The problem

INDIA is uniquely placed on the worlds tribal map, being home to 104 million of the worlds estimated 370 tribal
people. India is also called the melting pot for races and tribes with nearly 700 distinct tribes (ranging from a
minuscule 44 Onges in the Andaman and Nicobar Islands to over seven million Gonds spread over many states of
central India.) Together they constitute 8.6% of the countrys population the largest proportion in any country
globally. Indias tribals called adivasi (earliest dwellers), vanya jati(forest castes), van vasi (forest
dwellers), janjati (folk communities), girijan (hill dwellers), adimjati (primitive castes) and constitutionally,
Scheduled Tribes, are covered by protective and positive discrimination policies designed for their welfare and
social and economic upliftment.1
Unfortunately, despite constitutional protection and earmarked budgets they continue to remain among the poorest
and most nutritionally deprived social groups in the country. Poverty rates among Indias tribals are still where the
general population was 20 years ago. The fact that every second tribal in rural India lives in food-insecure conditions
with caloric and protein consumption 25 to 53% below the recommended dietary allowance and consuming a diet
with negligible amounts of milk and fruit leads one to question the implementation of our manifold legislations
and schemes for tribals. Though starvation deaths among tribal children are hardly uncommon, only a few catch the
headlines. If one was to rate nations on the yardstick of chronic undernutrition among children the starkest
manifestation of deprivation India would occupy centre stage, housing the highest proportion of chronically
undernourished children globally (61 out of 165 million), with the prevalence being highest among tribal children
(54%).
Field practitioners argue that land alienation, displacement and poor compensation and rehabilitation provisions are
among the core reasons for the prevailing poverty among tribals, which results in household food insecurity and
undernutrition in their children. Activists argue that physical destruction of forests, government monopoly over
minor forest produce, and lack of regulation on access to corporates over resources and wealth that belong to the
adivasis are critical factors contributing to their poverty and subsequent bondage and deprivation. It is undeniable
that the tribals of central India have borne the brunt of displacement as their mineral rich habitats also happen to be
among the best sites for hydroelectric projects. The failure of government to protect tribal rights to their land and
resources despite legislation is a major contributor to increasing civil strife, as also deprivation.
However, the present discourse, both official and multilateral, prefers to foreground their lifestyle, food habits,
traditional and cultural practices as key reasons for their chronic undernutrition, and on the forested, hilly and
undulating terrains for poor coverage of public services. Yet, though distance is a factor, the same geographically
isolated tribal domains are also overexploited for their natural resources, thereby weakening the argument of
geographical isolation as a rationale for poor access and coverage of services in tribal areas. It is true that
government servants are reluctant to work in such areas and far too often absent themselves from their official
duties, claiming danger from ongoing civil strife. Nevertheless, extremist violence affects only about one third of
tribal blocks in central India. So why is the remaining two-thirds still underdeveloped and deprived?
Undernutrition in children is influenced not only by food and child feeding practices in the first two years after birth
but also by maternal nutrition before and during pregnancy, narrow inter-pregnancy intervals, gender inequity,
household poverty, and other such issues. This makes it clear that any meaningful solution must follow a holistic
approach addressing issues related to nutrition, health, family planning, water and sanitation, poverty alleviation and
women empowerment simultaneously, and the concerned ministries should join hands to plan and implement
effective inter-sectoral interventions and not leave the responsibility to only one or two ministries. The Ministry of
Tribal Affairs (MoTA) being the nodal ministry for tribals can convene various ministries for policy, planning and
programme coordination for tribals to ensure that basic nutrition, health and sanitation and development reaches
them. However, undernutrition is far too often considered to be synonymous with hunger and starvation, a clear
failure to understand the complex relationship between calorific intake and nutritional status. Little surprise that the
solution is sought in food doles.
Although the current scenario appears to be grim, there are worthwhile examples for others to adapt and replicate.
Additionally, Unicefs experience in bringing nutrition counselling, services and support closer to adivasi children
and their mothers, shows that partnerships with non-government organizations can improve outreach in inaccessible
pockets. Equally, that formal engagement with adivasi communities as partners of change is imperative. Investing in
adivasi leadership and empowerment, while promoting strategies to improve nutrition, is critical. Otherwise, given
their (tribals) inherent shyness, a result both of unfamiliarity and negative experience with the outside world, and
lack of voice, reflective of poor organization, the adivasi demand for their entitlement(s) would never reach a critical
mass to influence the nature of response.
This issue of Seminar discusses the complex causes behind nutrition deprivation of tribals, brings to the forefront
broader issues of governance, which cannot be decoupled from trickle down nutrition schemes, and presents
solutions of what works and why in an effort to forge multi-sectoral commitments for improving the food and
nutrition security of our tribal children the youngest, poorest and most vulnerable.
VANI SET HI

Children of a lesser god
N. C. SAXENA

OVER 70% of adivasis reside in the central region of India, which though resource rich, is home to the poorest
people who have not benefited from social and economic development to the same extent as people in other regions.
In some cases they may have actually suffered due to the anti-tribal, market oriented forest policies (as they depleted
the gatherable biomass), or resulted in displacement from their ancestral lands. The lack of accountability of
government personnel in these remote and sometimes inaccessible regions has also resulted in poor delivery of all
government programmes, contributing to the utter neglect of the poor adivasis.
It is therefore not surprising that the proportion of adivasis both adults and children who suffer from malnutrition
is far greater than the Indian average. Studies done by Subal Das, Kaushik Bose and Amaresh Dubey indicate that
over half the adivasi adults have a BMI (Body Mass Index) below 18.5, which makes them chronically
undernourished, as compared to 35% of all Indians.
1
The figures are more dismal for women and children. For
instance, 71% of tribal women in Jharkhand suffer from various degrees of malnutrition. They often face
complications during pregnancy and are at risk of delivering low birth weight babies. Undernutrition of mothers is
usually passed on to children. Some of the reasons for this undernutrition among tribal women are an inadequate diet
intake, ignorance, early marriage, poor access to health services and high morbidity due to unhygienic practices and
surroundings.
A 2014 Unicef report
2
on nutrition and adivasis points out that only 2% adivasi children between 6 to 11 months
were fed complementary foods in the recommended quality and frequency. Of the 634 children surveyed in
Akkalkuwa block of Nandurbar district,3 378 were found to be malnourished and the number of girls among them
was as high as 60%. In 2005, more than 98 children died in just three months and of these 71 children were found to
be severely malnourished. The study also revealed that only 10% of malnourished children figure in government
records. In effect, the government is unaware of as many as 90% cases of malnutrition. According to the survey, the
number of third and fourth grade underweight children in April was 188, in May 185 and in June 138; however, the
government records show only 20, 48 and 20 children as malnourished in these months. Under reporting is
facilitated by collusion between field staff and their supervisors, who are thus able to evade responsibility for
improving nutritional outcomes.

There are cases to show that the tribes are denied their right to food. Children of the Birhor tribal community in
Madhya Pradesh do not have access to the right to education and right to a midday meal at the school as the teachers
fear that the Birhor children will pollute the utensils.
4
The human rights groups working on the right to food report
that tribal children cannot access facilities provided by the anganwadi centre (AWC) under the Integrated Child
Development Services (ICDS), and the chances of survival of a tribal child are low, with 71.4% of tribal children
being malnourished and 82.5% anaemic.5
More generally, the Supreme Court order issued in 2004 recommended that all new AWCs should be located in
habitations with high Scheduled Caste and Scheduled Tribe populations. Yet, many villages in Khandwa district
where the Korku tribe live in large numbers, do not have AWCs in their areas. More than 60% tribal children in
Jabalpur district were underweight. Micronutrient deficiency disorders such as anaemia and vitamin-A deficiency
were common among them. Unhygienic personal habits and adverse cultural practices relating to child rearing,
breastfeeding and weaning were also prevalent among them.
6

Another study found that malnutrition among tribal children (0-6 years) in Thane district of Maharashtra was 68.7%
while the incidence of severe underweight was 28.6%. The overall prevalence of stunting in the 0-6 year age group
was 60.4% while that of severe stunting was 38.5%.
7


The studies quoted above amply demonstrate that widespread poverty, illiteracy, absence of safe drinking water and
sanitary conditions, poor maternal and child health services, and ineffective coverage of national health and
nutritional programmes are major contributing factors for the dismal malnutrition indicators of tribal communities in
Central India. They also suffer from many communicable, non-communicable and silent killer genetic
diseases.
8
Their geographical isolation and remoteness further affects the developmental process as qualified health
workers refuse to work in these areas.
It is not only in tribal regions, but even in the so-called mainstream India that progress on nutrition indicators is
disappointing. Perhaps other essays in this issue will discuss this in detail, so we could touch on the main findings
here. First, the commonly held belief that food insecurity is the primary or even sole cause of malnutrition is
misplaced. However, the focus in India is still on food, and not on health and care related interventions.

Second, the ICDS design needs a change. At present it targets children mostly after the age of three when
malnutrition has already set in. Very little of the ICDS resources, in terms of funds and staff time, are spent on the
under-three child,
9
and this low priority must be reversed focusing more on improving mothers feeding and caring
behaviour, improving house-hold water and sanitation, strengthening referrals to the health system and providing
micronutrients. The basic nature of the programme should be changed from centre-based to out-reach based, as the
child under three cannot walk to the centre and has to be reached at home. Another advantage of visiting homes is
that the entire family, not just the mothers, are sensitized and counselled.
Third, ICDS faces substantial operational challenges, such as lack of accountability due to lack of oversight and an
irresponsible reporting system. It appears that state governments actively encourage reporting of inflated figures
from the districts, which renders monitoring ineffective and accountability meaningless. Objective evaluation by
NFHS-3 shows that 40.4% of children were underweight in 2005-06, 15.8% being severely malnourished. However,
the state governments in 2009 reported 13% of children as underweight, and only 0.4% as severely
malnourished.
10
Although reporting has somewhat improved, yet the Government of Indias (GoIs) website shows
the percentage of severely malnourished children (reported as grade III and grade IV children in the state data) in
March 2013 was 0.07 in Andhra, 0.70 in Assam, 0.38 in Rajasthan and UP, and 0.18 in Tamil Nadu. Where is the
problem then? India is as good as Denmark or Norway!
One district collector, when confronted with this kind of bogus figures, told the author that reporting correct data is
a high-risk and low-reward activity! The former prime minister termed governments performance as a national
shame, but was not able to persuade the states to even accept that the problem exists.
And lastly, there are large-scale irregularities in the supply of supplementary nutrition provisioning (SNP) in
violation of Supreme Court orders by engaging contractors for ICDS in many states such as Maharashtra, Karnataka,
Uttar Pradesh and Gujarat.

A recent evaluation of ICDS in Gorakhpur by the National Human Rights Commission
11
showed that despite
Supreme Court orders to provide hot cooked meals, all centres only supplied packaged ready-to-eat food, containing
only 100 calories, as against a norm of 500 calories, with 63% of food and funds misappropriated. Being
unpalatable, half the food ends up as cattle feed. The ready-to-eat food is produced in poor hygienic conditions.
Some of the ingredients listed on the packets containing the finished product were out of stock at the time of the visit
and the stocks of maize were barely enough to meet a quarter of the daily requirement.
The Government of India should discourage the distribution of manufactured ready-to-eat food as it leads to grand
corruption at the ministerial level. But unfortunately it has encouraged such tendering by laying down the minimum
nutritional norms for take-home rations (a permissible alternative to cooked meals for young children), including
micronutrient fortification, thus providing a dangerous foothold to food manufacturers and contractors, who are
constantly trying to infiltrate child nutrition programmes for profit making purposes.

Emerging economies have demonstrated that child undernutrition can be drastically reduced: Thailand
12
reduced the
percentage of underweight children by half (from 50% to 25%) between 1980 and 1986; Brazil reduced child
undernutrition by 75% (from 20% to 5%) from 1990 to 2006; and China reduced child undernutrition by 68% (from
25% to 8%) between 1990 and 2002.
13
Even Vietnam, a country poorer than India, has seen a reduction in
underweight children from 41% in 1996 to 25% in 2006.
14
Therefore, nutrition improvement at a national scale is
possible. However, economic growth is not enough; it needs to be coupled with effective policy and budgetary
action, particularly for the most vulnerable: the youngest, the poorest, and the excluded.
In addition to the general shortcomings in the design and implementation of nutrition programmes, there are
structural and specific limitations that adivasis face, as their record on all social indicators seems much worse than
other social groups. These cross-sectoral constraints affecting adivasis are discussed in this concluding section.
When ICDS is not doing well in the country, one could expect even more dismal results in tribal regions, as
discussed earlier in the paper. From the policy viewpoint, it is important to understand that tribal communities are
vulnerable not only because they are poor, without any assets and illiterate compared to the general population;
often their distinct vulnerability arises from their inability to negotiate and cope with the consequences of their
forced integration with the mainstream economy, society, cultural and political system, from which they were
historically protected as a result of their relative isolation.

Post-independence, the requirements of planned development brought with them the spectre of dams, mines,
industries and roads on tribal lands. With this came the concomitant processes of displacement, both literal and
metaphorical as tribal institutions and practices were forced into an uneasy existence with or gave way to market
or formal state institutions (most significantly, in the legal sphere), tribal peoples found themselves at a profound
disadvantage with respect to the influx of better equipped outsiders into their areas. The repercussions for the
already fragile socio-economic livelihood base of the adivasis were devastating ranging from loss of livelihoods,
land alienation on a vast scale, to hereditary bondage.
What has been the impact of government policies on tribal livelihoods? Where should central and state governments
focus to improve the situation? To answer these questions we quote in detail from a Planning Commission (2000)
document:
As tribal people in India perilously, sometimes hopelessly, grapple with these tragic consequences, the small clutch
of bureaucratic programmes have done little to assist the precipitous pauperization, exploitation and disintegration of
tribal communities. Tribal people respond occasionally with anger and assertion, but often also in anomie and
despair, because the following persistent problems have by and large remained unattended to: land alienation;
indebtedness, relation with forests, and government monopoly over MFPs, and non-implementation of the Forest
Rights Act, 2006; ineffective implementation of Panchayats (Extension to the Scheduled Areas) Act of 1996 (PESA,
1996) for Schedule V areas; involuntary displacement due to development projects and lack of proper rehabilitation;
shifting cultivation, such as podu; poor utilization of government funds; and poor delivery of government
programmes.

A recent Unicef study (2014) confirmed that land alienation and displacement without adequate rehabilitation have
been important causes for tribal impoverishment.
Many issues that need urgent attention are under the jurisdiction of Ministries of Environment and Forests, Rural
Development, Panchayati Raj, and others, where they often do not get much attention. It is unfortunate that the
Ministry of Tribal Affairs (MoTA) does not give sufficient attention to the important problems of the tribals on the
plea that many of these subjects such as land alienation, displacement and PESA are outside their jurisdiction. Even
so the ministry should play a more activist role in addressing these issues by pursuing adivasi concerns with the
relevant ministries.
When a new ministry is set up to focus on the marginalized people, it is expected that it would take a holistic view
of their problems and coordinate the activities of all other ministries that deal with the subjects impinging on the
work of the newly created ministry. The new ministry, however, takes a minimalist view of its responsibility and
reduces itself to dealing with only such schemes (distribution of scholarships and grants to NGOs) that are totally
outside the purview of the existing ministries. Such an ostrich-like attitude defeats the purpose for which the
ministry was created.

For instance, policies relating to minor forest produce (MFP) are often dictated by a desire to maximize state
revenues, and not the welfare of gatherers, who are often tribal women. However, this issue has never been raised by
MoTA. The revenue interests of Orissa can be judged by the fact that during the period 1989-2001, the state
government earned revenues of Rs 7.52 billion from kendu leaves (KL). The total wages earned by KL pluckers
during the same period was only Rs 3.87 billion. The high incidence of royalties on KL needs to be contrasted with
royalties collected on a major mineral, where labour is organized, e.g. royalties are Rs 30 per tonne on bauxite, but a
whopping Rs 12,000/tonne on KL!
Even when the ministry was asked to oversee the implementation of the Forest Rights Act (FRA), it failed to do so
faithfully.
15
Despite the fact that the main intention of FRA was to promote community participation and
management, the study shows that community rights over MFP etc, have been recognized in negligible cases.
Apart from poor utilization of funds, tribals have also suffered because of the poor quality of governance.
Programme delivery has deteriorated everywhere in India, but more so in tribal areas, where government servants
are reluctant to work, and are mostly absent from their official duties. Massive vacancies exist in tribal regions in the
face of acute educated unemployment in the country. A Unicef study on Jharkhand revealed that one of the main
constraints faced by the National Rural Health Mission (NRHM) was a lack of skilled manpower. In the two districts
visited, Sahibganj had less than 50% positions in place, while East Singbhum, with better infrastructure, it was
around 54%. Other major reasons identified by this study for low utilization appeared more due to a lack of systemic
controls, such as lack of monitoring, and lack of understanding among the staff regarding the implementation of
rules.

