Near ‘stable population’. Views of 18^th century – Thomas Malthus view.
But this has not worked in India. Population is still rising and this Contractive dependent path of reduction of burden of malnutrition dose not hold good so far as India is concerned. However this may be effective in some other country.

How population size is related to ‘Social Development’ & ‘Economic Surge’?

ž Development now concerns the individual as much as the nation. Development now spans the social, economic and political context of the individual and her / his ability to participate, as an equal, in the development process. To measure and compare the extent of development across different states and nations, new indices have been designed – like the Human Development Index (HDI) or the Human Poverty Index.

Role of Contraceptives in the poverty reduction  / improving malnutrition ?

    The apparent impact of about 72,000 Indians beings born every day i.e. 16 billion/year-equal to entire population of Australia being added every year will among other things cause a decrease in the per capita availability of food grain.

     “India will be more ‘crowded’, more ‘environmentally fragile’ and ‘ecologically brittle’ and the cost and effort in ‘feeding’ this large population pose pressing challenge.”

Then is there no Role of Contraceptives in the dev. of India?

    One  Million Dollar Question !!!

     To us (Doctors ) it appears that  liberal use of contraceptives "Fertility will  decline Slowing of pop growth  this will GDP Eco. Improv. Reduction of poverty This was the earlier thought which eventually proved to very much over simplification of a monumental problem.

Now Economist like Demographers have realized that some other path of poverty reduction has to be thought of.

 

Is there at all any Role of Contraceptives in imprving nutritional standard of Indians?

    This “Contraceptive dependent – Hunger Eradication  Path by liberal contraceptive use”- has been proved effective in some developing countries of Africa but unfortunately this policy has proved not to be that fruitful for economic improvement  in India. But still one can’t deny the role of contraceptive in economic surge and alleviation of malnutrition & disease burden in our country.

Role of Contraceptives in imporving nutrition

     One  Question  however  still  remain  unanswered i.e. “Does ‘high fertility’ cause ‘poverty’ or does ‘poverty’ encourage ‘high fertility?’

      The path of economic development of our country primarily depend on the answer to this question . If answer to first question is affirmative then we have to heavily depend on contraceptive promotion & not so much  on Industrialization / Urbanization

     Who will show the right path of Poverty Eradication and correction of malnutrition.

WHAT ARE THE GENERAL PRINCIPLES OF ‘POVERTY ERADICATION PATHWAYS’  APPLICABLE TO ANY COUNTRY ?

        To achieve sound economic development and improving the nutritional standard of citizen in any country there are several major established pathways: e.g.-

•    Primarily rely on liberal use of contraceptives "Lower ‘Total Fertility Rate per woman’ slow down pop growth Near ‘stable population’. Views of 18^th century – Thomas Malthus view.

Usual poverty eradication pathways (general principles / application to any country)? ( Contd.)

 

•   View of Twentieth Century (1970/1980):

        Sound and judicious economic policies, industrialization  & improvement of International Trade which are most suitable for a given country is of paramount importance for poverty eradication ( NeoMalthus  Theory ). According to the proponents of this theory- ‘Contraceptive use’ and thus ‘population size’ of a country is of little importance so far as poverty reduction is concerned.

Usual poverty eradication pathways (general principals / application to any country)? (Contd.)

 

    Followers of NeoMathus  group simply don’t bother on size of population of a country and they ignore Demographic statistics and density of population.

     They claim they can feed and provide accomodation for more  people  in any country with the blessings of sophisticated international trade.

NeoMalthus group firmly believe…

    "Development is the best contraceptive”.

    Demographic consideration / Rate of contraceptives use are largely irrelevant to poverty reduction in a given country.  They claim that world population has doubled from 3 billion in 1960 to 6 billion in 2000. Total land has not increased. But food scarcity and malnutrition did not occur to that extent.

But Industriazation is no guarantee against unemployment

Wrong industrial policies in India – one of the main cause of malnutrition

Path 2
Why then the Industrialization policy of Development and Economic Surge failed in some countries? Why? Why?

 

     Poverty is due to the imprecise economic growth model and lack of investment in the social sector. DEVELOPMENT SHOULD focus on  meeting  basic needs  and  not  on  numbers or economic figures.

      Is the social contribution made by Indian Industrialist  enough?       What about Free Schools / Charitable Hospitals / Public Roads / Free Drinking Water Supply / Free women’s education – Are these financially supported by Indian Industrialists ?

      “Development” = Quality of life of all citizen.

Why then still so many BPL / Hunger persists ? The arguments put forward by NeoMalthus group ….

 

       Global food production has exceeded rate of pop growth, for last four decades . Whatever hunger now persist that is due to :-

•   Poor  agricultural & trade policies of a particular country choosing the less profit yielding crops.

