Child undernutrition is significantly more severe in Bihar than in several other states in the country. One of the immediate causes of undernutrition is inadequate food intake. As the pandemic impacts livelihoods across marginalised communities, reduced food intake and food deprivation emerge as grave threats to the health and wellbeing of children in Bihar. Cooked meals provided through anganwadi centres (AWC) and the mid-day meal (MDM) scheme act as important safety nets protecting children from hunger and severe lack of nutrition. In the wake of the COVID-19 pandemic, these two services have been stopped, exacerbating the plight of one of the most undernourished cohort of children in India.
Good nutrition is not only essential for the overall growth of a child, but lack of it is also responsible for more ill-health in children than any other determinant. Undernutrition can cause serious immunodeficiency in children, making them more vulnerable to infectious diseases and these children are also more likely to suffer from non-communicable diseases in adulthood. Undernutrition is measured across three indices of stunting (low height-for-age), wasting (low weight-for-height) and underweight (low weight-for-age).
In Bihar, the prevalence of stunting in the children of the below five years group is 48.3%, making it the worst state in India. It is 10% higher than the national average. In districts like Sitamarhi and Nalanda, it is as high as 57.3% and 54.1%. In the 5-9 years age group, stunting is 28.5%, again the worst in India. The percentage of underweight children is 43.9 and 39.5% in the two age groups respectively. Again in some of the districts, it is more than 50% in the below five years group. To say that every third child in Bihar who is under nine years old is stunted and underweight would be an understatement of the actual prevalence.
Wasting is only measured in the 0-5 age group and its prevalence is 20.8% in Bihar against the national average of 21%. However, this apparent improvement over the national average is because of the increased prevalence of wasting nationally. Looking at the segregated data, it comes out that Bihar has some of the worst-performing districts in the country, with wasting prevalence as high as 30.7%.
Catastrophic impact of discontinuation of schemes
It is in this context that we should look at the catastrophic impact that discontinuation of MDM and AWC services would have for the children of Bihar. On March 13, the government of Bihar closed all the schools and anganwadi centres in the state to contain the spread of the COVID-19 infection. However, take-home rations from the anganwadi centres were to be continued. One should note that schools were effectively closed since February 17, when contract teachers began a strike to demand equal work for equal pay. Even with less than 60% coverage of the MDM scheme, nearly two crore children in Classes I-VIII benefit from these meals in Bihar.
Food being distributed at an anganwadi centre.
We found government orders making provision for monetary compensation against the mid-day meals, but there is no information available either on the government websites or in the media about any plan to do the same for the AWCs. We also spoke to some anganwadi workers who either maintained unawareness or made conjectures about any possible reimbursement.
Even the amount of money given in compensation for MDMs is egregiously low. Students in class I-V and VI-VIII get Rs.6.3 and Rs.9.5 per meal, respectively. To imagine that one can get a nutritious meal for these prices is nothing but a cruel joke on the hungry and undernourished children of the state. According to the MDM norms, this is what school children in the two groups are entitled to get in every meal:
| Ingredients | Every Day Amount | |
| Class I-V | Class VI-VIII | |
| Rice | 100 gm | 150 gm |
| Pulse | 20 gm | 30 gm |
| Vegetable | 50 gm | 75 gm |
| Oil | 5 gm | 7.5 gm |
In addition to this, children should be provided with a banana or a seasonal fruit two days a week and a boiled egg once a week. These dietary norms are already conservative and are rice-heavy to fulfil the calorie intake criteria. Nevertheless, for several of these children, a balanced diet is a luxury they can’t afford. How the government expects a parent to buy even a small portion of this diet at retail prices for Rs 6.3 and Rs 9.5 is beyond incomprehensible. It is callous, given the child undernutrition crisis that already prevails in the state.
The state is perilously ignoring the immediate and the long term impact that undernutrition would have on its children. The monetary compensation provided by the states in lieu of the mid-day meals is paltry and will most likely be of little to no help. After factoring in market prices, it would be difficult to get even rice and dal at these rates. The government should ideally home deliver rations to these children as is being done by the government of Kerala. However, if lack of human resources is an insurmountable impediment, then the least it can do is increase the monetary compensation, based on the market prices of the food items. Otherwise, reduced access to food will end up debilitating and killing more children than the coronavirus would.
Pratyush Singh is a doctoral student at the Center of Social Medicine and Community Health, JNU. Chandan Kumar is an independent researcher and holds a PhD from the Center of Social Medicine and Community Health, JNU.