The law pertaining to involuntary displacement has been discussed since 1998, and although a new law has been
enacted, it has yet to be implemented, though it is well established that tribals suffer most when new projects lead to
involuntary displacement. MoTA should be empowered to pressure the states to change their laws in conformity
with PESA and FRA. A white paper should be prepared by the ministry relating to governance in forest dependent
villages, including huge vacancies and absenteeism of staff. The ministry must develop a meaningful partnership
with advocacy organizations to produce credible reports in order to put pressure on other ministries that ignore tribal
interests.
The outcome of policies and programmes pertaining to the issues that are critical for tribal livelihoods are not
frequently assessed by the concerned ministries. There is perhaps a need for capacity enhancement within MoTA,
and its counterparts in the states, which should periodically evaluate the results of government interventions in tribal
regions. Such reports should be used for advocacy with other ministries, who have been vested with the
responsibility to ensure that basic justice and development reaches the adivasi. These studies should also assess
whether basic services in education, health, or nutrition are reaching the tribal hamlets.
Therefore, a systemic change is needed in the way state tribal departments function; their approach must change
from simply spending budgets through narrow departmental schemes to knowledge based advocacy with other
concerned ministries/departments. MoTA should highlight the failure of governance that deprives the poor adivasis
from accessing elementary services, and put pressure on the concerned ministries and state governments to ensure
better policies and delivery.
The Planning Commission should also regularly monitor the impact of existing policies on the tribal population and
engage itself with the concerned sectoral ministries. In addition to spending financial budgets, departments should
also be conscious of the impact that policies (or the lack of it) have on the marginalized peoples. Policies and
budgetary provisions, despite the rhetoric, have not been integrated so far. Changes in policy or laws are not seen as
an integral part of the development process because these have no direct financial implications. One lesser known
reason for this isolation is that development and planning in India are associated with spending money. That
planning means expenditure, and this will lead to development is the mindset behind such beliefs. The Indian
planner unfortunately has still to understand the difference between planning and budgeting. This is where a
systemic change is needed in India. In addition to spending budgets, we need to give equal importance to non-
monetary issues such as institutions, laws and policies.

Footnotes:
1. Subal Das and Kaushik Bose, Nutritional Deprivation Among Indian Tribals: A Cause for
Concern, Anthropological Notebooks 18(2), 2012, pp. 5-16; and Amaresh Dubey, Poverty and Undernutrition
Among Scheduled Tribes in India: A Disaggregated Analysis. IGIDR Proceedings/Project Reports Series, 2009,
Mumbai.
2. Nutrition and Adivasis. Unicef, New Delhi, 2014.
3. http://infochangeindia.org/agriculture/books-a-reports/malnutrition-amongst-maharashtras-tribals-how-bad-is-
it.html
4. http://www.humanrights.asia/news/ahrc-news/AHRC-STM-129-2009
5. http://www.alrc.net/doc/mainfile.php/alrc_st2010/591/?print=yes
6. V.G. Rao, Rajeev Yadav, C.K. Dolla, Surendra Kumar, M.K. Bhondeley and Mahendra Ukey, Undernutrition
and Childhood Morbidities Among Tribal Preschool Children, Indian J Med Research 122, July 2005, pp. 43-47.
7. A.L. Khandare, V. Siruguri, A. Rao, K. Venkaiah, G. Reddy and G.S. Rao, Diet and Nutrition Status of Children
in Four Tribal Blocks of Thane District of Maharashtra, India (nutrition status of children), Pakistan Journal of
Nutrition 7(3), 2008, pp. 485-488.
8. R.S. Balgir, Tribal Health Problems, Disease Burden and Ameliorative Challenges in Tribal Communities With
Special Emphasis on Tribes of Orissa, accessed at http://www. rmrct.org/files_rmrc_web/centres_
publications/NSTH_06/NSTH06_22.RS.Balgir.pdf
9. Planning Commission, 2012 Report of the Working Group on Nutrition for the 12th Five Year Plan (2012-17),
New Delhi.
10. IAMR, India Human Development Report, New Delhi, 2011, p. 140.
11. http://nhrc.nic.in/Reports/misc/SKTiwari _Gorakhpur.pdf
12. http://www.righttofoodindia.org/data/garg-nandi07thailand-reducing-child-malnutrition.pdf
13. http://www.unicef.org/india/reallives_ 5901.htm
14. http://www.unsystem.org/scn/Publications/SCNNews/scnnews36.pdf
15. http://fracommittee.icfre.org

Height of the problem
DI ANE COFF EY a n d DEAN SPEARS

CHILDREN in India are much shorter than children in other countries. More disturbingly, they come across as much
too short according to international norms for populations of healthy children. Adivasi children are even shorter, on
average, than other children in India. This gives rise to two questions. First, why are adivasi children so short? And
second, why are they shorter than children in other population groups in India?
We will primarily discuss existing results in the literature, but will also illustrate these sometimes technical findings
with simple analysis of data on child height. Our discussion of the second question why are Scheduled Tribe (ST)
children shorter than other children in India draws heavily on research that we have done in collaboration with
Ashwini Deshpande and Jeff Hammer.
1
Our research shows that while the ST-general and Scheduled Caste (SC)-
general child height gaps in India are almost identical, the ST-general gap can be completely accounted for by
observable differences in wealth and material resources, but the SC-general gap cannot. This is because STs tend to
live in different places than other groups, and are therefore exposed to different threats and resources. SCs, in
contrast, are more likely to be mixed into the same villages as higher castes.
2
These results suggest that the ST
height gap is no special puzzle: ST children are shorter than general children primarily because they are poorer and
live in more remote places with fewer resources.
But why are ST children and general children alike so short? All Indian children, including ST children, are much
too short. They are too short both in the sense that they are shorter, on average, than guidelines for healthy growth
recommend, and in the sense that being too short matters for health and economic outcomes. Children in India are
also much shorter than even children in other countries of similar or lower levels of economic development.
Population height is largely determined by early-life net nutrition. Here, net means nutrition that is consumed, net
of losses due to energy expenditure, malabsorption, parasites and disease.
3
The relevant early-life period in a childs
life from conception to two years of age is sometimes characterized as the critical first 1,000 days. Physical
height is not the only part of a child growing in early life: brains and bodies, skills and cognition are all developing
and shaped by health and net nutrition. Children who do not experience the health and net nutrition in the first 1,000
days that allows them to grow to their genetic height potential are also unlikely to grow to their genetic cognitive
potential.
FIGURE 1
Average Child Height by Population Group

This is one reason why height is important for adult economic outcomes: taller people are, on average, paid more
because taller people have greater cognitive achievement, since the same early-life health that allowed them to grow
towards their height potential also allowed them to grow towards their cognitive potential.
4
In India, the height
cognitive achievement gradient is even steeper than in developed countries, where it was first studied by economists,
suggesting that profound deficits in early-life health and net nutrition are particularly important factors shaping the
distribution of human capital in India.
5


Because height is so important, the puzzle of child height in India has received much attention. It is an apparent
paradox, called the Asian Enigma, that children in India are shorter on average than children in sub-Saharan Africa
even though children in Africa are poorer, on average. In prior research, we have shown that the India-Africa gap in
average child height can be completely statistically accounted for by the fact that Indian children are exposed to
particularly poor sanitation: almost every Indian child lives near many people who defecate in the open, and because
population density is high, this open defecation is especially threatening for child health.
6
We will draw on this
research and related papers in this discussion note: sanitation is one of many factors that importantly limit the
growth of adivasi children.

Here, we study child height in India using the third round of the National Family Health Survey (NFHS). In
particular, we use data on 39,864 children under five for whom height-for-age was measured. Although this is the
most recent Demographic and Health Survey (DHS) in India, it is almost a decade old; India has not adequately
invested in even knowing just how stunted its children are. Throughout this essay, we use the DHS categorization of
children into four categories: ST (or Adivasi), SC (or Dalit), OBC (Other Backward Classes), and general.
7
This
means that we are ignoring religion, a critically important dimension of social distance in India. Of the 6,548 ST
children in the DHS with height-for-age data, a plurality (3,023) are identified as Christian, and most others (2,769)
are identified as Hindu. This method has the disadvantage of grouping together middle and high caste Hindus and
Muslims into the general category; this is awkward, but is unlikely to change our findings.
The two basic facts that we attempt to explain are presented in Figure 1. First, essentially all children in India are
much too short. The vertical axis is average child height-for-age, or height relative to a healthy population. Negative
numbers represent children who are too short, and all of these numbers are importantly negative. Second, ST
children are substantially shorter than general children. A further observation, noted by Coffey, et al.,
8
is that ST
children have almost the exact same average height-for-age as SC children; however, these similar levels of
deprivation seem to have very different explanations.

This comparison may appear unfair: 95% of ST children in our height sample live in rural places, while only 65% of
general caste children do, and only 75% of all children in the sample. Because rural children are importantly shorter
than urban children (by 0.41 height-for-age z-points), is there still an ST gap when we compare ST children with
general caste children from rural areas? Yes, there is: rural ST children are still 0.38 z-points shorter than rural
general caste children. Although rural residence accounts for 19% of the ST-general height gap, there is still 81% of
the gap left to explain. Rural homes are only a small part of the gap.

More than a billion people worldwide defecate in the open without using a toilet or latrine. India, with some of the
worlds worst stunting, also has one of the very highest rates of open defecation: more than half of the Indian
population does not use any toilet or latrine, and most people worldwide who defecate in the open live in India.
Worse still, high population density in India means that children are especially likely to be exposed to neighbours
germs: the same amount of open defecation is more harmful to early-life health where population density is greater
.9

Researchers have long recognized that disease is an important part of early life net nutrition, and therefore disease
control has historically been an important part of improvements in height.
10
In a recent study of the historical
increase in European heights, Hatton
11
found that improvements in height occurred when disease control (measured
as infant mortality) improved. Evidence in the medical and epidemiological literature has documented that germs in
faeces can stunt childrens growth. This is in part due to diarrhoea, parasite infections, energy spent fighting disease,
and possibly in part due to enteropathy,
12
which is a change in the lining of the intestines
13
that may make it harder
for the body to use nutrients. New observational evidence is consistent with the idea that enteropathy may lead to
stunting.
14
Econometric papers focusing on cause and effect have also shown a causal link from sanitation to child
height.
15


Therefore, Spears
16
asked the quantitative, accounting question: are differences in child height associated with
differences in exposure to open defecation big enough such that, given the differences in exposure to open
defecation, sanitation could explain some international differences in child height? In particular, could it explain the
Asian enigma? Using different statistical methods, one finds similarly sized effects of sanitation on child height.
These effects are big enough that sanitation could account for the entire India-Africa height gap. This result suggests
that if Indian children faced similar exposure (or lack of it) to open defecation as African children, Indian children
would be about as tall as African children. That restatement makes clear that we are not claiming that open
defecation is the only important threat to child height in India: as tall as African children is still much too short for
good health and human capital outcomes!
17


What are the effects of sanitation on child height among adivasis? Faecal germs are impersonal, and there is every
reason to expect the effect of open defecation on height to be comparable to what it is on other Indians. A greater
fraction of the average adivasi childs neighbours defecate in the open than other groups: 35 %age points more of
the average ST childs neighbours defecate in the open than the average general childs neighbours; this
disadvantage falls to only 20 percentage points if we only look at rural children. On the other hand, if ST children
tend to live in low population density places which the DHS data do not let one assess this might decrease the
harmfulness of a given difference in open defecation.
18

Figure 2 plots the average height of ST and general children at each level of exposure to open defecation. The
horizontal axis is the fraction of households surveyed in the DHS living near the child who report defecating in the
open; for rural children, this can be thought of as the fraction of the childs village that defecates in the open. Rural
children are plotted separately so that we can see how much of the difference is due to the fact that STs are more
likely to live in rural places.
FIGURE 2
Average Child Height by Local Open Defecation

Two conclusions are visible in the figure. First, the lines slope down for both groups: this means that among adivasi
children and among general caste children, those exposed to more open defecation are shorter, on average. Exposure
to open defecation is one of the reasons ST children are so short, relative to healthy norms. Second, the vertical
distance between the lines suggests that, even at the same level of exposure to open defecation, and even looking
only within rural India, ST children are still shorter than general children.
19
Sanitation alone cannot account for the
ST-general height gap.
Of course, this figure by itself is not enough to prove that open defecation has a causal effect on child height: places
with more open defecation almost certainly have more of other health hazards too, on average. Nevertheless, we
know that open defecation is indeed bad for child height, from the totality of a literature that uses multiple
identification strategies such as randomization, fixed effects, discontinuities, and instrumental variables and that
also impacts related outcomes such as haemoglobin levels,
20
infant mortality,
21
and cognitive achievement.
22

To understand why two population groups differ in some outcome, economists use decomposition methods. These
techniques decompose the average difference in outcome between two population groups into the part that can be
explained by other observable differences between the two groups and the part that is still left unexplained after
taking those differences into account.
FIGURE 3
Decomposition of ST-General Height Gap

A classic application is the U.S. wage gap between whites and blacks: blacks are paid less, on average, than whites
in the U.S. labour market. How much of this difference in wages can be explained by the fact that blacks have, on
average less education? Often, the part of the difference that is left over and cannot be explained by the differences
in inputs is interpreted as an effect of discrimination, although in fact it could be an effect of any factor that is not
accounted for in the decomposition. So, if blacks are still paid less even at the same level of education, skills, and
experience, an economist might interpret this as evidence of discrimination.
We apply similar decomposition techniques to the height gap between ST and general children. This section follows
Coffey, et al. (2014), in which we perform a similar but more detailed decomposition of these height differences.
We will proceed step by step, first asking what fraction of the general-ST gap can be explained by the mere fact that
STs are more likely to live in rural places; then adding the difference in exposure to open defecation, and finally
adding a measure of relative wealth and poverty. For this analysis we will differentiate between richer and poorer
children simply by using the division of the population into asset wealth quintiles that is included with DHS data. In
Coffey et al. we use a more detailed accounting for wealth and poverty differences and find similar results.
Figure 3 graphs the decomposition results. Each bar after the first is the remaining unexplained height gap after the
listed variables are accounted for. As we have already argued, rural or urban location can account for very little of
the height gap. While differences in sanitation can account for more of the height gap, there is still an important
smaller gap left to be explained. The five wealth categories, however, can completely account for the ST-general
height gap, even without taking rural location and sanitation into account.
23
Therefore, in this statistical accounting
sense, the fact that ST children are shorter, on average, than general children can be completely accounted for by the
fact that they are poorer. Presumably, this is in part because they live in more remote locations with fewer resources,
but this decomposition cannot assess this directly.

The decomposition result above suggests that ST children are shorter than general children in large part because
they are poorer. Of course, this does not estimate any sort of impact of any sort of policy, and tells us little about
what sort of improvements in the material environment of ST children might make them richer or healthier most
effectively.
But the ST-general height gap is only 22% of the more important gap between ST children and the healthy reference
population. Therefore, the most important question may not be what can be done to make ST children as tall as
general children, but what can be done to make ST children grow to healthy heights. The graph above, along with a
large and growing body of evidence, suggests that reducing the amount of open defecation to which ST children are
exposed will help them grow taller. Improving sanitation is a particularly appropriate policy recommendation
because sanitation is a public good and open defecation has negative externalities meaning bad effects on other
people. In public economics, such externalities are a classic situation requiring public action to achieve a good
outcome.