Why then still so many BPL / Hunger persists ? The arguments put forward by NeoMalthus group ….

        

•                                                                                 Poor food distribution system inside the country. (?Politics)

•                                                                               Faulty application of technologies to various production units.

•                                                                                 Racial discrimination .

         Note:       Can world Feed 10 billion ? 20 billion.?

 

         NeoMalthus group claims .. YES!!!

 

However the long term goal of any nation is economic growth (sustainainable dev) and removal of malnutrition

But , what is the single most effective magic bullet?

Which path is most important for dev?

Path 2
Why then the Industrialization policy of Development and Economic Surge failed in some countries? Why? Why?

 

     Poverty is due to the imprecise economic growth model and lack of investment in the social sector. DEVELOPMENT SHOULD focus on  meeting  basic needs  and  not  on  numbers or economic figures.

      Is the social contribution made by Indian Industrialist  enough?       What about Free Schools / Charitable Hospitals / Public Roads / Free Drinking Water Supply / Free women’s education – Are these financially supported by Indian Industrialists ?

      “Development” = Quality of life of all citizen.

Should we really still pay stress on the Path of industrialization: Path 2 (Contd.)

         There are so many industries in India. Why then still so many BPL / Hunger persist  in 2009?    

      NeoMalthus group, who strongly believe on Industrialization explains…

         Global food production has far exceeded than rate of population growth, in last four years decades . Whatever hunger now persist that is due to :-

Problems & Remedies

S U M M A R Y

•   F.P. alone will not necessarily reduce poverty neither will many of the present economic plans in  India.

•   For any country even if economic policies are considered primarily sound . But growth can be impeded by:-

Problem & Remedies

•   A bad govt. with poor administration.

•   Rampant corruption amongst the politicians /officers/ panchayet leaders.

•   Lack of proper use of natural resources. Policy was originally prepared by less expert.

•   Poor execution at grass root level.

•   Imbalance between various production units.

•   Ill distribution of ownership of land and wealth.

 

SO , WHAT WENT WRONG IN INDIA?

    In India – combining the extensive F.P. services and installing some giant industries did not bring forth noticeable poverty reduction and improvement of nutrition of its citizen.

    So the combination of above two policies   are possibly not the right paths for poverty reduction in Indian context.

Path – 2 
Industry Based Approach for ' Economic Spur ' and ' Removal of Poverty '

         Path – 2 – Role of Industrialization (1970)

         View of Twentieth Century(1970/1980):

         'Sound and judicious economic policies ', 'Industrialization  & improvement of  International Trade '   which are most suitable for a given country is of paramount importance for poverty eradication ( NeoMalthus  Theory ). According to the proponents of this theory-- ‘Contraceptive use’ and thus ‘population size’ of a country is of little importance so far as poverty reduction is concerned.

Is population control at all necessary (they consider that Path 1 is unnecessary)

Path – 2 Contd.

     Followers of NeoMathus  group simply don’t bother on size of population of a country and they confidently ignore Demographic statistics. In fact some of them (Economists) now consider that population size is the asset of any country and not a liability.

      However proponents of this view firmly claim  they can feed and provide more  people  in any country with the blessings of sophisticated International  Trade.

NeoMalthus group also …

    They Consider – “Development is the best contraceptive”.

    Demographic consideration / Rate of contraceptives use are largely irrelevant to poverty reduction in a given country.  They claim that world pop has doubled from 3 billion in 1960 to 6 billion in 2000. Total land has not increased any where. But mathematically food scarcity and malnutrition did not rise at all. On the contrary such prevalence has decreased to some extent.

There are so many industries in India. Why then still so many BPL / Hunger persists in 2009?

 

 

Development of India could not make foot mark by the path of Industrialization because of the followings:-

•                                                                               Poor agricultural and wrong trade  policies of a particular country choosing the less profit yielding crops.

•                                                                                 Poor food distribution system inside the country. (Politics)

 

There are so many industries in India. Why then still so many BPL / Hunger persists in 2009?

         

•                                                          Faulty application of technologies to various production units.

           Racial discrimination

          Note: Can world Feed 10 billion? 20 billion.?

                NeoMalsthus group confidently say .. YES !!!

What about Dunlop and Singur / Haldia, West Bengal, India ??

Path 1 and 2 reviewed
Problems of implementation of Path 1 and Path 2 & Remedies thereof

         Why Industrialization policy of Development and Economic Surge failed in some Countries have been discussed.

         It is admitted that F.P. alone will not reduce poverty neither will many of the present economics plans prevaling in  India (Current Industrialial policies).

         For any country even if economic policies are considered primarily sound. But economic growth of that country can be impeded by:-

Causes of failure of Development as expected from implementation of Path 1 and Path 2

        Why Path 1 Path 2 have failed to overall improvement of nutritional standard in India?

