Malnutrition as a term never occurred in my conversations before I started working with Project Koshika in Panna, Madhya Pradesh.It has become a reoccurring word in my dictionary now. Koshika runs a maternal and infant health intervention in 10 remote villages of Panna Tiger Reserve. I had started to visit the field areas after a couple of days of joining work. First couple of VHNDs (Villlage Health and Nutrition Day), I was simply assisting my team with measuring height and weight of infants and pregnant women.
The maximum weight I noticed on the scale was 40-44kgs. In these forest villages of Panna, malnutrition is frequently diagnosed in children and women. My naivety led me to think that undernourishment is a bi-product of poverty. However, over the past few months I have come to realise that is only one of the variables that count.
Here are my observations that have helped me widen my understanding of malnutrition in this area:
Lack of food options
The community here doesn’t have access to full-service grocery stores that stock fresh produce. The market area is 20-25kms away so it’s only possible to go on a weekly basis. Even if the villagers do manage to go, leafy green vegetables are expensive and not always affordable.
Eventually, they come back with a bag full of potatoes, onions, tomatoes, brinjals and pumpkins. Milk is also a luxury and only people who own cattle have the option to feed their children milk. In a nutshell, a balanced diet is absent and mostly they make do with what is available to them easily.
While visiting one of the village, Khamri for the monthly vaccination drive in June, I was shocked to find that every third child was malnourished. After wrapping up, I asked our field facilitator why the numbers have taken such a high stride.
They sat me down and explained that the month of February and March was when the community is busy harvesting the crops. While April, May and June is spent dwelling in the forest areas to collect mahua, chironji and tendu leaves. This is the biggest source of income in the year and the their entire time and energy is spent collecting forest produce.
Either both the parents are engaged in collecting forest produce. Or in some cases, it’s the women who ventures out and the men migrate to Delhi, Bhopal, Jabalpur in search of labor. Either way, the child at home gets a set of absentee parents. There is no one at home to ensure childcare. And in this case, if the child is being fed or not, who is in the wrong here?
The priority is of course to monetize on the forest produce so that some income gets generated. The field facilitator said, “Agar kamane ke liye jungle nahi jaenge toh baccho ko jitna khaana mil raha hai, utna bhi milna band ho jaaega. Yeh unki majboori hai.” (If they don’t go to the forest, whatever little food the child is getting will also stop. They are compelled to leave them behind). Women also have to take up responsibilities of collecting firewood, filling up water from wells and hand pumps, taking care of the cattle etc. Amidst all this, childcare seems to take a backseat.
No reference point/role model
I was conducting a survey with women who had lost their children. This was in effort to understand the cause of death better. One of the questions in the questionnaire was, “Was the child anaemic?” Most of the women said their children were perfectly healthy with no signs of anemia. The next question that followed was, “Did the child have pale hands when they passed away?” (This was asked to corroborate the claim for the previous question). Most women replied saying yes.
Series of questions would follow to establish that the child indeed was anaemic. All the symptoms were there in place but they have been so normalized in the community that anemia and malnutrition don’t stand out as something that need immediate intervention. There are barely any reference points that would tell the parents about what a healthy child looks like.
Lack of awareness
During our field visits when we come across infants who fall under the high risk radar for malnutrition. This essentially means their weight is not in line with their height, according to global health indicators. We ask their mothers about their diet, feeding patterns and frequency. Most women don’t know that complimentary feeding should be started after the child is more than 6 months of age. Only breastfeeding does not suffice the required nutritional quota of the children.
According to research, malnutrition is inter-generational in nature. A malnourished mother inevitably gives birth to a malnourished child and the vicious cycle doesn’t end. When families take a smaller gap between pregnancies and have many children, it worsens the mother’s nutrition levels which are then passed on to her children.
When I see a pregnant woman weighing 50-52kgs, with blood levels above 10, it surprises me because that’s how rare it is in the community.
A poem that I once heard explains malnutrition, the lack of family planning and their effect on children in a simple way:
पांच लड़को के बाद लक्ष्मी का जन्म हुआ– Anonymous
जन्म के कुछ महीनो बाद लक्ष्मी की माँ बहुत बीमार पढ़ी और आखिर में उसने दम तोड़ दिया
दादा दादी और परिवार के बाकी सदस्य लक्ष्मी का पालन पोषण करते
दुबली पतली काया लिए धीरे धीरे बड़ी होती गयी
बहुत ज़िम्मेदार थी
घर का सारा काम करती
खाना पकाती, सभी को खिलाती
उसके बाद जो कुछ बचता, वह खुद खाती
देखते ही देखते वह 15 की हो गयी
एक दिन हल्दी चढ़ी, फेरे लिए और अपने ससुराल चली गयी
माइके की तरह वह ससुराल में भी उतनी ही ज़िम्मेदार थी
परिवार को चलाना था इसीलिए काम भी करना पड़ता
काम करने के लिए लक्ष्मी मज़दूरी करने जाती थी
घर का सारा काम करे और उसके साथ मज़दूरी करने जाए
सबको खिलाये, जो बचे वह खुद खाये
लक्ष्मी के पैर कब भारी हो गए, पता ही न चला
लेकिन वह इन सब चीज़ो से बेफिक्र थी
सातवे महीने में अचानक खून बहने लगा
पेट में बहुत तेज़ दर्द हुआ
गाड़ी बुलाई गयी और उसको अस्पताल ले जाया गया
डॉक्टर ने देखा लक्ष्मी को बहुत तेज़ बुखार था
उसे काफी खून भी चढ़ा
अंत में लक्ष्मी ने एक बिटिया को जन्म दिया जिसका वज़न 1.5 किलो था
डिलीवरी के कुछ महीनो बाद लक्ष्मी को ज़बरदस्त बुखार आया
और अंत में लक्ष्मी ने दम तोड़ दिया I