Improving sanitation is an important step towards helping Indian children grow taller, but it will not be easy. Open
defecation in India has remained stubbornly resistant to policy initiatives. New evidence suggests that the fraction of
people in India who defecate in the open has declined so slowly that it has not kept pace with population growth.
Spears shows that most people in India live in a district where their exposure to open defecation density increased
between the 2001 and 2011 census rounds.
24
Many people in India do not believe that open defecation is harmful,
and some even prefer to defecate in the open. There is no clear, ready-made solution to the problem of sanitation
behaviour change in rural north India. Widespread child stunting demands that we get busy experimenting with
many different ways to address open defecation.

Footnotes:
1. Diane Coffey, Ashwini Deshpande, Jeffrey Hammer and Dean Spears, Unpublished research on differences in
child height across population groups in India, available on request. 2014.
2. Among SCs, social rank can account for height gap that remains after controlling for economic factors.
Additionally, we find that after controlling for material resources, SC children are no shorter than general caste
children when they live in villages where they are not outranked by higher caste people.
3. Angus Deaton, Height, Health and Development, Proceedings of the National Academy of Sciences 104(33),
2007, pp. 13232-237.
4. 4. Anne Case and Christina Paxson, Stature and Status: Height, Ability, and Labor Market Outcomes, Journal of
Political Economy 116(3), 2008, pp. 499-532.
5. Dean Spears, Height and Cognitive Achievement Among Indian Children, Economics and Human Biology,
10(2), 2012, pp. 210-219.
6. Dean Spears, How Much International Variation in Child Height Can Sanitation Explain? Policy Research
Working Paper 6351, World Bank, 2013.
7. Aficionados of the DHS: we are using question s118 in the birth recode. We use the birth recode throughout the
paper, except when we merge in local open defecation computed from the household recode: the fraction of
households reporting open defecation in a childs PSU. Primarily because it is consistent with the language used in
the DHS data, on which we rely, we will often follow the DHS terminology of ST and SC. This terminology
emphasizes the origins of these categories in the Indian state. We find it awkward to refer to non-SC, non-ST, and
non-OBC children as general children, but this appears to be a convention, and we know of no better alternative,
so we shall do so.
8. Diane Coffey, Ashwini Deshpande, Jeffrey Hammer and Dean Spears, op. cit., fn. 1.
9. Payal Hathi, Sabrine Haque, Lovey Pant, Diane Coffey and Dean Spears, Do Toilets Spill Over? Population
Density and the Effect of Sanitation on Early-Life Health. Working paper, RICE, 2014.
10. Carlos Bozzoli, Angus Deaton and Climent Quintana-Domeque, Adult Height and Childhood
Disease, Demography 46(4), 2009, pp. 647-669.
11. Timothy Hatton, How Have Europeans Grown so Tall? Oxford Economic Papers, 2013.
12. Jean H. Humphrey, Child Undernutrition, Tropical Enteropathy, Toilets, and Hand-Washing, Lancet 374,
2009, pp. 1032-1035.
13. Poonum S. Korpe and William A. Petri, Jr., Environmental Enteropathy: Critical Implications of a Poorly
Understood Condition, Trends in Molecular Medicine 18(6), 2012, pp. 328-336.
14. Audrie Lin, Benjamin F. Arnold, Sadia Afreen, Rie Goto, Tarique Mohammad Nurul Huda, Rashidul Haque,
Rubhana Raqib, Leanne Unicomb, Tahmeed Ahmed, John M. Colford Jr. and Stephen P. Luby, Household
Environmental Conditions are Associated with Enteropathy and Impaired Growth in Rural Bangladesh, American
Journal of Tropical Medicine and Hygiene, 2013; Margaret Kosek, et al. and the MAL-ED Network, Fecal Markers
of Intestinal Inflammation and Permeability Associated with the Subsequent Acquisition of Linear Growth Deficits
in Infants, American Journal of Tropical Medicine and Hygiene 88(2), 2013, pp. 390-396.
15. Dean Spears, Effects of Rural Sanitation on Infant Mortality and Human Capital: Evidence From a Local
Governance Incentive in India. Working paper, Princeton, 2012.
16. Dean Spears, 2013, op. cit., fn. 6.
17. Indeed, we have other research joint with Reetika Khera exploring social rank within Indian rural joint
households to show that womens social status is another important constraint on child height in India (Diane
Coffey, Reetika Khera and Dean Spears, Womens Status and Childrens Height in India: Evidence From Joint
Rural Households. Paper presented at Economic Demography Workshop, PAA, 2013).
18. Payal Hathi, et. al., 2014, op. cit., fn. 9.
19. Strikingly, sanitation does seem able to account for the difference in this figure between general children who
live in rural and urban areas. A regression confirms this, general rural children are 0.354 height-for-age points
shorter than general urban children, but this disappears (the point estimate becomes + 0.040, in the other direction)
when the fraction of households in the childs PSU who defecate in the open is linearly controlled for. Of course,
this is merely suggestive.
20. Diane Coffey, Open Defecation and Hemoglobin Deficiency in Young Children. Paper presented at PAA, 2014.
21. Michael Geruso and Dean Spears, Sanitation and Health Externalities: Resolving the Muslim Mortality Paradox.
Paper presented at PAA, 2014.
22. Dean Spears and Sneha Lamba, Effects of Early-Life Exposure to Rural Sanitation on Childhood Cognitive
Skills: Evidence from Indias Total Sanitation Campaign. Paper presented at PAA, 2013.
23. See Coffey, et. al., (2014), op. cit., fn. 1, 8. For more details, and a more transparent accounting for asset wealth
than this use of the DHS quintiles.
24. Dean Spears, Increasing Average Exposure to Open Defecation in India, 2001-2011. Working paper, RICE,
2014.
Nutrition, biodiversity and traditional knowledge
CAROL YN ST EPHENS

INDIGENOUS peoples are the most potent symbol of our human diversity of culture, language and spirit. They
have been the guardians of our global environment and its medicines for millennia built on a holistic communal
view of humanity and its links to the ecosystem. Yet now, in the new millennium, indigenous peoples are amongst
those most marginalized within many nation states, have the worst health indicators, and their knowledge is fast
disappearing as their land is appropriated and environment destroyed.
Before we begin to discuss the issue of nutrition for the indigenous peoples of Asia, it is important to place the
debate about indigenous well-being in context. The first challenge at the international level and in almost every
country is the very definition of indigenous. In most contexts, indigenous peoples are those groups or individuals
who self-identify as indigenous within national surveys and or in a national census. Box 1 shows the complex
United Nations position on the definition of indigenous. This is important to highlight because in many contexts
indigenous peoples may go unrecognized as indigenous by governments, or may not want to self-identify due to
stigma and marginalization within the dominant mainstream society. This makes it very difficult to understand both
how many indigenous peoples exist in each country or region, and subsequently, what health and well-being
problems each indigenous group experiences.
Box 1 Defining Indigenous
Indigenous communities, peoples and nations are those which, having a
historical continuity with pre-invasion and pre-colonial societies that
developed on their territories, consider themselves distinct from other
sectors of the societies now prevailing on those territories, or parts of
them. They form at present non-dominant sectors of society and are
determined to preserve, develop and transmit to future generations their
ancestral territories, and their ethnic identity, as the basis of their
continued existence as peoples, in accordance with their own cultural
patterns, social institutions and legal system.
This historical continuity may consist of the continuation, for an extended
period reaching into the present of one or more of the following factors:
* Occupation of ancestral lands, or at least of part of them;
* Common ancestry with the original occupants of these lands;
* Culture in general, or in specific manifestations (such as religion, living
under a tribal system, membership of an indigenous community, dress,
means of livelihood, lifestyle, etc.);
* Language (whether used as the only language, as mother tongue, as the
habitual means of communication at home or in the family, or as the
main, preferred, habitual, general or normal language);
* Residence on certain parts of the country, or in certain regions of the
world.
Other relevant factors:
On an individual basis, an indigenous person is one who belongs to these
indigenous populations through self-identification as indigenous (group
consciousness) and is recognized and accepted by these populations as
one of its members (acceptance by the group).
This preserves for these communities the sovereign right and power to
decide who belongs to them, without external interference (United
Nations 2004).
A second problem we have in understanding indigenous well-being, including nutrition, relates to the way in which
we measure health. In Occidental or western medical science, for example, health is evaluated with measures such
as mortality and morbidity. In nutritional terms, nutritional status is measured with anthropometric indicators such as
weight for height, weight for age and height for age.
Most indigenous groups do not conceptualize their health and well-being in these terms at all. They often do not
regard health as an individual physical state but as a state of community and ecological well-being, and often
indigenous concepts of health include a spiritual component. This is particularly important in terms of foods and
medicines some foods may be spiritually important and this importance is greater than their direct value for
nutrition. The same is true of medicines.
This is extremely important to understand when we discuss indigenous nutrition as it becomes simplistic, and often
misguided, to look at indigenous nutritional health simply in terms of western concepts such as mortality and
morbidity, or measures used in anthropometry. Interestingly, and also important to understand, in many senses
indigenous definitions of health are closer to the World Health Organization definition of health as, a state of
complete physical, mental and social well-being and not merely the absence of disease or infirmity, than current
measures used by western medical science.

Bearing in mind first the complexity of defining indigeneity, it is estimated that globally there are more than 370
million self-identified indigenous peoples in approximately 70 countries. This comprises over 5000 cultural and
linguistic groups, who form the basis of the worlds linguistic, genetic and cultural diversity. These peoples are often
the original inhabitants of the lands where they live, but are now usually in a minority within the current nation
states where they live. The largest concentration of indigenous peoples internationally is in Asia and the Pacific an
estimated 70 per cent of all indigenous peoples live in this region.

Indigenous wisdom internationally and within this region is under threat. In a globalized world, traditional
knowledge can be eroded, and ecosystems put to service of international economic processes such as mining,
resource extraction, and deforestation.
A major Lancet series on global indigenous health in 2006 identified several key themes that define the well-being
of indigenous peoples. Lack of data is very important: indigenous identity is highly contested, and where indigenous
peoples are recognized, data are rarely routinely collected or disaggregated. Where data exists, evidence suggests
that in all settings indigenous peoples suffer poverty, marginalization, extreme ill health, and many population
groups are at risk of demographic extinction. Indigenous peoples concepts of poverty, development and health
differ from western models. Rarely focusing on individual well-being or on traditional poverty indicators,
indigenous peoples see their social and physical well-being as intimately linked to that of the wider community and
the resources of the ecosystems in which they live. Sociopolitical factors linked to marginalization and colonialism,
and relationships with land and environment, are seen as fundamental determinants of indigenous poverty, well-
being and health.

In many settings, there is a basic lack of evidence on indigenous poverty, health and well-being, particularly for
those in isolated settings, and indigenous peoples have often been overlooked in national programmes on poverty,
health or education. If we look specifically at the Asian region, here are approximately 260 million indigenous
peoples. They live in the following 17 countries throughout the region. If we now turn then to the countries of South
Asia, including India, Nepal, China and Burma, indigenous peoples in the region sustain a wealth of cultural and
ecological diversity, largely based on their highly diverse indigenous cultures living in remote forest and mountain
ecosystems.
It is only now being understood that the bio-cultural treasure of South Asia is maintained by the regions indigenous
peoples. This treasure includes foods and medicines of direct importance to human well-being, but also includes a
history of indigenous spiritual beliefs which have influenced Asian philosophy and religion for millennia. Directly,
indigenous peoples hold knowledge about foods and medicines from their lands of origin that are important for them
and the peoples of the region, but globally Asian bio-culture contains foods, medicines and knowledge that have
been used for centuries throughout the world.
Many countries in Asia have incredible cultural diversity. In India, for example, 461 ethnic groups are recognized as
Scheduled Tribes (STs) which can be considered as a way of defining indigenous groups in India. In mainland
India, STs are usually referred to as adivasis, a controversial and often pejorative term which has been widely
criticized but is still in use. These groups have an estimated population of 84.3 million, and comprise approximately
8.2% of the total population. It should be noted, however, and this relates to our former point about data, there are
many more ethnic groups in India who are not officially recognized. It may be that as many as 635 indigenous
groups exist in India and the largest concentrations are found in the seven states of Northeast India, and central
tribal belt stretching from Rajasthan to West Bengal.

Indigenous peoples in this region experience discrimination, expulsion from their lands, and displacement to urban
settlements where they lose access to their cultural heritage and their traditional foods, practices and languages.
They are often unable to access health services and are stigmatized when they try to use their traditional medicines.
In many countries, indigenous communities are considered backward and are treated as second class citizens, just
as the adivasi are in India.
Despite these challenges, indigenous peoples in the region continue to maintain their cultures and languages, and
hold a wealth of knowledge about their ecosystems, local indigenous medicines and foods. Nutrition of indigenous
groups in their local forest and mountain environments is often good, but deteriorates on contact with outside
population groups and with displacement and acculturation into mainstream societies.

A study of indigenous nutrition in Arunachal Pradesh, India, found that the Adi indigenous community, living in
remote regions of the mountainous state, maintained an intimate knowledge of foods and medicines that they could
access from their ecosystem. Members of the same communities, but in closer contact with mainstream society, had
lost a significant amount of traditional knowledge about their foods and medicines and were unable to access those
that they did remember from childhood or family. Important local traditional foods included: cereals and millets,
rice boiled and as wine, and mirung (finger millet) as wine; legumes principally boiled; vegetables including ongin
(Cleroden-drum colebrookianum), pettu (Bras-sica), kopi (Solanum torvum), kopir (Solanum khasianum), and ange
(Collocasia), fermented bamboo shoot. They also eat fruits including banana and pineapple, meat and local fish and
use spices such as ginger and chilli.
Forest ecosystems in Asia are incredibly important for the nutrition of indigenous peoples. Forests cover 26% of all
land area in Asia and comprise 740 million hectares. This sounds an extensive area, but in fact Asia has the lowest
proportion of forest cover per capita in the world, with only 0.2 hectares per person, and this is rapidly being
encroached by deforestation and population growth.
Despite threats to the forest ecosystem in Asia, indigenous groups have lived and learnt from the forest for millennia
and they utilize a wide range of forest products for both direct nutritional benefits and for indirect support of their
agriculture and well-being. This includes products from trees and plants including fruits, berries, leaves, seeds, nuts,
barks, mushrooms and from forest wildlife, insects and wild animals and grubs. Indirect benefits for nutrition
include fodder for livestock, fuelwood and charcoal and stabilizing agricultural products. Forest foods are also a
source of income for indigenous peoples with products such as jams, wines and dried fruit and insect products.

Forests and mountains also have an incredible and valuable spiritual component for indigenous nutrition and well-
being, not only in Asia but also internationally. For example, a study of indigenous use of forest plants in Nepal
found that more than 80 different plant species and their products were required to perform religious and cultural
festivals. The nature of species varied from annual herbs, climber, palm trees, shrub to big sized trees and their parts.
The plants ranged from purely wild to domesticated plants and trees. The accompanying image shows animals,
plants and birds pictured on an ancient mural in central China.
Things change for indigenous peoples when they are displaced from their forests and mountains in Asia. This is
often due to deforestation or major projects including mining and road expansion. As these changes occur,
indigenous peoples are often displaced to towns and cities in Asia where lifestyles are very different, and major
inequalities exist between the urbanites who have managed to achieve western lifestyles and the vast majority of city
dwellers in Asia who live in unhealthy low income settlements, where conditions are poor in terms of water,
sanitation and housing. This has impact on nutrition and indicators for low income urban peoples are as poor or
poorer than their rural counterparts. Indigenous peoples arriving in these towns and cities rarely move into wealthy,
healthy areas and almost always end up in the low income settlements as displaced peoples.

In western biomedical terms, there is a vast difference in indicators of health and well-being between isolated
indigenous groups who are able to maintain their culture and access to their ecosystem, and those forced off their
lands and distanced from their culture and traditions. Indigenous community members who are displaced to urban
settlements often experience the worst of both the worlds of modernity and antiquity. They find it difficult to adapt
to urban life and even harder to maintain their cultural traditions and access to traditional foods. They also lose
touch with their important spiritual contact with the mountains and forests.