•    A bad govt. with poor administration.

•   Rampant corruption amongst the politicians / officers / panchayet leaders.

•    Lack of proper use of natural resources. Policy was originally prepared by technically less expert person / persons.

 

Causes of failure of Development as expected by implementation of Path 1 and Path 2 (Contd.)

 

 

•   Poor execution at grass root level.

•   Imbalance between various production units.

•   Ill distribution of ownership of land and wealth.

 

SO ,  WHAT  WENT  WRONG  IN   INDIA?

 

    In India – combining the extensive F.P. services and installing some giant industries did not bring forth noticeable poverty reduction.

    So the combination of above two policies   are possibly not the right paths for poverty reduction in Indian context.

 

Any other path / paths  for Development of our Country except population control and Industrialization ?

Other 4 new Paths (Additional Paths) for  total  development of our Country.

Path – 3
Women's  education and their employment (1985)

     Policy makers believed that if most of women are educated and employed  then  development of any country is bound to follow.

     We are listening to this wonderful solution(!) for last 25 years but its effective implementation in Indian community is poor. So this path of Development (Path 3) is not applicable in India at the moment.

 

If Indian women are Employed at all – See thier sufferings !!!

Women’s employment – A theoretical proposition in Indian community

    There is little scope of women in high official ranks for variety of social reasons. This applies to their involment in the sphere of politics too.

'Come together – if you can' – A dead slogan indeed voiced by male counterparts (Unemployment ratio amongst women)

Path – 4 of Development (1995)

    After execution Path 1, 2 and 3 :-

     Still unhappy about incidence of undernutrition and Seeking out further solutions?

     Fourth view of ‘Removal of hunger! This path was proposed in 1995 (A new solution for an old problem!!!)

Reproductive and Child Health Care (Path – 4)

A novel approach to the economic development of a nation is the implementation of complete package of   Reproduction and Child Health Care (R.C.H.). Thus saving of thousands of crores of Rupees ($ Dollar) spent in treating  sick  child  and  women  of  India.

     It is the health of the women & children of a country which is instrumental for a prosperous nation. The main component of RCH are—

 

Reproductive Health Based Approach of Development - Path 4

(RCH)

Six problems were identified at the ICPD; 1994(International Conference on Population & Development, Cairo where representatives from 179 countries met.

Delegates present in the said congress also agreed that  key solution for poverty reduction & removal of hunger is to establish Reproductive Rights. They also agreed that REPRODUCTIVE RIGHTS ARE HUMAN RIGHTS.

Seeking out Further solutions for Hunger reduction? (Path – 4) (Contd.)

•    Safe delivery  2)contraception 3)Safe abortion service

4) STD control      5) Down staging of Cancer and 6) Child care.

Linking reproduction health to economic development & removal of Hunger( ICPD-1994).

 

 

Diff. Paths of Development -What MDG opines?
 ( Millennium Dev. Goals)

In the year 2000, there was a declaration made by the 189 heads of countries. The declaration agreed to follow the path of ICPD,1994. But they stressed that   more emphasis should be paid on   “reproduction rights & sexual health of the women" to achieve persistent development.

They  later  reviewed  the progress of MDG in sept.2005 & observed that ‘gender inequality’, ‘maternal & child health’, ‘HIV/AIDS’, ‘hunger & poverty’, & ‘environmental sustainability’ need  high  priority.

“ Diff. Paths of Development” as defined in “World Leaders Statement, October 13,2004”

Nearly 100 heads of countries, 36 Nobel Laureates, numerous businessman and religions leaders- signed an universal declaration. This declaration refers to different paths of “Development” in any nation.

    They also firmly affirmed the importance of “Women’s sexual and reproductive right"  in the process of development of any nation.

Seeking out Further solutions for Hunger reduction? (Path – 4) (Contd.)

Millenium Development Goals (MDG)

   Millenuum Declaration was adopted by 189 nations and signed by 147 heads of state and governments duings the UN Millennium Summit in September 2000.

     The expected that the followings goals i.e. Millennuum Development Goals (MDG) will be achieved by 2015 and the followings are the plans and goals which were targeted.

Millenium Development Goals (MDG)

    The objectives are as follows :-

— Eradicate extreme poverty and  hunger

— Achieve universal primary education

— Promote gender equality and empower women

— Reduce child mortality

— Improve maternal health

— Combat HIV / AIDS, malaria and other diseases

— Ensure environmental sustainability and

— Develop a lobal partnership for development

Seeking out Further solutions for Hunger reduction?( Contd.)

•   Safe delivery  2)contraception 3)Safe abortion service

4) STD control 5) Down staging of Cancer and 6) Child care.

Linking reproduction health to economic development & removal of Hunger( ICPD-1994).

