Half the Kids in This Part of India Are Stunted

Nicholas Kristof, New York Times

Lucknow, India — I’m on my annual win-a-trip journey, in which I take a university student with me on a reporting trip. I’m traipsing through Indian villages with the winner, Austin Meyer of Stanford University, to tackle one of the world’s great whodunits: Why are hundreds of millions of children here stunted physically and mentally?

India is a vigorous democracy that has sent an orbiter to Mars. Yet its children are more likely to starve than children in far poorer nations in Africa.

In a remarkable failure of democracy, India is the epicenter of global malnutrition: 39 percent of Indian children are stunted from poor nutrition, according to government figures (other estimates are higher). Stunting is worse in India than in Burkina Faso or Haiti, worse than in Bangladesh or North Korea.

Here in Uttar Pradesh, a vast state of 200 million people in India’s north, the malnutrition is even more horrifying. By the government’s own reckoning, a slight majority of children under age 5 in this state are stunted — worse than in any country in Africa save Burundi, according to figures in the 2015 Global Nutrition Report.

The greatest cost of stunting isn’t stature but brain power. Repeated studies have found that malnutrition early in life reduces intelligence in ways that can never be regained. The brains of stunted children don’t develop properly — you see the difference in brain scans — which is perhaps why stunted children on average drop out of school early.

“We’re not focused on stunting because we fear kids will be too short,” said Shawn Baker, a nutrition expert at the Bill and Melinda Gates Foundation, who accompanied me on visits to rural areas here. “We’re focused on stunting because it’s a proxy for cognitive development, and because kids are at risk of dying.”

The win-a-trip journey is a chance to spotlight issues that aren’t sexy but matter most. And when hundreds of millions of children are unnecessarily malnourished, holding them back all their lives, that should be a global priority.

Now a couple of bold new theories are emerging to explain why India does so poorly in child nutrition.

The first is that the low status of women leads to maternal nutrition in India that is much worse than previously believed. Women often eat last in Indian households — and 42 percent of Indian women are underweight before pregnancy, according to Diane Coffey, a Princeton University economist. Then during pregnancy, Indian women gain only half the recommended weight.

“The average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy,” Coffey writes in the Proceedings of the National Academy of Sciences.

The upshot is that many children are malnourished in the uterus and never recover.

The second new theory is poor sanitation, particularly open defecation. About half of Indians defecate outside without using toilets. The result is that children pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrients — and 117,000 Indian children die each year from diarrhea, according to Unicef.

That may explain an anomaly: Infant mortality is lower for Indian Muslims than for Hindus, even though Muslims are poorer. One reason may be that Muslim villagers are more likely to use outhouses.

This is a life-or-death matter. Governments invest in tanks and fighter aircraft to defend their people, when the greater threat to their citizens comes from their own poop.

Still, few recognize the risk. Worldwide, far more people have access to mobile phones than to toilets. That’s because phones are seen as the higher priority. In the villages that Austin and I visited, villagers routinely had mobile phones, but very few had outhouses. Even fewer used them: It’s easy for aid groups to build latrines, harder to get people to use them.

One woman we met, Sahliha Bano, is a villager with an 11-month-old girl named Munni, who is acutely malnourished. The family doesn’t have a toilet (few in the village do).

Bano herself reflected other factors sometimes associated with malnutrition. She is illiterate and was married at about 14, and Munni is her sixth child. Bano rejects birth control because she believes it is against God’s wishes.

These are complex issues, but if Afghanistan and Bangladesh can make great progress (along with Indian states like Kerala), so can all of India. Manmohan Singh, India’s former prime minister, called child malnutrition “a national shame” — but there’s still no political will to address it.

Instead, in a political move to win support from religious groups that object to eating fertilized eggs, the state of Madhya Pradesh recently rejected the idea of serving eggs in child-feeding programs. The result will be more children added to the hundreds of millions held back unnecessarily for the rest of their lives — as a great nation weakens itself.

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