Traditional mural in China.
What does the future look like for indigenous peoples in Asia? There are major issues of population growth,
urbanization, massive inequalities and increasing deforestation and destruction of ecosystems. All this will
potentially impact negatively on the well-being of indigenous peoples unless governments protect them from the
impacts of these massive development policies. Ironically, if Asian governments do not protect the 260 million
indigenous peoples in thousands of cultural and linguistic groups, the region and the world will lose a vast amount
of cultural diversity and wisdom. We stand at a crossroads to choose whether to protect or abandon those who have
protected and cared for the forest and mountains ecosystems of Asia for millennia.

Alongside this bleak picture, the international stage has been changing. The crucial role played by indigenous
peoples and local communities has increasingly been highlighted in global environmental and development policy
processes, including the United Nations Convention on Biological Diversity (CBD) and the UN Framework
Convention on Climate Change (UNFCCC). In January 2011, the International Union for Conservation of Nature
(IUCN) met with indigenous representatives and conservation organizations to discuss conservation priorities in the
context of indigenous rights. The 2011 meeting concluded with a call to reinforce IUCNs multi-level process
(encompassing international, regional, national and local levels) to assess and advance the implementation of the
new conservation paradigm.

Specifically, they call for assessments in protected areas with indigenous peoples that can specify recommendations
to address gaps between the observed practices and the new conservation paradigm. A major challenge is how to
bring indigenous communities to local and international policy tables, particularly given their relatively isolated
existence in remote forest locations, where normal communication technologies do not reach. Isolated in many
settings, but increasingly in contact with modern society to the detriment of health and well-being, the nutrition of
indigenous peoples in Asia will ultimately depend on their ability to maintain their healthy ecological and
sustainable lifestyles with their access to biodiverse environments and cultural traditions. The world has an
enormous amount to learn from these communities and stigmatizing, marginalizing and displacing them is the last
thing we should be doing.

References:
P. Durst, Inedible or Incredible: Asia Pacific Forests for Improved Nutrition and Food Security. FAO, 2009.
International Work Group for Indigenous Affairs http://www.iwgia.org/culture-and-identity/identification-of-
indigenous-peoples
H.V. Kuhnlein, B. Erasmus and D. Spigelski (eds.), Indigenous Peoples Food Systems: The Many Dimensions of
Culture, Diversity and Environment for Nutrition and Health. Food and Agriculture Organisation, Rome, 2009.
United Nations. The Concept of Indigenous. Background paper prepared by the Secretariat of the Permanent
Forum on Indigenous Issues. Workshop on Data Collection and Disaggregation for Indigenous Peoples. D. o. E. a.
S. Affairs. United Nations, Secretariat for Indigenous Peoples. New York, 2004.

Women and nutrition security
GOVI ND KEL KAR

OF the numerous studies on nutrition in India, only a few pay attention to womens assetless gendered position in
social institutions, not appreciating that without substantial improvement in womens socioeconomic position it
would be difficult to achieve nutrition security. Most state schemes and development projects tend to focus on
womens responsibility in the provisioning of nutrition, without giving attention to enhancing their freedom from
male dependency in resource management and a systemic subjugation embedded in socio-cultural norms. This
article explores the growing concern for womens access to justice with gender asset equality among Indias
indigenous societies.
Research has increasingly highlighted that asset disparities between women and men affect agricultural productivity
and food/nutrition security, and that womens work in agriculture and production of food goes unrecognized and
social norms about womens work limit their unmediated right to access forests, land, finances and new
technologies. This, in turn, skews distribution of economic growth and promotes structures of power and inequality
that deny marginalized people, such as indigenous peoples and indigenous women in particular, access to justice and
effective control over their lands and forests.
According to recent reports, close to 870 million people of the 7.1 billion people in the world (1 in 8) suffered from
chronic undernourishment in 2010-2012
1
and the consumption level of almost 680 million people across both urban
and rural areas in India fell short of its poverty line of Rs 1,336 per capita per month.
2
Rough estimates suggest that
1.3 billion people lack access to electricity and 2.7 billion people rely on traditional biomass for cooking food.
3

Estimates show that 70% of these are women/girls who have much lower right to production assets: land, house,
new technologies, as well as representation in political and economic decision making. Further, women have the
primary responsibility for the production of food and procurement of energy and water. Surprisingly enough, the
invisibility of these tasks in systems of national accounting, and womens marginal access to rights to own and
control productive assets, show the massive and complex nature of gender inequality. Close to half the population is
kept under control with systemic violence within the home and outside, and their dependency is maintained by
traditional institutions and state policies.
Following the post 2015 development agenda discussions, civil society groups across the Asia-Pacific region have
drawn attention to the inter-country global inequality as well as rise in intra-country inequality in the emergent
economies. For example, the pattern of economic growth in China since the 1980s and in India since the 1990s has
worsened inequality within the country, possibly a result of a shift from agriculture to industry and from rural to
urban areas.
Discussing the growing intra-country inequality in the rising powers of Asia, a recent study noted that the Gini
Coefficient increased by 24% in China and by 16% in India during the decade of the 1990s.
4
Significantly,
disproving the Kuznets curve (i.e., income inequality falls as society modernizes), Thomas Pikettys analysis of
accumulation and distribution of capital worldwide shows that inequality has increased in the last 30 years almost
everywhere, including the United States. The history of inequality is shaped by the way economic, social and
political actors view what is just and what is not, as well as by the relative power of those actors and the collective
choices that result.
5


Indigenous peoples arguably constitute among the most vulnerable populations for a variety of reasons. Most
notable is their substantial dependence on natural resources, making them vulnerable to changes in the quality and
quantity of natural resources. They encounter additional challenges as they often face discrimination and live in
secluded communities. Frequently denied access to decision making processes, the ecological systems upon which
they depend are increasingly controlled by non-indigenous peoples and corporations.
The 2006 Human Development Index (HDI) for Scheduled Tribes (adivasis) in India shows that their HDI is almost
one-third below that of the Indian average and, on an international scale, they fall among the poorer countries of
Africa.
6
They are subject to displacement in the name of development projects from which they derive little or no
benefit. Often they suffer legal discrimination, viz. in peninsular India, where they are subject to non-judicial forms
of punishment and imprisonment. Given limited access to education, health facilities, new technologies, agricultural
inputs, credit and infrastructure development, their economies have remained virtually cut-off from the countrys
economic growth and technological development.

Their vulnerability to food and nutrition is attributable to the iniquitous relations of gender and power embedded in
the larger social, political and economic institutions that determine, inter alia, legal rights and ownership, customary
and religious practices, and economic, business and livelihood options. Among adivasi women, for example, access
to land, credit, and resources can be further restricted, going beyond the already limited access to indigenous peoples
on the whole, such that they may experience inequality in the market and workplace even within their communities,
all of which further exacerbates exclusion and poverty. This is clear when examining indigenous womens
ownership and control of assets, participation in decision making processes, production of food, gender roles in the
household and local economy and womens risk of gender based violence.

The transfer of forest management out of community hands and into private companies or individuals has resulted in
greater socio-economic disparity in many forest societies. Income generated from forests and power is accumulated
under local elites, who have commonly excluded women and the poor from usufruct, ownership and control rights to
land and forests. Hence, forest based adivasi and indigenous societies have in many cases experienced enhanced
gender inequalities.
7

Among the matrilineal Khasi, for example, womens status has traditionally depended on their claim to and
ownership of ancestral property. Womens ownership of land, however, is no longer the determinant feature of the
Khasi property system, in large part due to privatization. In some villages, formerly community owned forests are no
longer deemed to constitute ancestral property in the process of registration. Instead, the land may be deemed self-
acquired property, the right to which is governed by different principles and controlled by men who legalize
ownership. In other villages, however, forests were privatized and the land was divided and distributed to those
whose lands or households were adjacent to the forest, and titles given in the names of women and men.
8

Alongside the legalities of ownership, rules governing resource use have been changed in land and forest
management. In the traditional systems of the Khasi, Jaintia and Garo in India, and Mosuo in Yunnan, China, for
example, womens ancestral property was managed by her uncle or brother. The direct role of the maternal uncle or
brother remained even after the men married into other clans. This was possible since marriages often took place
within the same village. But, increasingly husbands are effectively managing land and forests, as well as the capital
they generate a key economic resource for households. This capital, however, may also be deemed self-acquired
property and thus passed on from father to son, bypassing the traditional matrilineal economic system. While
women in landholding Khasi families are in a better position than if they were completely property-less, the rise of
the timber industry has enabled men, as husbands, to increase control of the familys economy.

In landless Khasi families, the main source of cash income is wages from logging, typically earned and controlled
by men, which has contributed to male domination in these households. During field visits in 2006, 2008 and more
recently in 2011 in Jharkhand, Chhattisgarh and Andhra Pradesh, India, women often cited threats by their husbands
including beatings and expulsion from the house should their husbands demand but be denied money for liquor.
The women, without claim to land or the house, had little with which to bargain. Comparatively, being thrown out of
the house is something that a house owning Khasi woman is not likely to be subjected to.
9
The Nagas, on the other
hand, are patrilineal where women have no inheritance rights over land and housing.

The linkage between womens exclusion and inequality can appear self-evident. Less evident, however, are the
multiple interdependent causes of vulnerability of women resulting from inequality in gendered social systems
among indigenous peoples. The only case of a woman becoming a Gaon Buri (village elder) near Dimapur has been
strongly opposed by the Federation of Gaon Buras of Nagaland. On the other hand, there are cases in Arunachal
Pradesh of woman being designated as gaon buris.
10
Discussing the image of the Khasi male, Tiplut Nongbri
captures the complex reality through a poem.
11

A new world comes rolling in heralding the epoch of father and son
Yet mans position remains unchanged
His power/authority gains greater height
In his natal home he is the revered mama
In his conjugal home, the father
It is for us to take good care
To bring the maternal uncle and father together
Among adivasis, women can be further marginalized within their traditional institutions as they often have little
representation or voice in village councils. While amendments to Indias Constitution in the 1990s which
decentralized governance, like the Panchayati Raj Extension to Scheduled Areas (PESA), mandate that women shall
have one-third reservation in local government institutions, this has not been implemented in a number of states
including in adivasi areas. Male leaders in adivasi communities defend practices that exclude women from decision
making in the communities; even in matrilineal communities of Meghalaya in India, and Mosuo in China, women
are excluded from the village councils.

Patricia Mukhim, a Khasi woman writer and journalist, observed that the recent introduction of formal village
management systems, which reinforce mens role as community managers, limits womens participation in
community-level decision making processes regarding natural resource management, including management of
forests and land. We can also attribute this control by men to the establishment of once fallow lands as village
reserved forests, and the associated flow of funds into the village through development projects like the IFAD
funded Northeast India Natural Resource Management Project, which have also served to increase mens control
over the economy, even though their knowledge of the local economy is limited since they neither play much of a
role in production nor in marketing of agricultural produce.
12

These power relations fit easily into the marketplace. In Khasi and Jaintia Hills of Meghalaya, for example, adivasi
women are frequently at the mercy of more powerful traders who control the movement of goods in the market,
resulting in women losing a lucrative enterprise since it has passed on to male hands because of womens exclusion
from markets. Compounding this, the role of women in subsistence and barter has increasingly been devalued with
the expansion of market structures. One notable exception to this trend is in the wool-based enterprises of some
mountain communities, such as in Uttarakhand, which are now moving into monetary economies.
There are, however, a few examples of advances in adivasi womens empowerment. In the villages of East Khasi
Hills, Meghalaya, for instance, a number of cases were reported in recent years where Khadduh the youngest
daughter who is traditionally obligated to provide support and succour to all members of the family has asserted
her claim to full ownership and management rights of her parental property. These claims were made in response to
attempts by the uncle or brother of the Khadduh to claim the family income and/or trees for their personal benefit.

Another example is the initiative of a forest cooperative woman leader Kalavati Devi. While president of the
Primary Forest Produce Cooperative Society in Bajawand block of Bastar district from 1996-2000, Kalavati initiated
reform of the policies that govern distribution of harvesting allocations and payment for tendu leaf, commonly used
in the bidi trade. Harvesting allocations granted via collection cards, were traditionally issued to the male head of
the household, even if the woman was the primary collector of the tendu leaf. After much political bargaining, the
policy was changed so the collectives member (i.e., the person, typically a woman, who harvested the tendu leaf)
would be issued the card as well as the related payments. As a result women are now better positioned to control the
income from tendu leaf sales; household savings have reportedly increased, and women have gained influence over
the cooperatives decisions on the sale of tendu leaf. These policy changes have spurred the growth of the
cooperative and enhanced the participation of women members in particular, who now have an opportunity to regain
some control over forests, and their livelihoods.

The weakening of traditional norms among adivasi and indigenous peoples, along with the growing visibility of
women in the marketing of agricultural products and in the public sphere overall has angered some men who have
called for womens return to domesticity. On the other hand, women having grown familiar with new gender roles
and realizing the implication of the loss of control over land and other productive natural resources, are now
demanding greater autonomy and independence. This underlying social context should be understood in cases where
women suffer gender based violence, including the continued and in some areas increased violence against women
in forest areas through such practices as demonizing of women as witches and witchcraft persecution.
In sum, this trend towards loss of control by indigenous women over natural resources and the compounding loss of
relative power in relation to men, can largely be attributed to four significant constraints: (a) interventions from
outside the community such as colonization, privatization, and globalization which have by and large been
extractive and exploitive; (b) fragility of indigenous economy and production structures; (c) weakening of traditional
institutional mechanisms which could mitigate the damage; and as is typical in gendered relations, (d) a power
differentiation between women and men reinforced by social, economic and political structures, whereby women
have restricted voice and efficacy in community affairs, as well as limited and often exploitive external contacts.

What then can be the process of correcting gender inequality and nutrition insecurity among indigenous households
and communities? The first step is to recognize the need for transformative change in hierarchy and power between
women and men for individual rights to access ownership and control of land, forests and other assets. Indigenous
societies, like many non-indigenous societies, are characterized by womens unpaid, unrecognized household and
care work, social subordination of women and its close links with violence against women and unequal access to
ownership and management of productive assets.
A central concern is about womens ownership of land, and why land is key to address food and nutrition security.
First, social and economic justice suggests that those who work in fields should have the right to own and manage
the fields. In India, 79% of rural women work in agriculture, and state level studies show that less than 10% have
some kind of land titles in their names. Second, womens unmediated (not through the house-hold or its head) right
to land is important for better productivity and efficiency of resource use. Several studies in recent years
13
have
pointed out that secure and inalienable user rights with full control and ownership is necessary for spurring
investment in food production and nutrition security. Based on a number of cases in Africa, researchers have pointed
out that if women had similar access and inputs to land as the men, they could increase yields on their farms by 2.5-
4%. And this in turn could reduce the number of malnourished and hungry people in the world by 12 to
17%.
14
Third, womens control and ownership of land, house and household income, enables them to use it for their
own well-being as well as for other household members, children in particular. Fourth, asset distribution yields
superior outcomes to income distribution. Land or asset ownership provides a meaningful basis for overcoming
distortions in the functioning of the market and for restructuring unequal relations between women and men, with
access to economic rights, technology, healthcare and governance.

Ownership is a bundle of rights. Along with ownership there is a need for further developing technical skills.
Capacity development is not just a technical skill; it is a combination of knowledge, marketing and management
skills alongside the effective right to own land and other productive assets. What is important to understand is that
womens asset/land ownership is most likely to change gender based power dynamics within the home and outside,
thereby creating an egalitarian society. As pointed out by Thomas Piketty, Knowledge and skill diffusion is the key
to overall productivity growth as well as the reduction of inequality both within and between countries.
A recent workshop in Delhi on adivasi women recommended support for capacity building in alternate livelihoods:
(i) upgrading of traditional knowledge and skills and revitalizing then in areas where they have been lost; (ii)
introduction of new knowledge and technologies to support womens access to expanded markets; and (iii) womens
unmediated access to collective or individual ownership of resources, including land, housing and finances. This last
is seen as a means to empower women and increase their economic security for better provision of food and
nutrition of the young and not so young adivasi women and men. For example, in Chinas agriculture system, it has
been seen that through policies that improve womens access to technologies and credit, indigenous women have
been more likely to increase efficiency in their use of renewable energy, and more secure access to forest resources
has resulted in lower rates of deforestation.