 

 

GENDER EQUITY ANDS MEN'S  ACTIVE INVOLVEMENT IN HUNGER REDUCTION” (Contd.)

       There is urgent need to improve women’s education  and Job prospects in particular. In patriarchal societies, men continue to determine all purchases including  food items. So one has to focus on the role & responsibilities of men too. This is more relevant in  four BIMARU STATES (e.g. Bihar, M.P. ,Rajasthan & U.P ).- which comprise  40% of India's population.

M.M.R

In West Bengal the total maternal death was as follows:-

 

IMPLEMPTION OF RCH PROGRAM CAN HELP POVERTY ERADICATION ONLY TO SOME EXTENT ( POST – CAIRO ‘PARADIGM SHIFT’ )

The Proof is Here!

‘Cairo + 10’ has proved that all these six steps are important pathway for poverty eradication . In some country one path may be more relevant than other. That is the key. We  have to find out which principle will be more relevant for our country. Search for appropriate path for poverty eradication in India still continues! As on 2006, 37.7% of women of Bengal have BMI <Normal (NFHS-3,2005-06) and 63.8% are anaemic!

50% did not heard of AIDS & 54.3% of all births were not attended by skilled persons!!!

Then came Path – 5   Empowering the women
Gender Equity & Removal of Undernutrition

 

    Alias! Experience has seen that the RCH (Path 4 of Development) also did not work in removal of Poverty & Hunger!!!

    Thus, 5^th view on poverty eradication (2000) emerged as ‘Empowering women with decision making power  in family / community’ -  that may work.

   

Womens Empowerment
a good gesture indeed !!!

Path – 5   Empowering the women
Gender Equity & Removal of Undernutrition (Contd.)

 

    Empowering women   will eradicate  poverty, improve nutrition- a good idea indeed!!! But who will bell the Cat? Who will communicate this idea to men?

 Almost all husbands will possibly lament by exclaiming…’Knon banagya Chapati’(i.e. who will perform household jobs ) !!!

 

Path – 5: Gender equity and women's  active involvement in hunger reduction” (Path – 5 contd.)

    

     There is urgent need to improve women’s education  and Job  prospects in particular.

      But in patriarchal societies,  what actually happen that men continue to determine all purchases including  food items. In most Indian families decision of husband remains final. Occasionally women are allowed to express their opinion freely on family matters. Thus one has to focus on the role & responsibilities of women too.

Path 5 (Contd.)
Womens empowerment – it was a 'great black hope'

 

 

ž  Gender discrimination, Poor adolescent health, Early marriage, Uncontrolled fertility, Unsafe abortion, S T I and Genital Cancers are still the worst enemies of Indian women.

ž  Are Indian husbands / community going to hand over the power to wives / women at large? In Indian context this seems to be a difficult proposition.

      Thus 5^th view of development also does not hold good in India.

Human rights - - Abducted !!!

Prevalence  of  DOMESTIC VIOLENCE  in  India

ž More than a third ( 34 percent ) of women age 15-49 years have experienced physical violence, and 9 percent have experienced sexual violence. In all, 35 percent of women age 15-49 in India have experienced physical or sexual violence.

žSlapping is the most common form of physical violence experienced  by over-married women at the hands of their husband.

     (Source: National Family Health Survey, NFHS-3, 2005-06, I.I.P.S., Mumbai & Macro International.)

Women's empowerment in India
(A Black Hope)

Decision making power as enjoyed by Indian Women

     The following  questions  were asked to the several thousand of Indian women. e.g. a) decision on their health care, b) on making large household purchases, c) making purchases for daily household needs, d) and on visiting their family or relatives. These questions were put to assess the status of Women's Empowerment.

      Only 37 percent of currently married women participate (make the dicision alone or jointly with their husband in making all four decisions. There is no decision for which a majority of currently married women alone are the main decision makers.

Fun with Indian womens' freedom !!!

 

 

 

    Freedom of  Women Abducted  -  honoured  violence !!

    Will empowerment program of women will work in present Indian scenario? Community culture !

 

Path – 6 (yet another  new path)

Educate girls & Empower them.” The 6^th path of poverty eradication & lowering the burden of Hunger

 

 

   

    Numerically dozens of suggestions are pouring in for curtailing the problems of poverty and hunger but what is the key solution? We are yet to find the right path.

   

Educating girls in proper way and thus improve nutritional standard

ž Many  policy makers and few economists believed  that  Empowering women will alleviate poverty (path 5). But its practical applicability  in Indian context has been poor. So there was evolution of yet another path i.e. path 6. This emphasizes … 'Empowering  and  Educating Girl Child' – Kishori Shakti Yojona Prakolpa of Govt. of India … the path – 6.

