SHIVPURI. MAFHYA PRADESH // When Neeraj Adivasi opens his mouth as if to cry, not a sound comes out of his wasted body. As he is placed on the scales at the Nutrition Rehabilitation Centre (NRC) in Shivpuri, in the central Indian state of Madhya Pradesh, the reason for that becomes apparent: at three years old he weighs the same as a healthy three-month-old should. It is a scene more familiar with sub-Saharan Africa, ravaged by war and drought. But this is India, an emerging economic power. Since 1991, when economic reforms began, India's economy has grown at an average of 6.4 per cent annually. The country now boasts a world-renowned IT industry and its big cities are home to air-conditioned shopping malls, where international brands are sold and diners can chew on sushi. One thing, however, has remained constant - the rate of childhood malnutrition. Though estimates differ, most surveys estimate the levels of malnutrition - a state in which normal bodily functions such as growth are impaired - among young children in India at just under 50 per cent, roughly the same level as 18 years ago. More starkly, that is double the level found in many sub-Saharan African countries. In some Indian states, such as Madhya Pradesh, malnutrition levels are on par with Ethiopia or Chad, at 60 per cent or more. "It's the contrast between India's economic growth and its nutritional stagnation which is shocking," said Prof Lawrence Haddad, director of the Institute for Development Studies in Britain. The institute last month released a report in which it described India as an "economic powerhouse and a nutritional weakling". According to the report, it is normal to see a one per cent reduction in child malnourishment for each three per cent rise in per capita incomes. Indeed, other nations like China managed to reduce levels of malnourishment dramatically as their economies grew. But India falls below North Korea, Sudan, and Rwanda on the Global Hunger Index, despite having much higher average incomes. It is now home to one-third of the world's malnourished children. An estimated 3,000 Indian children die every day from the effects of malnutrition, according to the UK's Department for International Development, and those who survive are often physically and intellectually stunted. Now, experts are warning that failure to combat the problem will have an impact on India's ability to sustain its rapid economic growth. The World Bank, in a report this year, calculated that malnutrition already wipes out three per cent of India's gross domestic product annually. "It's got to be one of the biggest obstacles to development," said Sarah Crowe, Unicef's regional spokeswoman. Then there is the damage done to India's international credibility. "Malnutrition is to India what human rights is to China," said one UN official who did not want to be named. India's government has repeatedly pledged to tackle the problem. Manmohan Singh, the prime minister, last year described it as a "curse that we must remove". While economic reforms have produced a middle class of 50 million people who can afford to buy consumer goods, two-thirds of the country's 1.1 billion strong population survive on US$2 (Dh7.3), or less, a day. It is the twin issues of caste and gender rights that prove the biggest bars to tackling malnutrition. A look around Neeraj's ward seems to confirm this. The listless, skeletal children in its beds are all from social groups at the bottom of India's ancient social hierarchy. Neeraj, like many of them, is an Adivasi or "Tribal", a word that is also their surname - marking out their low social status. Neeraj's father earns 900 rupees (Dh70) a month doing manual labour, but no one will offer him any other work because of his caste. This means the family can afford to eat little more than roti, or flat bread. Twice a week Kusma, Neeraj's mother, has sufficient money to buy enough lentils to make some watery daal. The only vegetables they eat are ones she finds growing wild. Neeraj survives on two roti a day and breast milk. The doctor at the NRC calculates that Neeraj has probably been receiving one fifth of what his daily calorie intake should be. His mother also gets fewer calories than she needs, meaning her milk is of little use - especially since Neeraj should be on solid foods. "What can I do?" she asks. "I don't have anything else to give him" Yet Neeraj's condition is not just due to his family's social status: it is also down to the low position his mother - like many rural Indian women - occupies within her family. Married at 16, she moved into her husband's home where his family sets the rules and controls the finances. She almost never leaves the village and her husband does all the shopping. The lack of control women like Kusma have over the well-being of themselves and their children, say experts, goes a long way to explaining why Indian levels of malnutrition are so much higher than Africa's. "In Africa, women may be discriminated against but not in ways that affect their households. They have more control over care for themselves and their children," said Dr Purnima Menon, a senior researcher at the Washington-based International Institute for Food Policy Research. "Here, so many of these decisions are made by men" Often, those decisions involve spending a large portion of the family's meagre income on tobacco and alcohol. In rural areas, women's lives can be so restricted that they are not even allowed to visit clinics. For Kusma to get treatment for Neeraj, she had to get her father-in-law to take him to the local hosptial. When Neeraj was admitted to the main NRC in Shivpuri, Kusma had to get permission from her husband to go too. "He was happy to let me come: he wanted his son to get better," said Kusma. Neeraj was lucky. Often parents are reluctant to admit their children, even though treatment is free. In the village of Silanagar last week there were several babies who required treatement but their families would not let them or their mothers go. One of them was nine-month-old Roshini, whose upper arm measured 9cm in circumference, categorising her as severely malnourished. Unicef staff tried in vain to persuade the family to let her and her mother, 20-year-old Jhanki, travel with them to Shivpuri. The local angawadi, or nursery worker, said she had been trying to convince them to send the baby to the centre for weeks but the father had resisted. "He is resisting because it is a girl child," she said. Statistics suggest this may this may be common - the mortality rate for girls aged one to four is 61 per cent higher than that for boys, according to Unicef. As dusk began to fall in Silanagar, the Unicef staff made one last attempt to get Roshini to the NRC for treatment with food designed specially for severely malnourished infants. But Jhanki, carrying her skeletal child in her arms as she and her husband left their mud and straw hut on their way to a nearby temple, refused. "If she dies, she dies," said Jhanki. "It means it was not her fate to live. We are going to the festival: there is food there, we don't want to miss it." email@example.com
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