Culture is neither historically given; nor is it static. Rather, it is part of the ongoing process of socio-economic and
political change. Womens movement, like any other social movement, creates its own culture and new social
gender norms. Such new social norms or cultural configurations also create social conflicts or possible
contradictions arising from existing and newly created norms. Thus, new social and gender relations and norms
operate in a dialectical way, introducing the germs of change that new movements may carry.
Initiatives to implement gender-responsive policies can influence change in the slow-moving institutions of social
and cultural norms. Hence, the state policy has a definite role to play in creating enabling and empowering
conditions for women to advance their agency for nutrition security with womens unmediated rights to land, forests
and management capabilities.

Footnotes:
1. Food and Agriculture Organization, The State of Food Insecurity in the World, 2012.
<http://www.fao.org/docrep/016/i3027e/i3027e00.htm> (accessed on 17 June 2014).
2. McKinsey Global Institute, From Poverty to Empowerment: Indias Imperative for Jobs, Growth and Effective
Basic Services. Mumbai, 2014.
3. McKinsey Global Institute, 2014, ibid; International Energy Agency, Modern Energy for All.
<http://www.worldenergyoutlook. org/resources/energydevelopment/> (accessed on 17 June. 2014).
4. Dev Nathan and Sandip Sarkar, Global Inequality, Rising Powers and Labour Standards, Oxford Development
Studies 42(2), June 2014, pp. 278-295.
5. Thomas Piketty, Capital in the 21st Century. Harvard University Press, Cambridge, 2014.
6. Sandip Sarkar, Sunil Mishra, Harishwar Dayal and Dev Nathan, Development and Deprivation of Scheduled
Tribes, Economic and Political Weekly, 18 November 2006.
7. Govind Kelkar, Dev Nathan and Pierre Walter (eds.), Gender Relations and Forest Societies in Asia: Patriarchy
at Odds. Sage Publications, New Delhi, London and Thousand Oaks, 2003.
8. Dev Nathan, Northeast India: Market and the Transition From Communal to Private Property, in Dev Nathan,
Govind Kelkar and Pierre Walter (eds.),Globalisation and Indigenous Peoples in Asia: Changing the Local-Global
Interface. Sage Publications, New Delhi, London and Thousand Oaks, 2004.
9. Govind Kelkar, Adivasi Women Engaging with Climate Change. UNIFEM, IFAD and The Christensen Fund,
New Delhi, 2009.
10. Jarjum Ete and Julie Bazeley, Local Governance in Arunachal Pradesh. Rome, IFAD, mimeo; Dev Nathan,
Ganesh Thapa and Govind Kelkar, Market and Indigenous Peoples in Asia: Lessons from Development Projects.
Oxford University Press, New Delhi, 2012.
11. Tiplut Nongbri, Development Masculinity and Christianity: Essays and Verses From Indias North East. Indian
Institute of Advanced Study, Shimla, 2014.
12. Patricia Mukhim, Retrieving Indigenous Traditional Practices of Khasi Indigenous Tribes of Northeast India.
Unpublished report, 2008.
13. ILO, Economic Security for a Better World. International Labour Organization, 2004; Food and Agriculture
Organization, The State of Food and Agriculture 2010-2011: Women in Agriculture: Closing the Gender Gap for
Development. FAO, Rome, 2011; World Bank, World Development Report 2012: Gender Equality and
Development. World Bank, Washington D.C., 2011.
14. FAO, 2011, ibid.

Ensuring a civil life
YOGESH J AI N, ANJ U KAT ARI A, RAMAN KAT ARI A, RACHNA J AI N a n d RAVI NDRA KURBUDE

When I give food to the poor, they call me a saint. When I ask why the poor have no food, they call me a
communist.
Dom Hlder Cmara,
Catholic Archbishop of Olinda and Recife, Brazil, circa 1990.
THE general belief is that adivasis face a greater burden of illness for which care is often compromised due to the
inaccessibility of health facilities and inadequate personal resources. It is also felt that adivasis are affected mainly
by infectious diseases; other conditions like cancer, diabetes, mental illnesses and heart disease are uncommon
among them.
Unfortunately, there is only scattered information on the actual burden and patterns of illness that afflict adivasis.
For example, even for a serious and important illness like tuberculosis, reliable information about its prevalence
amongst adivasis is scarce. Data comparing the patterns of these illnesses between tribals and non-tribals sharing the
same geographical space is just not available. The situation becomes worse when one talks of the unequal
distribution of determinants of these illnesses such as food, public health systems, roads and safe drinking water.
What is the reason for this apparently high burden of disease that manifests itself in such a severe form? Could it be
attributed to deprivation? Or genetic factors? Or cultural factors that could influence people in choosing to seek
health care, select food choices or adopt a certain lifestyle?
Not just this discussions on tribal health often concentrate on the exotic nature of many rare and genetic illnesses
they suffer from. Let us take the example of sickle cell disease. This is an inherited blood disorder that developed
due to a strong survival instinct when people in central India were exposed to the deadly falciparum malaria parasite.
Those who inherit a single gene from one of the two parents are partially protected from this serious form of
malaria, while those who inherit the gene from both parents suffer this painful and potentially fatal illness. Both
adivasis and non-adivasis in central India face the brunt of falciparum malaria equally; yet this disease affects
adivasis more severely because of their inability to access adequate health care.
Similar beliefs are held about their nutrition as well. While many people know about the frightening figures on the
high levels of hunger among adivasi adults and children, there seems to be little concern about how that affects
overall health, how prone they are to falling sick and even when treated, whether they can recover quickly. The
stunting of both the physical and intellectual potential that may result, particularly when a young tribal infant or
toddler suffers such food deprivation, does not seem to give sleepless nights to the policy planners.

At Jan Swasthya Sahyog (Peoples Health Support Group) in rural Bilaspur, where we run a community health
programme accessed by people from over 2500 villages of north-central Chhattisgarh and eastern Madhya Pradesh
for their major health needs, we observed illnesses that people suffer from through the lens of hunger. While we
have provided for some unmet needs of health care and nutrition support through focused interventions, especially to
under three-year-old children, we see our larger role, and that of other civil society organizations working in adivasi
domains, as advocates of these perspectives and in providing solutions.


In this essay we share some specific observations about these links with the objective of debunking commonly held
myths, as well as suggest some solutions to nutrition and health problems in adivasi and other poor rural
communities.

Overall, we believe that the adivasi predicament in both health and nutrition is a result of continued deprivation a
consequence of a historical injustice, especially the carting away of natural resources. The deprivation adivasis face
is not just of food, but also the quality of the environment (such as water and air) and public services such as health
systems, roads, transport, education and markets. Not determined by either cultural factors or anything genetic, the
status of adivasi health and nutrition could be equated with that of the poorest in this country. Unnecessary deaths, a
huge burden of diseases that have become more complex, and problems relating to nutrition are the bane of the
people.

In their local habitat, the weight of adivasi children is generally normal in over 75% of children at birth. This is
maintained for the first six months of life, thanks to breastfeeding. As breast milk alone cannot meet the energy and
protein needs of the child after six months, an appropriate amount of supplementary feeding becomes essential for
the childs growth. If that does not happen, these fairly healthy children progressively become weak, and by the age
of two, a majority are significantly undernourished.

Almost 65% of Indian children below five are undernourished. Most of the mental development occurs in early
childhood, and mostly before three years of age. Undernourished children grow into undernourished adults who
have a low threshold for illness and poor work capacities. This in turn affects their earning capabilities.
Undernourished girls grow into weak mothers and give birth to underweight babies, and the vicious cycle of poverty
and ill health continues. Unaddressed undernutrition in the first three years of life thus has both immediate and long-
term consequences, causing more acute illnesses and deaths. Further, once a child is malnourished due to a chronic
dietary inadequacy, the catch-up is likely to be difficult. What should put us Indians to shame is the fact that our
infant and young child feeding practices are even worse than our poorer neighbours, Bangladesh and Nepal.

Why dont our young children get enough nutrients? Poverty cannot be an adequate explanation because most
families can afford some cereal, even if their diet lacks in oil, meat, lentils and milk. One possible reason may be
inadequate knowledge, but the most important reason is probably that the child is not looked after for a better part of
the day when both parents, who are often poor, are out working. As a result the child gets very little food, mostly
given by an older brother or sister or an old grandparent.

The government run anganwadis under the Integrated Child Development Services (ICDS) aim to provide
supplementary feeds to preschool children. However, their effectiveness is compromised by poor attendance of the
six months to three year old children, that they run only for four hours and that the child caretaker ratio is 20:1 or
more, making care for them almost impossible. The current practice of take home rations for the under three-year-
old child is also ineffective as the full ration does not reach the child. Developing homestead gardens or going in for
intensive IEC and health education activities too have not been effective. Running nutritional rehabilitation centres
(NRCs) or addressing severe acute malnutrition (SAM) will by itself not solve the problem unless we concentrate on
preventive strategies. Since we are unable to feed our young children, we suffer from the persistent and shameful
record of poor under-three year old child malnutrition, with the adivasi children coming way down the pecking
order.

To address this problem we promoted crches or phulwaris as we call them, at hamlet level for children below three.
This involved the parents, particularly in the selection of a caretaker who is a woman from the same hamlet. These
crches operate for eight hours a day at a time suitable to working parents. With a child caretaker ratio not exceeding
10:1, the phulwari workers provide three hygienically prepared meals, ensuring at least 75% of the childrens daily
food needs. These care givers are trained enough to recognize common childhood infections and ensure treatment
from the local accredited social health activist (ASHA) worker as well as provide early childhood education to these
kids. Over the last nine years, more than 1200 children in 126 phul-waris in 56 adivasi villages of rural Bilaspur
have benefited.
This programme has been a runaway success, with over 85% eligible children in the poor and remotest villages
regularly attending the phul-waris. With a secure and comfortable environment for their young children close to
their homes, not only are parents more confident to go out to work, the elder child-parent, who had to stay back to
look after their younger siblings is now able to return to school. The enrolment of women in MGNREGA has
increased substantially. Happily, with nutrition levels improving, the rates of childhood illness have dropped
substantially. We felt proud and fulfilled when a middle aged woman from Surhi village in the Achanakmar
Sanctuary, said, hamaarey bachchon ke pet mein aaglagaadee hai! (Food has started reaching our childrens
bellies!)
The success of this strategy in rural Bilaspur led to several civil society partners in Madhya Pradesh, Rajasthan,
Orissa, Jharkhand, and Bihar immediately taking up similar programmes. The chief minister of Chhattisgarh
announced that phul-waris would be set up in each hamlet of the poorer districts. However, progress has been tardy.
Even if we dont count the spin-offs mentioned above, here is an intervention, tested out in a poor adivasi area, that
offers a solution to the almost insoluble problem of preventing early child malnutrition, at a cost of Rs 26 per child
per day (including the wage of the caregiver).

How can this be up-scaled? One way is for the Women and the Child Department to establish crches or modify
anganwadis at the hamlet level to meet the needs of the under-3 year old child. A second possibility is to harness the
existing provision of the crche in the MGNREGA, even if it is for 150 days a year and run a special programme in
poor rural areas? Unfortunately, our efforts to advocate this simple technical solution along with operational details
has met with little success, possibly because solutions emanating from civil society do not get the attention of policy
makers.
At our clinics, we measure the weight and height of those who seek treatment. Our community and hospital based
health work allows us to confirm massive levels of hunger or malnutrition among people in central Indian villages.
This manifests as both stunting or short heights as well as wasting as measured by low BMIs (birth mass index). We
observed a clear gradient of worsening undernutrition as one goes down the scale, with particularly vulnerable tribal
groups at the rear, and other adivasis only a shade better. (Table 1)
TABLE 1
Body Mass Index of People in Community Programme of
Jan Swasthya Sahyog, 2012.
Social group 25th median 75th
centile centile
Particularly
Vulnerable Tribal
Groups
17.35 18.36 19.71
Other Tribals 17.26 18.69 20.18
Backward Castes 17.44 18.75 20.34
Dalits 17.78 19.11 20.38
Others 17.61 19.35 22.37
Body Mass Index is a measure of wasting or undernutrition,
calculated as bodyweight in kg/(height in metres)2*100; a
value of < 18.5 suggests undernutrition.

Providing primary, secondary and, where necessary, tertiary level health care in the community health programmes
has allowed us to observe massive levels of morbidity. A quick glance at the number of new illness episodes seen in
the year 2013 shows that conventional infectious diseases such as tuberculosis, falciparum malaria, leprosy,
childhood infections, skin and serious soft tissue infections occur in large numbers. Not just these, but also cancer,
especially of the cervix and breast in women, and of the oral cavity in both men and women, severe hypertension,
thin diabetes, rheumatic heart disease (most prevalent in the poor), mental health problems, crippling joint illnesses
and thyroid problems are seen in equally large numbers in adivasis as in other social groups. Besides this, snake
bites and from rabid animals and scorpions, obstetric emergencies, agricultural injuries, lightning strikes are clearly
higher among the adivasis.
TABLE 2
Common Serious Illness Seen at Jan
Swasthya Sahyog Health Centre,
Ganiyari, Chhattisgarh, 2013.
Tuberculosis 502
Cancers 468
Severe hypertension 555
Diabetes, 80% non-obese 346
Leprosy 134
Falciparum malaria 189
Rheumatic heart disease 118
Illnesses requiring
emergency surgery
250
Sickle cell disease 141
Chronic renal failure 108
Viewing the nutrition levels of these people, even those with non-infectious illnesses like diabetes, we find they are
no better than those who have infectious illnesses. Adivasis thus suffer not only a double burden of infectious and
non-infectious illnesses, but also show poorer outcomes. We believe that these outcomes are a consequence of their
poor nutritional status, more complex presentations, delayed access to health care and inadequate resources at their
disposal.

We would not have been able to understand and share these observations about tribal and other poor rural
communities, had we not been in actual health care service delivery. Only when effective and necessary health care
is accessed can we really understand the true burden of the illnesses. Health service provision, that is accompanied
by careful documentation and asking the right questions, allows us to understand what works and what does not, and
this information can help policy makers.
Several questions seem to have come up regarding tribal health, and we are struggling to find answers. Should we
attempt an exclusive health care delivery structure for the tribals, or do we need to strengthen an all inclusive health
system that offers some positive affirmation for them? Are there illnesses that can be ignored since they dont occur
as commonly among tribals? Perhaps not! Are there any illnesses that are more prevalent among tribals as compared
to non-tribals? Due to extreme deprivation, we continue to see some conditions such as syphilis, cholera, falciparum
malaria deaths, snake bite deaths, lepromatous leprosy and acute rheumatic fever being proportionately higher
among adivasis.
Once we understood the magnitude and the bottlenecks in reaching a solution, we thought of simple remedies. For
instance, a blood slides courier system to ensure swift reporting of malaria and a method for detection of cancer
cervix through paramedics in the remotest tribal villages.

The dynamic relation between hunger and illnesses can best be understood when we look at tuberculosis. Among
tuberculosis patients, almost half of who are adivasis, we see the median body weight of women is 34 kg while that
of men is 42 kg. Almost 80% of them are moderate to severely undernourished and about half are stunted. Even
after successful treatment about half remain undernourished. Despite providing the best drug treatment free to those
suffering from tuberculosis, the death rates of the severely undernourished are at least twice that of the normally
nourished. There is clearly a case for providing supplemental food rations for the family besides free and effective
care for people suffering from tuberculosis.
The larger issue to address is how the massive level of undernutrition makes a person more vulnerable to serious
illnesses such as tuberculosis. A woman weighing 40 kg is at three times higher risk of getting tuberculosis
compared to one who weighs 50 kg. These shocking statistics on nutrition are rarely revealed and hide the
vulnerability of some people, and the inhumanity with which they are treated. People like us, who work in such
areas, must prevent this by uncovering the truth. Once we realize its importance, we should look at the possible
remedial actions such as ensuring adequate food for all so everyone can have a basic, normal nutrition level.
Here it may be of interest to look at the role of public distribution systems (PDS). Chhattisgarh has a robust and
well-functioning PDS that provides 35 kg of cereals and 2 kg each of black gram and pulses per month to 90%
households. This PDS is certainly better than that of most states in the country and has the potential to prevent acute
starvation and hunger. But we still need to determine whether it has led to better food intakes among those who are
chronically hungry. It is likely that the money saved from supply of subsidized food is now available for other
pressing needs. In our study among few adivasi households in 2011, we found that the PDS food grains last a
median of 13 days in a month; for the rest of the month the families have to depend upon their own produce or buy
food from the market.