 

Path - 6
Kishori Shakti Yojona Prakolpa
(Govt. of India Programme)

 

ž Empowering girl child is important “- So that when they become responsible women or house wife they can establish not only their own health and rights  but also enable to build up a healthy family with good nutritional status "    leading to Prosperous Nation.reasonably free of malnutrition and ill health

ž Many believe that as a planner   women are  superior than men. Author’s belief  is also like that.

 

The 6^th view of poverty eradication

ž  The “Girls Power Initiative” (GPI) -  a NGO (recognized by Nigeria Govt.) has shown that this path have worked in their country in a big way.

ž  GPI ( a NGO) urges call to other countries to follow their principle of empowering & educating girl child to build up a prosperous nation. This is the latest view of poverty eradication which surprisingly many economists have now started approving.

ž   What next path of development and hunger reduction yet to come???     Don’t Know !!

Proper  Care and Affection to Girl Child can not only remove poverty from India but also restore the missing sex ratio (0 – 6 year )

7^th Path of development which seems to be more relevant in OUR Nation
Role of Attitudinal factor –
Knowledge Attitude & Practice (K.A.P.) in the development process and hunger reduction.

 

ž  It is difficult to impart scientific knowledge to common people, particularly illiterate rural people of India.

ž  It is an common observation that community often don’t listen to good words (polio vaccine). In case of malnutrition if the remedies are not accepted by the community then it is no point in discussing  about  good foods /  unhealthy foods.

Knowledge  Attitude & Practice (K.A.P.) in the development process and hunger reduction.

ž But does this mean it is irrelevant to discuss under nutrition to them? No. We should not be so pessimistic about them. Time has come to break the community barriers. We should understand that long term habits acquired in a community setting  is difficult to change and great patience are warranted. Can we change Smoking overnight? Alcohol drinking? Corruption in India?

 

ROLE OF  ATTITUDINAL   FACTORS   IN FOOD SELECTION  TOO

ž   It appears, that 7^th view i.e. if we are able to change the attitude of people towards present food habits and science of nutrtion then much of the battle is won. By appropiate counselling we can overcome significant barriers to the adoption of nutritious foods that still exist amongst  poor  illiterate INDIAN men & women who suffer from malnutrition most.

ž   Contrary to commonly held assumption, particularly among policy makers and program managers in agriculture, attitudinal factors- such as ‘crave for certain foods’ which are neither ‘energy yielding’ nor ‘calorie yielding’ play an important part in the persistence of malnutrition in spite of some economic surge in our country.

WHAT IS THE ROLE OF  ATTITUDINAL FACTORS   IN  COOKING  PROCESS ,  FOOD STORAGE  AND FOOD  SELECTION

ž  Not only selection of healthy foods but mode of cooking and method of storage of food all counts so far as nutrition is concerned.

ž   Thus KAP – is very important. (Knowledge, Attitude and practice).

ž   The point is who will be going to villages and educate rural people about these? The ‘fire’ of ignorance lies  there, not at metro cities. Who will devote time and explain them the relevance of easily available nutritious foods thus bell the cat ???

 

Language of Indian people differs in every six hundred k.m. distance so also food habits

ž Ours is a vast land with varying resources. Different provinces have different food habits.

ž  We have to formulate diet chart for different group of people. The  have-nots  should be made aware how to get adequate proteins from easily available local and cheaper foods e.g. dals(pulses), snails and scrab. A pint of milk is a day dream for them not to speak of fish or meat. The problem is will community accept ?

ž One million dolllar question !

Role of Attitudinal Barriers in improving nutritional status (Contd.)

 

ž To be fully effective, the principal objectives should not only include guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection of locally available, low cost  healthy food items and scientific cooking procedures.

 

Role of Attitudinal Barriers in raising nutritional status

 

ž  To raise standard of nutrition - improvement of ‘cultural & attitudinal’ barriers   are more important than   subsidy on foods.

ž  A broad-scale intervention aimed at modifying the bad food habits among the poor by offering foods at subsidized prices or at no cost would be only partially successful.

ž  To be effective, the principal objectives should not only includes guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection health food items and cooking procedures.

Attitude – WHO will educate rural people

     Poor coking habits, improper food storage, selection of wrong food items, community ethics. Food is a subject of widespread customs, habits and beliefs, which vary from country to country, and from one region to another. The diet of the people is influenced by local conditions (e.g. soil, climate) religious customs and beliefs. Vegetarianism is given a place of honor in Hindu society. Even among vegetarians, the patter of eating is not the same; some do not take onions and garlic on religious grounds.

 

Attitude – Who will educate rural people? (Contd.)

