Nadiya (name changed), a 22-year-old resident of Medak district, is pregnant with her fourth child. She got married when she was 15, and suffers from general weakness.
Nadiya gave birth to three girl children and all of them are underweight and malnourished.
She once told CARPED (Centre for Action Research and People's Development), an NGO that works for women and child development in Medak district, that the children often fall sick due to weakness.
Nadiya and her family represent the plight of many families across Telangana.
According to National Family Health Survey-4, nearly 37% children below six years are underweight in Medak district, which has the highest number of underweight and malnourished children in Telangana.
However, MS Chandra, Director of CARPED claimed that the number of malnourished children could be as high as 48%, as many cases go unreported.
Child and maternal care through central and state welfare schemes is provided through a network of anganwadis. But although Medak district has over 3,000 anganwadis, they are hardly effective due to lack of funding and infrastructure.
“There is a lack of infrastructure in anganwadi centres, with regard to supplies and trained staff. They supply food in very unhygienic conditions because they are untrained,” says Hyderabad-based child rights activist Achyuta Rao.
And even where anganwadis functioned, there are other problems. “Even in the mid-day meal, standards are not maintained. Moreover, schemes such as the ICDS which are implemented through anganwadis, and the Janini Suraksha Yojna for pregnant women, do not reach anganwadis. There is also misuse of funds by the women and child welfare officials,” Achyuta alleged.
The NFHS-4 data also revealed that 33% of children of the same age group were found to be severely stunted, that is, they had height which is more than two standard deviations less than the expected height for their age.
Chandra attributed the drought as an important reason for the poor growth among children. “Because of drought, access to clean water and food is cut off, and nutrition is affected. It is the government’s responsibility to provide proper food supplements to children and also pregnant women,” he pointed out.
The situation is further worsened by the huge shortage of doctors and nurses in PHCs in the district. Medak had 72 PHCs in 52 mandals before it was divided into three districts in 2015.
“Even the district hospital doesn’t have proper equipment. People generally have to go to Hyderabad when they suffer serious health issues. You can imagine the condition of PHCs here. Most of them have two doctors and nurses attending to hundreds of people. Other than that there is an acute shortage of medicines,” Chandra added.
After Medak, Nizamabad followed by Adilabad have the highest number of underweight children. While Nizamabad recorded more than 36% children as underweight, Adilabad is just behind at 35%.
“Rural Telangana suffers the most. The highest rates of malnutrition are among rural children, the poorest children, and children from socially disadvantaged groups,” Chandra said.
Before the bifurcation of the two Telugu states, a survey revealed high malnutrition levels in the two states because, as per World Health Organisations’ (WHO) global database on child growth and malnutrition, a 30 to 39 per cent prevalence of stunting is an indicator of severity of malnutrition by prevalence.
In 2015, the newly formed state of Telangana fared poorly when it comes to other indicators of malnutrition, including wasting and being underweight. According to NFHS-4 data, 18% of children below five years were found to be wasted or having weight that is more than three standard deviations less than the expected weight for their height.
A total of 28% of the children were found to be underweight in the state. It was also reported that stunting rates remained higher for girls than boys. “In a male dominated country, where people give more importance to boys, this will happen. The girls here get married early, and give birth to undernourished children,” Chandra said.