Another point to ponder on when we know that body weight broadly affects a persons ability to labour and thus
earn is whether there is a case for body weight related wage determination? Otherwise those who are
undernourished due to food deprivation will always stand at a disadvantage in their ability to earn. Can MGNREGA
or other employment programmes take cognizance of this?
Civil society organizations should not limit themselves to merely implementing health care and nutrition
programmes which have been contracted out by the state or by corporates as part of their social responsibility.
Their understanding of ground realities and where the real problem lies has placed them in a more responsible
position. They should be asking difficult questions about the poor state of affairs, documenting problems, suggesting
solutions, and aggressively lobbying for them at the right fora.

* The authors are doctors based in rural central India, running a community health and nutrition programme for the
last 14 years.

Creating the connect
RAMA NARAYANAN

STUDIES and surveys indicate that of all the marginalized groups in India who face a serious threat to livelihood
and food security, the tribals are the worst off. Besides cultivation, they depend on forests and the local
neighbourhood to get wild food, small game, medicinal plants and timber to make agricultural implements, construct
their homes and to use for fuel.
A major reason cited for this marginalization and subsequent loss of traditional livelihood and food source is the
alienation of land or forests from tribal communities. This process began during the British era when the colonial
rulers found the need to bring the entire population under one administrative head for purpose of governance and
establish communication links with the entire country. Engineers, contractors, provision suppliers and traders went
to the tribal areas and acquired land used by the local community that did not have the kind of documentation that
secured proof of ownership. Hence, many communities lost their right to land and hunting and fishing.
In the post-independence era, the commercial value of forests became important and this led to the large-scale
exploitation of natural resources by the mainstream population causing a serious threat to the environment. The
states attempt to check exploitation by declaring several forests as reserved areas backfired, in part since this posed
a problem for the tribals who could not access them anymore. Evidently our officials find it difficult to accept that
the tribals do not pose a threat to the forests they have a material and spiritual connect and have strict codes of
utilization that help conserve rather than destroy natural resources. Unfortunately, policies evolved to conserve
forests did not blend with the unique needs of the tribal communities. In addition, developmental projects such as
the construction of dams led to large-scale displacement of tribal communities from their own land to an alien
environment with which they were unfamiliar and where they did not have ownership rights.
Tribals in India can be broadly classified into one of the following categories based on their dominant economic
activity. They are hunter gatherers, shifting/settled cultivators, pastoralists, artisans or engaged in manual labour.
Currently a majority of the tribals are settled agriculturists, while hunting and other such activities are restricted to a
few communities.
Unlike in other parts of the world, tribals in India were never completely alienated from the mainstream population.
Despite unique linguistic, social and cultural identities, they engaged with the rest of the population and regularly
traded with non-tribals for minor forest produce such as honey. This association also led them to adopt local
agricultural practices.

Several tribal groups practised shifting cultivation. Also known as slash and burn cultivation, it consists of clearing
a forest slope, burning the fallen trees and broadcasting the seeds (a method of seeding that involves scattering seed,
by hand or mechanically, over a relatively large area). No other agricultural techniques are used. After cultivating
this land for one or two seasons, the cultivators take up another area. This method, which is uneconomical due to
low productivity and arguably depletes the fertility of soil, has since been banned and the practice has declined
significantly.
Even as most tribal communities have little exposure to modern agricultural methods, their knowledge of traditional
farming practices is impressive. They have also shown remarkable resilience in their will to survive. The Mizos of
Mizoram and the Apatanis in Arunachal Pradesh present excellent examples of communities willing to adapt and
change from shifting to plough cultivation. Both grow rice and have adopted terrace cultivation in the mountains
slopes and this indicates an ability to adapt culturally and ecologically.
Sadly, most of the development programmes have bypassed them. While the problems of marginalization and
substandard quality of life is common to tribal communities across India, the degree of deprivation and its
subsequent impact on the health and nutritional status of the population varies considerably from one region to
another.

It is in this context that the M.S. Swaminathan Research Foundation (MSSRF) has been engaged in participatory
research, education and capacity building of tribal communities in three locations in India, namely Jeypore in
Koraput district of Odisha, Wayanad in Kerala and Kolli Hill in Tamil Nadu. Exceptions apart, most tribal groups in
these regions are settled agriculturists and depend on the forest for timber and other minor products. Surveys carried
out by the foundation have highlighted multiple problems faced by these communities. Lack of good quality seeds,
especially of staple crops such as rice and millets, low yield among staple and other crops, lack of awareness about
soil health, improved production technologies and water harvesting measures are major issues.
While seeds of high yielding and hybrid varieties are available from the agriculture department, the farmers do not
receive any support for the propagation and conservation of traditional varieties of rice and millets, which they grow
for their own consumption as well as for festive occasions. In addition, landscape conversion also poses a threat
since traditional agro-ecosystems are giving way to cash crops and there is lack of availability of wild edibles. The
wild edibles that the tribals accessed from forests were tubers, especially several yam varieties, wild mushroom,
leafy greens and fruits and seeds. A steady loss of knowledge transfer is also found as the younger generation is
unaware about wild edibles and assigns greater importance to market food.
With a pro-poor, pro-nature, pro-women and pro-sustainable approach, the foundation is engaged in a variety of
activities to promote the food and nutrition security of tribal households, both at the micro and macro levels. At the
micro level, it undertakes participatory research with tribal communities in the areas of conservation, food
production and sustainable agricultural practices, usually in collaboration with government and non-government
agencies to provide end to end support for the entire gamut of agricultural operations, including on farm and non-
farm activities and in demanding and receiving entitlements. In addition, the foundation focuses on building social
capital through awareness generation, capacity building and forming, supporting or strengthening community based
organizations.

As part of improving farm productivity in a participatory manner, promising local varieties of crops were identified
and multiplied on the field. This included paddy and millet in Jeypore tract of Odisha, paddy and cassava in Kolli
Hills and paddy and elephant foot yam in Wayanad. The varieties selected by farmers were raised in demonstration
plots close to the road. Farmer visits were organized to these demonstration plots facilitating farmer-to-farmer
exchange of knowledge. For revitalization of farm level conservation, participatory plant breeding with tribal
families in Koraput district was done in order to improve the yield potential and agronomic qualities of local strains.
This led to the development of the kalinga kalajeera strain, which is both high yielding and has a high market value.
To help the communities become more self-reliant in seed production and ensure a secure food chain mechanism,
community food grain and gene banks have been set up from which the village community can borrow during times
of need and repay in kind, with interest also in kind. Households can become members of the grain bank and the
initial stock is built up with a contribution from the foundation as well as excess grain available in the village. The
banks operate on the principle of social inclusion, and help enlarge the food basket through the addition of local
grains.

In Koraput, 30 community food and gene banks established with support from MSSRF over the last 12 years have
been functioning well and provide villagers easy access to food grains. The grains include paddy, pulse and millet.
Quality seeds of both local and improved varieties of paddy and millets are exchanged among farmers, mediated by
seed banks in both Kolli Hills and Jeypore. Each village has a grain bank management committee that oversees the
day-to-day transactions of the bank. The management committees meet at regular intervals to take decisions on the
functioning and management of the banks. In all banks, the committee displays grain stock and other details on the
storehouse wall so that all members are aware of the stock status. When stocks are in surplus, the excess grain is
sold and the funds utilized for village development work. The banks cater to scheduled tribes (STs), landless, small
and marginal farmers. In order to strengthen skills of the management committee, capacity building sessions are
organized.
To address micronutrient malnutrition and to help compensate for the loss of access to forests, about 400 nutrition
gardens or kitchen/home gardens as they are popularly known, have been set up, all developed and designed through
community mobilization. Taking into account the poor nutritional status of the geographic regions, specific crop
varieties have been selected, with an emphasis on leafy vegetables, pulses, tubers, aroids and fruit trees. Nutrition
gardens in the Kolli Hills are based on a crop calendar of local and other species of vegetables, greens and some
fruits to supplement household nutrition. These activities are backed by a series of nutrition awareness and training
programmes for women, households and adolescent girls.
Another important action research initiative in the Kolli Hills is the creation of on-farm livelihood diversification
activities to reduce the out-migration of tribal farm families. This is done by creating wadi farms that integrate
silviculture, horticulture and animal husbandry. Based on plot locations, the tribal farmers are grouped and
registered with a public sector bank at the Kolli Hills talukheadquarters. The farmers are advised to level, plough
and clear weeds and rocks in their plots. Facilitation with horticulture research stations and farms, veterinary and
agricultural colleges and research institutions as well as nurseries was undertaken to provide the farmers with quality
saplings of jack-fruit, clove, silver oak, mango, cashew and fodder grass as planting materials.

Another key intervention promoted in the Kolli Hills and Jeypore is vermicomposting. Farmers in Kolli Hills are
harvesting vermicompost and using the manure on paddy, tapioca, banana, coffee and pepper crops. Similar
livelihood enhancement, agriculture and food security (LEAFS) initiatives are ongoing in Wayanad in partnership
with the Kerala State Tribal Department. Several varieties of tubers, legumes, seasonal vegetables and fruit crops are
being supplied to the nutrition gardens of tribal households. Capacity building has been undertaken on various
subjects including home nutrition gardening, herbal gardening, vegetable crop cultivation, rice cultivation, bio-input
production and nursery techniques. The bio-input production units run by two women self help groups (SHGs) have
produced and marketed two biofertilizers: Trichoderma and Pseudomonas.

In order to reduce drudgery, improve efficiency and save time, the use of small farm machinery is critical for those
with small holdings. In Wayanad and Jeypore, small farm machinery, especially threshers and power tillers, were
provided to farmers groups and a team of people were trained in their use. In the Kolli Hills, pulverizers have been
promoted as a non-farm enterprise. Improved land and water management strategies have been envisaged as key
components in sustainable agricultural practices. The community has joined hands in creating open shallow wells,
rainwater harvesting through water storage structures, percolation ponds and community tanks. Bunding in the fields
was undertaken in the hilly regions and this enabled wastelands to be brought under cultivation. Today these lands
have crops of millets, maize, horsegram, niger and vegetables.
Several studies point to a growing disconnect between agriculture and nutrition. To address this, MSSRF has
conceptualized and developed a programme on an Integrated Farming System for Nutrition that is being tried out in
a village cluster in the tribal belt of Koraput district in Odisha. It involves four steps. To begin with, understand the
natural endowment base, prevailing farming systems and the nutrition situation in terms of the prevalence of
chronic, transient and hidden hunger. Then, redesign the farming system so that agricultural remedies are introduced
to address nutritional maladies, such as the cultivation of pulses and vegetables, and crop-livestock integration. Bio-
fortified crops like iron rich sorghum should be introduced to help address micronutrient malnutrition. Finally, and
most importantly, providing accurate knowledge on nutrition, sanitation, healthcare and childcare within the
community in the study area.

Integrated farming includes animal husbandry activities and pisciculture in the existing farming system. In Jeypore,
fish fingerlings of major and minor carp have been released in public ponds and are managed by local communities.
The species chosen are a combination of surface, middle and bottom feeders that efficiently make use of nutrients in
the pond. Fish raised in the ponds is provided at subsidized rates to households in the village.
Knowledge and skill empowerment is a prerequisite for sustainable development. Village Knowledge Centres
(VKCs) and Village Resource Centres (VRCs) provide location-specific and demand driven information to tribal
communities, especially on annual and perennial crops, livestock and government programmes. The VKCs are
operated by trained rural women and men with the goal of providing a host of knowledge services following the
principle of last mile last person connectivity. They also provide a platform for the scientific community to engage
meaningfully with the tribals in generating a two way process of information sharing. Operating on the hub and
spokes model, the VRC which forms the hub has satellite connectivity and telecommunication facilities that are
supported by the Indian Space Research Organization (ISRO). It provides audio-video conference facilities.
As part of its programme of enhancing social capital, MSSRF has created a cadre of community hunger fighters
(CHFs). This is an action-education model where critical awareness and desire for action among the village
communities is generated through training five representatives, men and women, belonging to different social
groups from each village. The capacity building consists of residential training on the concepts of food and nutrition
security spread over three modules which include the concept of balanced diet, role of macro and micro nutrients in
the health of human beings, hygiene and sanitation, the social causes of undernutrition and the various schemes,
programmes and entitlements pertaining to food and nutrition security. In addition, visits are organized to other
areas to gain knowledge on varied subjects such as village sanitation and agricultural practices. The CHF
programme has been initiated in 18 hamlets in the tribal belt of Koraput region of Odisha. The trained CHFs have
been provided with a certificate. Each village has come up with an action plan for elimination of hunger and
undernutrition which is then submitted to the block development officer for action.

Another initiative in the tribal belt of Koraput district of Odisha is the Mahila Kisan Sashaktikaran Pariyojana
(MKSP). This programme addresses empowerment of women farmers, who are actively engaged in agriculture,
operating in either own or family land or labouring for wages, through a range of capacity building measures. These
include grassroots institution building, sustainable agriculture and household food security. Facilitating access to
eligible entitlements is a cross-cutting activity across the three focal themes. The women farmers are brought
together in a common plat-form by grouping them into samitis of 10-20 women in each village. In 2010 the GOI in
its Union budget announced the launch of the MKSP scheme as a government programme.

At MSSRFs suggestion, the Government of India has instituted two recognition and reward systems: the Genome
Saviour Award for tribal and rural families who have conserved rich genetic diversity and the Breed Saviour Award
as recognition and reward for rural men and women for their contribution to the conservation of indigenous animal
breeds. These awards remind the world at large that far from endangering ecological security, the tribal men and
women have in fact contributed to the protection of the environment.
Based on detailed documentation prepared by MSSRF, the Traditional Agriculture System of Koraput, Odisha was
declared as one of the Globally Important Agriculture Heritage Systems (GIAHS). GIAHS acknowledges the role of
women in the origin and development of crop and animal husbandry, fisheries and forestry. Recognition as GIAHS
is not only a matter of celebrating our heritage, but could also be a pathway to achieving sustainable food and
nutrition security in an era of climate change

References:
Indra Munshi (ed.), The Adivasi Question. Orient Blackswan, New Delhi, 2012.
C. Manjula, Girigan Gopi, M.K. Nandakumar, Benudhar Suchen and C.S. Mishra, Wild Food Plants: Status of
Knowledge and Usage Among Communities in Agrobiodiversity Hotspots of Koraput and Wayanad, India. Poster
presentation made at the Dialogue on Food Security at University of Alberta, Edmonton, Canada, 30 April-2 May
2014.
Nadeem Hasnain, Tribal India. Palaka Prakashan, New Delhi, 2011.
Twenty-Second Annual Report 2011-2012, M.S. Swaminathan Research Foundation, Chennai.
Twenty-Third Annual Report, 2012-2013, M.S. Swaminathan Research Foundation, Chennai.

Unequal destinies
HARSH MANDER

AMONG Indias most dispossessed children are those born into tribal homes. Often raised close to nature in
increasingly threatened and rapidly depleting forest habitats, they are more likely than most other children in India
to be hungry and malnourished, to not receive health care when they are sick, to not enter or remain in school, and to
die too early as compared to other children, including even highly disadvantaged children who are born to other
historically oppressed groups such as the dalits.
In the year 2000, a distressing 47% children overall were underweight in India, almost one in two children. But the
story was far more troubling for Indias subaltern social groups: the corresponding figures for the proportion of
underweight children among Scheduled Castes (SCs) was 54%, and for Scheduled Tribes (STs) an even higher 56%.
According to Thorat et. al., this means that 27% more ST children were underweight compared to non-ST
children.
1
53% ST children were stunted, 29% severely, compared with 48 and 24% respectively for all children.
2

Not only is an unconscionable proportion of tribal children grossly malnourished, but their condition is improving at
a very tardy pace compared to the rest of the child population. During the 1990s, the nutritional status of non-SC and
ST children improved annually at 2.36% compared to just 1.02% for SC and only 0.24% for ST children. This
means that even as other children in India are slowly (indeed far too slowly) becoming more healthy and well-
nourished, tribal children are being left further and further behind in this land.