ž  Although the motive is economic gain, a deep-rooted belief is also responsible for this practice, i.e., if pure milk is boiled, the milk secretion of the donor animal may dry up. Muslims observe fasts during Ramzan and Hindus on several occasions. These fasts are considered important adjuncts to religion. Hindu women often take food left over by their husband. In some societies, men eat first and women last and poorly. Some people do not eat unless they have taken a bath. (Source: K Park, PREVENTIVE AND SOCIAL MEDICINE, Published by M/s BANARSIIDAS BHANOT, 2002)

What is exatcly meant by removal of attitudinal factor?
How to remove the barrier?

 

ž There should be at least one or more chapter in local language on fruits / vegetables / locally available nutritious food in the school curriculum.

ž The education should commence from standard IV , especially those belonging to socially disadvantage and marginalized communities who suffer most from malnutrition. The Applied Nutrition Program (ANP) of India also strive to make people conscious of their nutritional needs and to provide supplementaty nutrition of children aged between 3-6 years and to pregnant and lactating mothers.

Path – 7: Attitude – Who will educate rural people? Social resistance and social prejudices are important challenges to improve nutrition

      Poor coking habits, improper food storage, selection of wrong food items, are the  community ethics in rural India.

      Food is a subject of widespread customs, habits and beliefs, which vary from country to country, and from one region to another. The diet of the people is influenced by local conditions (e.g. soil, climate), religious customs and beliefs.

Vegetarianism is given a place of honor in Hindu society. Even among vegetarians, the pattern of food item selection  is not the same; some do not take onions and garlics even   on religious grounds, not to speak of milk.

 

Can we not educate and train young local girls as 'Rural Food Counselor'

     There is none to counsel uneducated illiterate poor villagers about food selection and scientific way of cooking. Often these are carried out in an unscientific manner with much loss of nutritive value of foods.

      The proposed ‘Rural Food Counselors’ will work at Block level. Author believes that they (Food Counselors) will succeed in changing the ‘Attitude’ of the rural people and thus be able to improve nutritional standard to some extent even with limited finalcial capability. Informations on locally available low cost food items which donot require much fuel to cook should thus be made known to the poor villagers.

Rural 'Food Counselors' at Block Level

     Local girls who have passed class VIII standard may be selected for such purpose. They will have one year training course at any local college where science stream is taught. The teachers should be well aware of the unscientific and age-old beliefs and customs which prevail in the perticular locality. These relate to a) food selection b) food habit c) cooking procedure d) food storage e) procurement & preservation of safe drinking water and above all f) basic aspects of sanitation.

I.C.D.S. staff have also undergone such short training course

    Such short course of training has been found to be considerably effective in training a) 'bare footed doctors' (unregistered Medical practioners' working at remote villages), b) women working in recently introduced 'ASHA' scheme (Scheme of Govt. of India) and c) training of Anganwadi workers who are engaged in implementing ICDS programme nationally (India).

In villages cooking is often done on alternate days

     In some villages cooked food is preserved in an unhyginic way for long 48-72 hours. This is primarily to save time and fuel. Many housewife are engaged in fields / road repair / brick field etc. from where they (women) return to home at night. At that time they are very much tired and physically unable to engage in cooking.

      There is none to teach rural women how best to preserve such cooked food as nutritionally as possible. The nutritional value of the food staff is often lost to great extent.

Existing Govt. and N.G.O. will not get time to teach rural women about good food habits neither they have got skill to counsel on these matter

     1) Govt. Doctor, other health personel working at rural area (Block Primary Health Center) are already overburdened with different public health  Jobs & family Planning Programs.

     2) University Qualified Dieticians & Nutrition specialists working at metro cities will invariably decline to do this job of counseling to rural people.

     3) Thus it is believed that these local girls will succeed in breaking the community barriers related to age-old unscientific food habits including  procurement  and  storage of safe driking water.

Details of breast feeding are seldom discussed by the existing Govt. Health Personel

     Author believes that several thousand neonates and infants doo die in India annually due to poor breast feeding practices which still prevail in our country. These are rarely discussed in an busy Antenetal Out Patient's  Department.

      The proposed rural food counselors can also be entrusted to impart the scientific informations related to proper breastfeeding  practices to rural women of the respective block. In a particular block each year about hundred to two hundred women becomes mothers and the local food counselors can teach theses new mothers about details of breastfeeding and can thus improve nutrtion of rural neonates / infants.

See the Attitude of a woman  of a particular Community – Can we prevent her from wearing from so many unnecessary ornaments? - So easy task? YES…NO

INDIA TODAY – THEREFORE WHERE DO WE STAND NOW?
( A country with full of contradictions!)

Achievements     

 

•   Advanced Space Technology.

•   Nuclear capability

•   We supply brain to western world.

•   Metro rails (Tube)

•   Rich cultural heritage.

Short comings

 

•   Still High BPL / High prevalence of Malnutrition

•   Rising STD (6%) and HIV

•   Poor  drinking  water and  so also poor housing conditions.

•   Ridiculous health care facilities in the rural areas.

INDIA –WHERE DO WE STAND NOW AS ON 2010 ?
( We are lagging behind in …)

•                       Very high Child Birth Related Death Rate(  High  MMR )

•                       High IMR(Infant mortality Rate)

•                       High Illiteracy rate

•                       Poor   road  conditions 

•                       Increasing Militant attacks over our mother land – Mumbai, 2008 and also at Jaipur, Delhi and Guahati.

•                       Above all corruption   - Blood testing kits/blood bags. Spurious drugs and  even spurious condom.!

       The spectrum of goals and achievements are less than the burden of hunger and poverty

In  summAry

ž Malnutrion is no longer viewed as a medical problem. Instead many issues need to addresss  to eradicate  MALNUTRIION.    Though   ensuring adequate food to  citizen is a constitutional binding that is too often not done. Additionally, ensuring adequate food to  citizen may not guarantee good health and maintainennance of NUTRTITIONAL status unless other basic health measures are simultaneously implemented which may cost much and demand heavy budgetary allocation.

 

In  summAry (Contd.)

ž There are six internationally recognized paths of development aiming to reduce the prevalence of malnutrition.  Feasibility of implementation of all those paths in India have been discussed  at length. But effective implementation of any path of development mandate not only heavy financial commitment but    strong political     will  as well.

      

       Thus Differential budgetary allocation is essential to improve nutrition . All said – All  done  where is the money ??? Moreover strong political support of all parties is essential for implementation of any successful policy at natinal level

Women’s empowerment is essential for effective implementation of all Family Welfare which includes Birth Control  Programmes as well (Path 5 )

 

    To be successful, family planning programmes need to be associated with social development and Women empowerment programmes, so that  they (women ) are in a position to take decisions that are in their interest and use available F.P. services accordingly.

 

BUDGETARY ALLOCATION  & ERADICATION OF POVERTY and  IMPROVING MALNUTRITION

 

 

Which path is more relevant and need much allocation?

 

žFor every valid and recognised recommendation there is a valid exception.

žWe are still to find the right path i.e. growth of the poor

We are still to find the right path of development and improving nutrition in India

The path of development is still undefined – then how to remove malnutrition?

 

 

 

 

 

 

The  nobel  laureate  is  also  in  dilemma

TAKE HOME MESSAGE

•     We as doctors come across variety of patients where malnutrition play an important etiological role. Therefore it is obligatory that  ( doctors) should know remedies of malnutrition.

ž            Medical knowledge should not be limited to functions of proteins , Vitamins or Trace elements/Anti-oxidants  . There are six internationally recognized paths of development aiming to reduce the prevalence of malnutrition.  Feasibility of implementation of all those paths in India have been discussed  at length. But effective implementation of any path of development mandate not only heavy financial commitment but a determined  political  will  as well.

         

          Thus , Differential budgetary allocation is essential to improve nutrition . All said – All  done  where is the money ???  Moreover strong political support of all parties is essential for implementation of any successful policy at natinal level.

TAKE HOME MESSAGE

ž  There are six internationally recognized paths of development aiming to reduce the prevalence of malnutrition.  Feasibility of implementation of all those paths in India have been discussed  at length. But effective implementation of any path of development mandate not only heavy financial commitment but    strong political     will  as well.

         

          Thus Differential budgetary allocation is essential to improve nutrition . All said – All  done  where is the money ??? Moreover strong political support of all parties is essential for implementation of any successful policy at natinal level

 

                   Instead, we must know the root cause of such deficiencies, otherwise such diseases will recur in no time.

 

TAKE HOME MESSAGE

•                                                                     Most of malnutrition in India stem from Poverty and therefore Inadequate Food Intake. To eradicate poverty and hunger we have to achieve food security for each citizen . And to achieve that we need not only money ( ? Industrialization)  but also sound agricultural policies and effective and liberal supply of birth control measures policies as applicable to our countruy .

          There are many steps to  improve Economical status but International Trade play a significant role . Improvement of Intrnational  trade thus decreases hunger burden & improves nutritional status of our  citizen.

 

TAKE HOME MESSAGE

•                                                                  Six paths for economic development have been discussed and one new has been added by the author. A particular policy which is most suitable & fruitful for a given country may not be that productive in the neighboring country. Sadly, India is still to find out the right path of Poverty Eradication & Reduction of Hunger Burden.

TAKE HOME MESSAGE (Contd.)

 

•                                                      Recent global unemployment occurring in some developed countries  were unforeseen! So which path will ensure sustainable development or a guaranteed reduction of hunger is still possibly unknown not only to the Indian Policy Makers but that of developed countries as well. Therefore budgetary allocation of different  Paths may change depending on GLOBAL  ECONOMIC  CHANGES.