Such high levels of malnutrition are closely associated with a much higher probability of illness and death as
compared to other children. 96 tribal children under the age of five years die among every 1000 live births,
compared to 74 children of all population segments. Rural tribal children form 12% of all rural children between the
ages 1 to 4 years, but contribute 23% of deaths in this group.
3

After crossing their first birthday, survival chances of tribal children are halved compared to non-tribal
children.
4
What is striking is that at birth until their first year, tribal children have almost the same chance of
survival as non-tribal children. The early parity in survival chances between tribal and non-tribal children is
probably the result of healthy breastfeeding, weaning and feeding practices prevalent in most tribal
communities.
5
But these initial advantages rapidly slip down a steep slope because of the intense poverty of tribal
households, low food intake and very poor access to health care in case young tribal children fall ill.
This pervasive malnutrition of tribal children is embedded in the ubiquitous and stubborn poverty of tribal
communities. In 1983, using the National Sample Survey Office (NSSO) data, it was estimated that 46% of all
Indians were poor, but the numbers of STs who were poor was much higher, at 63%. (These estimates are based on
minimalist definitions of poverty, closer to a starvation line than a poverty line, but nevertheless are still useful for
comparative purposes across groups and time.) By 2005, whereas poverty by these estimates fell by 40% for the
overall population, it fell only by 31% for STs, according to the World Bank report cited earlier. This slower decline
of poverty among STs resulted in an even greater concentration of tribal people in the lowest income deciles.
Although they constitute only 8% of the population, their share in the lowest wealth decile rose from 22 to 25% in
these two decades.

Given this dense and persisting concentration of poverty among tribal populations, it should not be surprising that
studies confirm widespread hunger among these communities. A 2009 study by the National Nutrition Monitoring
Board (NNMB) of 40,359 tribal households in 1032 villages of nine states found that their mean intake of most
foodstuffs was considerably below the Recommended Daily Intake (RDI, which is the daily intake level of a nutrient
considered to be sufficient to meet the requirements of healthy individuals).
6

The study confirms that routine hunger is part of the lived reality of a majority of tribal children. More than 70% of
the preschool and school age children consumed less than adequate levels of both protein and calories according to
the NNMB study. For children between 1 and 3 years the most critical years for a childs nutritional foundations
the average intake of cereals and millets was 149 grams per day, against the suggested level of 175 grams. The
average consumption of pulses and legumes (16 grams) was even lower, less than half the suggested level of 35
grams per day. The average consumption of fats and oils too was very low, at 4 grams, against the suggested level of
15 grams per day. The intake of sugar and jaggery was 6 grams as against suggested level of 30 grams per day. Even
though the consumption of protective foods, such as green leafy vegetables, milk and milk products, fruits, sugar
and jaggery increased marginally, their consumption levels were grossly deficient compared to recommended levels.
Even more gravely, among pregnant and lactating women the median intake of all the nutrients was below the RDI.
7


It is evident that the nutritional deprivation of tribal children is substantially rooted in the high levels of poverty and
absolute hunger of the households into which they are born. But their nutrition is further imperilled by the
rudimentary and often completely absent public health services in areas of tribal habitation. According to Das,
Kapoor and Nikitin in their essay, The Survival Disadvantage: Mortality among Adivasi Children, in the World
Bank Report, Poverty and Social Exclusion in India, 41% tribal children who fall prey to fever and coughs receive
no treatment, compared to 27% SC children, 28% Other Backward Classes (OBC) children and 25% children of
other castes. This means that even the inadequate quantity and quality of food which tribal children get to eat is
often not absorbed by their frail bodies because of untreated aliments. It is not just tribal children but the mothers too
who are much less likely to receive health care; for instance, the National Family Health Survey 3 (NFHS-3)
reported that only 40% tribal women receive three or more antenatal care visits, as compared to 63% for non-SC, ST
and OBC women. This too has adverse implications for the health, and ultimately the nutrition of their children.
Even this sombre story of tribal child hunger, malnutrition and health neglect hides the enormity of distress and want
endured by children in several million tribal households in many parts of the country because of enormous
heterogeneity between and within the tribal population in India. The NNMB study referred to earlier points to great
variations in food intake of tribal populations between states, with tribal communities in Kerala reflecting some of
the lowest food intakes. Not surprisingly, tribal populations in Kerala have been in the news because of malnutrition
deaths, which is all the more surprising in a state otherwise noted for its high human development indicators.

The Government of India notified 73 tribes as primitive tribal groups, based on extreme vulnerability: most of
these were hunter-gatherers and practiced shifting rather than settled agriculture. The official terminology was
amended to the more politically correct particularly vulnerable tribal groups in 2006, but their condition continues
to be even more fragile than that of tribes engaged in settled agriculture. It is among the particularly vulnerable tribal
groups that I have witnessed the highest levels of starvation deaths among children during nearly a decade of work
as Special Commissioner of Indias Supreme Court,
8
related to the right to food. Children in these groups fall prey
and often succumb to routine ailments such as measles and diarrhoea, because their frail bodies are unable to battle
the onslaughts which other better nourished children are able to handle in their stride.

This barely changing grim destiny of tribal children of persisting hunger, gaunt bodies, being easy prey to illness
and early death are not just the outcome of enormous state neglect. They are the cumulative wages of something
much more culpable: their condition results from the active pauperization and dispossession of tribal communities
by state policy itself, and by the states dominant models of governance and development. This systemic and
systematic deprivation and oppression began in early colonial times, but persisted seamlessly in the policies and
institutions introduced by the Indian republic after independence, despite the relative sensitivity of Indias first
prime minister, Jawaharlal Nehru, to tribal welfare.
Early tracts by anthropologists and colonial administrators describe these isolated communities, mostly living in
remote hills and forested regions, as distinct, relatively homogenous and self-contained social and cultural entities.
These studies were mostly preoccupied with their culture and social arrangements, and dwelt less on their material
conditions of poverty, illness and hunger. However, as tribal expert Virginius Xaxa observes, although their
housing and clothing were very elementary and their survival basically at subsistence levels, desperate poverty in the
form of hunger deaths was generally absent, except for periodic episodes of famines and epidemics. Apart from
these calamitous mass deaths from time to time, Xaxa points to evidence that food and survival were not a problem
in tribal society and there was a general increase in the population. In fact, the proportion of tribal population rose
significantly from 2.26 to 3.26% during 1881-1941, whereas the Hindu population steadily declined from 75.1% to
69.5% during this period.
9

Despite their isolation and subsistence existence, tribal communities probably benefited from their free access to a
wide variety of forest produce plants, tubers and animals and their healthy young child rearing practices. That
may be why individual hunger and malnutrition of the kind visible in tribal communities today was rare. Over many
years, when I sat among remote tribal communities, old men and women often recalled that when they were children
people were much sturdier. We would run up and down hill slopes without losing our breath. We would stand on
one hilltop and call out, and our voice would ring to the next hill and the next. Today we are a weak shadow of our
past.

The greatest blow to their survival, and communal dignity, was the colonial policy of introducing state control over
forests, thereby depriving them of traditional sources of nutrition and livelihood. As Amita Baviskar described in an
essay in the World Bank report mentioned earlier, from communal owners of the forest, they became encroachers,
tenants and poachers.
10
This policy remained unchanged even after independence: of all the government
departments in independent India, the forest department most retains its colonial culture. No wonder Verrier Elwin
famously recounted that paradise for a tribal person is miles and miles of forests with no forest guard. The forests
became a major source of state revenues, and tribal people found themselves increasingly debarred from hunting and
gathering in the forests, and from their traditional systems of shifting cultivation. Soon forests themselves dwindled.
As they could no longer gather, hunt, or grow food from the past abundance of forests, hunger and penury were
natural outcomes.

Matters were further aggravated by massive forced displacements from their forest homelands, again as a direct
consequence of state policy. In the early decades after independence, the state invested in large irrigation projects,
thermal and steel plants, resulting in enormous displacement of rural populations, without any policy for their
rehabilitation. The Government of India itself estimates in the 10th plan that between 1951 and 1990, more than 21
million people were displaced by large projects, of whom 40% were tribal people. Scholars estimate displacement to
be probably thrice this number, and maybe even more if one includes people who were not legal owners of the land
and forest on which they depended for their food and livelihoods. Ekka, in an essay in the World Bank report, for
instance, estimates that between 1951 and 1995, 90% of those displaced by big projects in Jharkhand were tribal
people.
The fact that STs are just around 8% of the countrys population, but probably more than half of those displaced
from their lands and livelihoods, is not just a technical accident of geography and engineering. It is the direct
outcome of their intense political powerlessness, which nurtures a dominant public discourse in which their
dispossession is seen as a legitimate cost to be paid for the countrys development. Clearly this discourse
excludes tribal people and even more, tribal children from the imagination of a developed country. It is only as
late as 2013 that rehabilitation was legislated as a legal right of those who lose both land and livelihoods to
compulsory acquisition. I have served as a civil servant in the areas in which enormous swathes of land were
acquired for the Narmada mega dams and the Singrauli super-thermal power project, and have subsequently studied
these projects as a researcher as well. I have not encountered a single example of resettlement and rehabilitation in
which any community of displaced people has been successfully assisted to reclaim the levels of livelihood and
habitat that they lost to development projects.

Sadly their displacement was to a degree hastened by some environmental activists, who supported their expulsion
from their traditional habitats for the creation of sanctuaries and national parks for the conservation of tigers and
biodiversity. I find the binary opposition that is sometimes constructed between tigers and tribal survival to be
spurious. Tigers are not threatened by tribal forest dwellers; they have coexisted through centuries.
State policy also introduced the concept of individual land ownership, which was alien to traditional community
ownership practices. Tribal landowners have lost their lands precipitously to non-tribal outsiders who have used
fraud, usury and intimidation to dispossess them, reducing them to landless workers, often in debt bondage. Most
states with large tribal populations passed laws to prevent fraudulent and forced land transfers from tribal to non-
tribal hands, and indeed to restore land illegally and exploitatively expropriated in the past. But most of these laws
have been singularly ineffective in protecting the land rights of tribal communities, because of pervasive
administrative bias and corruption, and because tribal landowners are completely unequal to the challenge of
working the legal system to secure their rights.
And now, in the decades after India opened up to global markets, it is the large and powerful corporations which
have penetrated tribal habitats for mining and extractive industries. It is the abiding and probably fatal
misfortune of tribal people that their traditional homelands embrace the countrys richest reservoirs of coal and
minerals. The new government elected in 2014 promises an even more investor friendly regime, which includes the
probable dismantling of the few, still inadequate but hard won protections for people who lose their lands and
livelihoods to powerful corporations.

In the face of such insurmountable odds of a vigorous, even triumphalist economic model which chases ceaseless
growth built on the necessary dispossession of tribal people, and a system of governance of tribal regions which is
alien, opaque and oppressive there seems little hope to reverse the sources of hunger and malnourishment of tribal
children in the near future, and probably not even in the medium run.
I am therefore convinced that the only hope even in the medium run for ensuring tribal child nutrition and survival,
is to hold the state accountable for implementing a far more effective and pervasive programme of direct food
transfers and health care in tribal regions. The current Integrated Child Development Services (ICDS) centres, which
provide young child feeding, nutrition tracking and counselling, and health services, tend to run at best in larger
tribal hamlets that exclude many of the more remote and scattered habitations where tribal communities typically
reside. Those centres that have been established in tribal regions tend to be poorly serviced.
The ICDS in all parts of the country badly needs comprehensive reforms to make any dent in malnutrition. But since
the burden of malnutrition lies within tribal communities and as we observed there is little hope in the medium
(and sadly even in the long) run for the reversal of the larger source of hunger and malnutrition the reform of
ICDS needs to address specific paramount challenges of tribal child hunger and malnutrition.

It is true that there is no neat overlap between hunger and malnutrition, insofar as non-poor households in which
children are assured a full stomach may still have malnourished children because of poor sanitation and drinking
water. But since evidence shows that tribal children are unable to eat enough proteins and calories in seven of every
ten tribal households,
11
there should first be a strong and effective supplementary feeding programme in place
reaching all tribal children. This requires ICDS feeding centres to be opened in every tribal hamlet, however small,
and local tribal women should be employed to run them as day care centres with two full meals and a snack for
children, as their mothers typically travel into the forests for work or to collect firewood and are absent from home
for long hours. There should be appropriate complementary food available for children even below three years. In
many tribal communities, mothers carry their infant children on their backs and regularly breastfeed them. These
practices need to be encouraged and supported, with appropriate nutrition counselling.
Studies confirm that child malnutrition in tribal households sets in after the first year. We also observed that in part
this is attributable to absolutely low intake of nutritious food; it is also due to a high incidence of infections with low
chances of treatment. The state needs to ensure that a clean water source is available and functioning in every tribal
hamlet, however small. There should also be a major drive for building household toilets. And there is a pressing
need to greatly strengthen primary health services in all tribal areas. There are, of course, enormous barriers to
finding formally trained health personnel in tribal areas, and the state needs to consider some kind of compulsory
rural service for all doctors and nurses. But the experience in Chhattisgarh has been that the Mitanin programme,
which identified one tribal woman from every tribal hamlet who volunteers to work as a health guide for all families
in the hamlet, with an extensive system to train and support her, has been effective in preventing illness and helping
parents deal with basic life saving measures such as ORH therapy for children with diarrhoea.

The ICDS system is also singularly unable to identify, let alone address, malnutrition. As Supreme Court
Commissioners, we find that in most states with significant tribal populations, the ICDS system is unable to identify
more than 1% of malnourished children, whereas NFHS-3 surveys suggest the numbers to be around 17 to 20% in
these states.
There needs to be a more robust system for early detection and treatment of malnutrition as it sets in among young
tribal children. Not only does this require that all ICDS centres, even small and remote ones, are well equipped with
weighing machines, but also training and monitoring of workers. Nutrition tracking needs to become a community
based activity, involving organized groups of mothers. Community based treatment of malnutrition, with locally
produced therapeutic calorie dense food, needs to kick in universally after a child is identified as malnourished. All
primary health centres in tribal areas need to be urgently upgraded to include nutrition rehabilitation centres, to save
lives of severely malnourished children, especially those with infections which because of their poor nutritional
condition are potentially life-threatening.

All of this fully equipped and functioning ICDS centres in every tribal hamlet and their extension into day care
centres for working mothers, clean water and sanitation in all tribal hamlets, compulsory rural service of medical
practitioners, arrangements for early detection and treatment of severe malnutrition, both in the community and in
institutions would require considerable enhancement of public investment and political will. But anything short of
this will mean that even as the health and nutritional well-being of other children in the country may slowly
improve, millions of young children born into tribal households will continue to waste, be stunted, and fall prey and
succumb to minor and preventable ailments.
Until this happens, millions of tribal children will continue to suffer the highest burden of hunger, malnutrition,
illness and early death. And with its insatiable hunger for more electric power, consumer goods, new glittering cities
and untrammelled economic growth, a young and restless middle class is unable or unwilling to make the straight
connection between glitzy malls and bulging shopping bags, and the malnourishment and early deaths of many
million tribal children.

* Harsh Mander is the author of Ash in the Belly: Indias Unfinished Battle Against Hunger, Penguin, 2012.
** The author is grateful to Vipul Kumar for research support.
Footnotes:
1. S.K. Thorat, et. al., Human Poverty and Socially Disadvantaged Groups in India. Discussion Paper Series 18,
Human Development Resource Centre, United Nations Development Programme, India, 2007.
2. The World Bank, The Survival Disadvantage: Mortality Among Adivasi Children in Poverty and Social
Exclusion in India. The World Bank, Washington, 2012.
3. Ibid., p. 48.
4. Ibid., p. 53.
5. Maharatna, (1998, 2000) cited in, The Survival Disadvantage: Mortality Among Adivasi Children in Poverty
and Social Exclusion in India. The World Bank, Washington, 2012, p. 52.
6. Indian Council of Medical Research, National Institute of Nutrition, National Nutrition Monitoring Bureau: Diet
and Nutritional Status of Tribal Population and Prevalence of Hypertension Among Adults. Report on Second
Repeat Survey (NNMB Technical Report no. 25), Hyderabad, 2009.
7. Ibid.
8. PUCL vs. Union of India and Others. Writ petition (C) no. 196 of 2001.
9. V. Xaxa, The Status of Tribal Children in India: A Historical Perspective. Unicef Working Paper Series. New
Delhi, 2011, p. 17.
10. A. Baviskar, (2004) cited in Adivasis in Poverty and Social Exclusion in India. The World Bank, Washington,
2012, p. 40.
11. Indian Council of Medical Research, National Institute of Nutrition, National Nutrition Monitoring Bureau: Diet
and Nutritional Status of Tribal Population and Prevalence of Hypertension Among Adults. Report on Second
Repeat Survey (NNMB Technical Report no. 25), Hyderabad, 2009.