•                                                      Will any citizen of India be able to show a new path which will guarantee food security for all Indians keeping mind that there is annual growth of population at the rate of 1.9%.

 

 

 

TAKE HOME MESSAGE (Contd.)

 

•                                                      Globally ‘Branded Nutritional Foods’ are becoming more attractive to affluent persons. They often prefer branded food products which are more appealing than normal home made foods.  How many rich persons consume Puffed Rice(muri, chira, khai)? How many of  us take GUAVA  or ATA(fruit), jamrul, jam, palang sakk, kumro, pepe and fresh vegetables which contains more fibres?

ROLE OF RURAL FOOD COUNSELLOR  - PERSONS WITH THREE MONTHS TRAINING ON LOCAL FOOD STUFF ntd.)

•                                                                     Scientific knowledge on  low-cost but  nutritious  foods, balanced diet, rational  cooking methods,  appropriate storage of food items and above all relevance of safe drinking water can however be imparted by Medical personnel , NGO or by Media people.

•                                                                     But are all such pesons worried / devoted to such heacvy burden of malnutrition ? Are educated urban people commited to malnutrition of rural people or urban poors or those who have migrated from other states ?

•                                                                      How many NGOs are dedicated on the nutritional problems of Indian mothers and children ???

 

ROLE OF FOOD COUNSELLOR IN RURAL AREAS

10. Continuous motivation of community is warranted: Unfortunately imparting  knowledge can not be equated with   community acceptance, awareness and  practice. Fulfillment of gap between knowledge and practice   is possibly another  key issue.

       Author strongly feels that it will take few decades to achieve food security by statndard foods. Till then we can   educate and motivate the rural  community to improve social acceptance of low cost locally available vegetables, food grains , fruits, proteins which are falsely believed not useful for human consumption  and scientific  cooking methods.

 

TAKE HOME MESSAGE (Contd.)

 

10. India being multi-linguistic, multi-religious and mult-ethnic population with varying food habits it is necessary to develop special programme  to tackle the needs of different groups.

 

 

What is this? How can we achieve Food Security .
Can we improve nutrition unless we check population growth?

TAKE HOME MESSAGE (Contd.)

•        Role of newer contraceptives:    We are aware of the limitations of  contraceptive-dependent population growth ,but it is equally true that many couple though desirous of limiting children do not adopt currently available birth control measures as many of them  have  doubts about ill effects of usingsuch contraceptives. These contraceptive-related rumour mandate availability of safer and newer contraceptives.

•        Therefore,  import / manufacturing of newer contraceptive is a high need charity, because any new contraceptive marketed will slow down the population growth. Incidentally some studies have shown that there is as high as 11% rise of C P R(couple protection rate) after a  new contraceptive become available  in a country.

 

TAKE HOME MESSAGE (Contd.)

•        Therefore,  import / manufacturing of newer contraceptive is a high need charity, because any new contraceptive marketed will slow down the population growth. Incidentally some studies have shown that there is as high as 11% rise of C P R(couple protection rate) after a  new contraceptive become available  in a country.

TAKE HOME MESSAGE (Contd.)

 

13.   At least 7 newer contraceptives (Implanon, skin patch, vaginal ring, monthly inj.  newer cervical caps and diaphragms, and newer spermicides) which are approved by different International agencies for last one or two decades back  are unavailable in India even in 2009.   Whose fault is this?

 14. Intersectoral co-ordnation between Govt. and Non-Govt. agencies, equitable distribution of food-stuff, application of modern technologies in agriculture and above all community perticipation will go a long way to erradiate malnutrition in India.

TAKE HOME MESSAGE (Contd.)

      Govt. should either issue license on newer contraceptives for domestic manufacturing in our own country or approve import of such newer contraceptives  urgently. Because the annual exponential growth rate of population in India was 1.96 (1961), 2.21 (1971), 2.20 (1981), 2.10( 1991) and    recently  1.96(2001) !

      To reduce hunger and malnutrition we must act now and implement different strategies on war footing. We don’t have a moment to loose. Because we have already crossed one billion mark and cultivable land is proportionally decreasing, so also food production.

 

Time is of essence.

 

FUTURE DIRECTIONS
(A call to all the members of IMA and FOGSI)

 

      Will members of    Indian  Medical  Association and Members of Federation of Obstetricians & Gynaecologists of India (FOGSI) will come forward to put suggestions to Govt. of India about ways and means of improving attitude of our countrymen by a 'modified educational program' for the most underpriveleged sector of our community ?

 It is the most important barrier not only in implementation of different nutrition-based-programmes but also other programs run by Govt. of India and other NGOs.

Let Our Mother Land be Prosperous and Free of Poverty AND Hunger