In conversation
Let the adivasi voice lead

HISTORICALLY, adivasi communities have best flourished in their own domain, where they had ownership of land
and forests, which they protected prudently. Sadly, when adivasis are displaced because of dams, industries or other
infrastructure, often there is either no or inadequate rehabilitation, resettlement and compensation. In Odisha and
Jharkhand where poverty among adivasis is highest, displacement has also been maximum. Weak governance is the
main reason for poverty and chronic undernutrition among adivasi children.
Adivasis rely heavily on forests for their livelihood and close to half of their daily food intake comes from the forest.
It follows that restricting their access to forests has a direct impact on their lives, nutrition status and therefore the
overall quality of health.
In the past, when adivasis lived in the forest, a wide variety of foods ranging from vegetables, fruits, milk and
animal products were available. But after moving out of their habitat, poor income has restricted their ability to buy
a variety of foods and this has had an adverse implication on their lives. Families also find it difficult to adjust to the
new food practices; unsurprisingly therefore, there is considerable deficiency in food intake.
The Constitution provides protection along with the provisions for development and implementation of welfare
programmes and schemes for adivasis. However, though there has beena lot of concentration on the development
part the protection part has not been taken care of. All the affirmative action programmes of education, health and
employment get undermined by the dominant trend in the political economy that actually throws them out from their
livelihood and where their voice unfortunately goes missing or unheard.
In order to make a difference to their lives, it is important that for some time, the larger trends in political economy
of development are altered to ensure that adivasis are really able to develop. The constitutional guarantee to provide
protection to tribals must be ensured along with the effective implementation of the different affirmative action
programmes and schemes.
The larger questions relating to land and forests should be addressed by giving tribals their entitlements to land,
forests and other kinds of resources. If they have their own voice, possibly a state of their own, and autonomy over
their territory, they should be better able to articulate their needs more forcefully. Therefore, the real issue is to
change the paternalistic mindset of the government that something good for the people is being done to ensure voice
and space is provided to them. This will help them regain their right to a better and productive life.
Virginius Xaxa
Deputy Director, Tata Institute of Social Sciences, Guwahati

Break the mould of penury
WHEN the Forest Rights Act (FRA) was passed during British rule in 1865, large tracts of forests, a community
resource for adivasis, became state property, restricting adivasis access to their main source of livelihood. It is worth
noting that colonial intervention in the systems of ownership and management of forests and land was minimal in
the northeastern states as compared to those in the mainland like West Bengal, Jharkhand, Odisha, Chhattisgarh and
Madhya Pradesh. Little surprise that in the North East, tribal communities can exercise a voice and are far more
aware of their rights.
Traditional tribal habitats, particularly in mainland India, are rich in mineral and other resources and this has
attracted mining, hydroelectric and infrastructure projects. The communities who live here have borne the brunt of
displacement as resettlement efforts have been pathetic.
The loss of habitat and source of livelihood continues to be a major cause of misery, not merely because of chronic
undernutrition in adults and children, but also because this has led to a loss of identity among adivasis.
Loss of forests and displacement has necessitated migration, in most cases as unskilled workers in brick kilns and
construction sites. Migration tells most on little children. Their hurried and forced integration into the mainstream
has left them most vulnerable. While parents work, the older children look after their siblings, living in the most
unhygienic conditions, often without food and water for long hours. At least in their earlier habitat, there was some
likelihood that children could collect edible fruits, berries, roots and flowers, but all that is lost in the new settings.
Apart from the loss of livelihood, an indifferent administration and a suboptimal public service delivery add to the
problem. Further, the prevalence of a wide range of illnesses, non-availability of safe drinking water and poor
sanitation are key factors that contribute to undernutrition in children under two. In some cases, early marriage and
early pregnancies in adolescent girls also result in chronically undernourished children. Since the young mother is
undernourished, her baby is undernourished while in the womb and in a majority of cases, stunted after birth.
Currently, the quality of public services at the balwadis and anganwadis meant to cater to children below five is
extremely poor. At least 75% of Primary Health Centres in these regions do not have a doctor or nurse. Further,
most anganwadi workers are often not adivasis themselves and live far away. Consequently, they dont have an
empathetic attitude towards tribal children and often ignore their needs.
The government has failed our tribal communities in many ways. Apart from disenfranchising them ostensibly for
industrialization, even earmarked budgets have been diverted. Even where the allocation is sufficient, the money is
either not disbursed or programmes not implemented optimally because of administrative inefficiencies. There are
also instances of the Tribal Sub Plan funds being diverted for projects of little direct benefit to adivasis. Under the
Panchayat Extension to Scheduled Areas or PESA, the management of forest land, local forests and water bodies
should be handed over to adivasi communities but the number of instances where such transfer of power has
happened is minuscule. The same goes for restoration of land to adivasis under FRA and roll out of MGNREGA, a
key source of income, which is currently inadequate.
Tribals are an integral part of our society who live under and operate a unique system. They are unfamiliar with
modern laws and find it difficult to cope with a forced move into modernization.
For change to occur, the need is for a more responsive administration. If the state governments were to ensure that
services like provision of drinking water and proper sanitation as also public health services work well, it would
make a huge difference. Anganwadi and balwadis must be made more functional and the tribal affairs ministry
needs to be more proactive in addressing the rights of the adivasis. Clearly, a special mandate is needed for them;
only then will adivasis be able to break out of poverty and discrimination and live fulfilling lives on their own terms.
Deep Joshi
Social activist; Magsaysay award winner, Delhi

The politics of disenfranchisement
GLOBALLY, India is ranked at 136 in the human development index, among the lowest in the world, and within the
country, it is our adivasis who fare the worst. They face numerous challenges and deprivation is rampant across all
communities. As a result, approximately 88% of all adivasis are impoverished.
Chronic undernutrition caused by poverty is one manifestation, particularly in children, whose life expectancy is far
lower than those of children in other groups. However, those who struggle with undernutrition caused by poverty are
unfortunately invisible.
Apart from hunger, displacement and land alienation there is another factor bondage and semi-slavery as
adivasis are forced to borrow from moneylenders after losing their land, and are often unable to repay the loans.
The biggest casualty is household food security. Across the country, inadequate availability of food has had an
adverse impact on the lives of adivasi children. Child deaths among adivasis because of lack of food have been
reported from many states, with Maharashtra recording the largest number of child deaths due to undernourishment.
Persistent hunger in adivasis continues to be a serious problem.
Even in Kerala, a state with far better social indicators, 40 child deaths were reported due to undernutrition. Here,
too, land acquisition by non-adivasis has driven adivasis into nutrition deprivation.
The midday meal scheme, usually run by womens self help groups, has in many instances been handed over to
corporations, but centralizing the food basket has created a serious problems for adivasis since most of them do not
eat rice and wheat. Their nutrition and sources of nutrition are linked to their dependence on forest and land, a
situation which is marked differently from non-tribals.
Similarly, the adverse impact on health and nutrition due to indiscriminate mining without any safeguards has been
severe. For instance, since the process of manufacturing aluminium is poisonous, the mortality is higher for those
families who live in the vicinity of such projects.
If the status of adivasis has to be improved, not only their proclivity to be in debt, but also the restoration of land that
has been lost due to debts and finally the protection of adivasi land, is imperative. The enforcement of laws
governing access to forests for adivasis must be urgently implemented along with construction of roads that can be
only used by adivasis so that they are able to reach markets and avail other services such as healthcare and
education.
There are fortunately a few instances of good practices such as the Kudumbashree initiative in Kerala. With nearly
four million members, this movement has empowered underprivileged women to address their basic needs such as
food security through employment. Today, they live a dignified life on their own terms. However, in the rest of the
country, especially in central and eastern India, even where the adivasis voices are demanding that their rights be
restored, who is listening?
Palagummi Sainath
Journalist, Mumbai

Empower local bodies in tribal areas
IT is truly unfortunate that in almost all adivasi areas, children are highly undernourished and this has now become a
generational problem. A prime cause is the mothers inadequate nutrition and malnutrition iron deficiency is very
high and very often she survives on a single staple that does not provide enough micronutrients. This results in a low
birth rate child (less than 2.5 kg) who obviously has a lot of problems. The mother is unable to feed her child well,
because she is usually anaemic and as a consequence, so is the child. Another important cause is poor sanitation and
inadequate drinking water. Even if a child has enough calories, it often has a diarrheal infection what we call a
leaky pot. Finally, there is the question of diversity in the diet. A child needs enough calories, proteins (either daal
or non vegetarian food or eggs or milk) and adequate micronutrients. What we refer what is refer to as hidden
hunger is about micronutrient deficiency particularly iron, zinc, vitamin b12.
If you want to attack this problem, you have to start with the mother a good diet for women affects the child both
in the womb and outside. We call this very critical period a 1000 day opportunity (nine months in a mothers womb
and two years outside).
The Integrated Child Development Services (ICDS) in the 70s was designed not only to look at the problem of
malnutrition but also healthcare and education. So the government delivery services and ICDS were tailored for the
child in and out of the womb. This was a holistic, life cycle approach. You cant reach a child below two in an
anganwadi you can only reach it through the mother.
In India, malnutrition is more acute in tribal areas. Here access to public services is poor; nutritional literacy is poor.
The supporting services (malnutrition is not just about lack of food) like clean drinking water, sanitation, primary
healthcare and immunisation also have to be in place. What is required is an integrated approach to what we now
call nutrition security.
Tribal areas are rich in biodiversity and in minerals mining has been a major cause for displacement and in the past
they have been treated very shabbily. When displacement is envisaged, we must give a checklist. What were the
original sources of food? Do they now have a balanced diet? Has it got the calorie, protein and micronutrient
content? The human dimensions of displacement are very serious and seldom discussed. Once you start putting faces
before figures and look at the problem in a more humanistic way, then things will fall in place.
We definitely require coordinated action among several ministries and they should deliver as one, there must be
convergence. The lack of integration and coordination is undermining the utility of expenditure. Budgets for tribal
areas are high there are many tribal area development programmes, but despite this poverty and malnutrition are
high, education is poor, children development is poor. A very important element of governance is to understand that
when you have a multidimensional problem, you cant deal with it unidimensionally.
I feel we should empower the local bodies in tribal areas. I am very encouraged by the opportunity we have to
involve local bodies in tribal areas, making the community aware of what are the nutritional problems and what are
the agricultural remedies nutritional sensitive agriculture.
Last year the then finance minister provided Rs 200 crore for nutrifarms in tribal areas and where there is a high
malnutrition burden in order to ascertain what kind of crops to grow. For every nutritional malady, there is an
agricultural remedy. We must take a humanistic view, not merely administrative or financial. I hope with a new and
growing awareness we learn to work together, have time-bound targets, and progress indicators the birth weight of
a child; the incidence of anaemia for instance. We must have the will and heart to ensure that there is nobody whose
potential is wasted. That nobody misses out on the opportunity for a healthy and productive life because of
malnutrition.
M.S. Swaminathan
Geneticist; Founder Chairman, MS Swaminathan Research Foundation, Chennai

Bring livelihoods closer home
IN our region malnutrition has many causes. But now our land has been taken away to build highways and what we
have is not good enough to cultivate, so we are able to do only a bit of farming and at a small scale. Earlier, we
would have eggs, now we cannot afford them.
When the land was taken from us, we were told that we would stand to gain, but we ended up facing more losses.
We got very little as compensation and mostly the money was insufficient and often misused. Though the law
envisages rehabilitation and restoration for adivasis, it is rarely implemented correctly. Those who have some
education save money, but a majority spend it on alcohol.
Those rehabilitated cannot cultivate vegetables and pulses in their new fields. They do not know what kind of diet is
good for children and are unable to provide the right kind of food. Government schemes have brought some
improvement in what children are being fed, but the scale is too small to make a difference. For us adivasis, the
benefits and reach of government schemes is barely visible.
Women are malnourished and have many children in a short time span. These children are born undernourished and
remain underweight. Mothers are often unable to breastfeed and give their children cows or processed milk. Denied
the immunity that breast milk gives, these children then become prone to infections. Children here are very weak
and severely undernourished.
Some parents are able to ensure that their children get proper nourishment, but in families where there is no support
system in the form of grandparents or other family members, there are problems. It is hard for a mother to take care
of children alone. At times poverty prevents children getting proper nutrition. Since there are no livelihood
opportunities, many men stay at home and are without any income.
There are no anganwadis in our village. When we requested the panchayat to set up one, we were told that since
there was a centre in the next village, we should take our children there. The distance is too much for children. So,
very few go to the anganwadi because mothers dont have time as they would rather earn some money to run their
household. Besides, in the anganwadi, all the children get is khitchri which is inadequate for growing children.
The government needs to set up anganwadis in every village so that we are able to provide good quality food that
children need. Children must be taken care of properly and not in the way things are happening now. Meals are only
given to children under three. Those below two and above three are left out. Besides, the centre is open only till 12
pm. If it was run till 4 pm, mothers would be able to leave their children at the centre and work without any worry.
Anganwadis should be strengthened so that pregnant women get more care and supplies such as iron and folic acid
tablets and take home rations where children get at least two to three meals in a day along with an iron syrup so that
malnutrition can be controlled. Only then can the lives of our children improve.
To fight undernutrition, families need work where they reside so that they dont have to migrate. We also need to
regain some of our land. We have approached the government, right up to the chief minister and asked him to shift
the security forces from our area but no one listens. All our land has been taken. Now, we are left with just one pond
where our cattle can get some water.
If only our land is restored, will we regain our lives once again.
Sanji Toppo
Field worker; from the Oraon tribe, Bhunda village, Ranchi

Bring back local wisdom
OUR lives were very different in the past along with the main crops, we grew indigenous leafy vegetables that
were nutritious and healthy. But everything changed with the introduction of new farming techniques. With an
increased demand for hybrid cultivation, such nutritious plants are no longer grown and children no longer benefit
from their nutrients. Hybrid cultivation has also destroyed seasonal vegetables that were grown earlier.
Another hazard is the use of urea which is sprayed by women who tie their little children on their backs while
working in the fields. This is harmful and a cause of ill health among adivasi women and their children.
Hybrid cultivation was initially subsidized but later became so expensive that the adivasis were forced to look for
other kinds of employment such as working on construction sites, leaving behind their basic skill farming. Here,
they face a lot of difficulties and because of their ignorance, are also exploited. When they return home after six
months or so, they find their houses broken and in need of repair. So whatever money they earned is spent on repairs
and for the treatment of those who are sick.
These are some causes that lead to poverty, hunger and undernutrition. Another health hazard is alcohol-ism; it leads
to a deterioration in health and some even die before they turn 50. In such cases their children suffer the most, as the
parents are sick and can neither treat their own illness nor educate and look after their young.
To really make a difference, the government must first increase the reach and improve the quality of anganwadis.
Currently, the required quantity of ration is not distributed either because the villages are too far away or due to
scarcity. Not just anganwadis, even government health facilities are either missing or defunct in adivasi areas.
Second, the use of local seeds and manure must increase and the use of fertilizers and pesticides should be
prevented. Third, alcoholism stands as an obstacle to any development and this needs to be addressed. Fourth, the
government should support day care centres that would look after children between six months to three years in
terms of giving them appropriate food and education. This would allow parents to go out into the fields and work,
and at the same time their childrens health would improve. Their daily struggle would end and they would get a
new lease of life.
Dildaar Hussain
Field Facilitator, Action Against Malnutrition Public Health Resource Network, Bhunda, Ranchi

* The interviews were conducted by Mohuya Chaudhuri.