At least 8.82 lakh Indian children under the age of five died of malnutrition in 2018. We rank 102 out of 117 in the Global Hunger Index 2019, which reported that around 90 per cent of children aged between six and 23 months in the country don’t even get the minimum required food. According to the National Family Health Survey 2015-16 (NFHS-4), the Infant Mortality Rate in urban India is 29 as compared to rural which is at 46 per 1000 live births, while the under-five child mortality rate is 34 in cities and 56 in villages. Stunting (low height for age) is prevalent among 38 per cent of our under-fives and the rate of wasting (low weight for height) of 20.8 percent among our underfives is the highest in the world. Reed-thin arms, the swelling from oedema distorting their body, some with distended tummies, others wheezing with pneumonia, and most of them with lacklustre eyes and scarcely able to move...this is the state of India’s children. While they may not all be dying of starvation before our eyes, millions are at risk of lifelong problems because their diet does not support their physical and cognitive development. Studies estimate that the situation will only escalate further in the years to come. Many organisations are working to address this problem besetting the next generation and its dire consequences for productivity, but is help reaching the right people? What exactly lies at the end of the chain? How do the Integrated Child Development Services’ (ICDS) outreach programmes via Anganwadi Centres actually work? Are there any success stories that throw light on how things can be done right? It’s only by investigating conditions at the grassroots level that one can get answers that present the true and whole picture. Assam: The gateway to the Northeast is rich in tea, silk and oil, and receives more rainfall than most parts of India. But many parts of the state are still underdeveloped and has a high incidence of poverty. The vulnerable groups comprise tea garden labourers, Bodo and Rabha tribes living in areas like the Bodoland Territorial Area Districts, migrant populations of the Brahmaputra floodplains, as well as predominantly Muslim communities in Darrang’s Kharupetia region. Assam is one of the bottom-five states of the country when it comes to health and hygiene. Undernutrition is rife among children, adolescent girls and mothers. The infant mortality rate is high at 48; and 38 per cent of children under five are stunted, primarily due to poor infant and child feeding practices, poor hygiene and sanitation. Fourteen per cent of children suffer from acute malnutrition, with four per cent falling in the category of Severe Acute Malnutrition (SAM). Chhattisgarh: It is one of the richest states in terms of minerals, ranking first in coal production. It is also one of country’s poorest states. A large number Fountain Ink | January | 2020 4 Photo story of inhabitants are tribal groups that often have nutrition-poor food habits, low literacy and subsistence-level economies. Besides, Maoists are active in many of the densely-forested districts of this state. According to NHFS-4, the population of Chhattisgarh has high levels of wasting (15 per cent) whereas a report by NITI Aayog shows that an alarming 37.6 per cent of children below five suffer from malnutrition and 41.5 per cent of daughters and mothers in the state are anaemic. Home visits in regions high in SAM children such as Dongargaon and other areas surrounding Rajnandgaon, and in the Manpur, Narayanpur and Kanker region gave unique insights into the issue. Jharkhand: It possesses 40 per cent of the mineral resources of India, and is rich in everything from iron ore and coal to uranium, gold and silver. It registers a higher rate of economic growth than the rest of the country, but conversely, reports show that more than 40 per cent of the population lives below poverty line, about 45 per cent of children under the age of five are stunted, and almost 48 per cent are underweight. Tribals such as Hos and Santals make up a large part of the poorest groups in areas surrounding Chakradharpur. Maharashtra: It’s India’s wealthiest and most industrialised state and the largest contributor to the country’s GDP (15 per cent). And yet, Maharashtra has vast areas where people suffer from scarcity of basic nutrients. Less than 100 km from Mumbai, Palghar district has become the epicentre of a SAM crisis over the last two decades. In 2015-2016, there were 555 SAM-related deaths, while the following year saw 475 similar deaths of children. In districts such as Nandurbar and Amravati too, the situation is dire. According to a state government missive, there were almost 94,000 children suffering from SAM in 2018, even though they assert infant mortality has been reduced by 60 per cent from 45 in 2003 to 19 in 2018. While the NFHS-4 reported that the prevalence of SAM in Maharashtra was 9.4 per cent, independent assessments suggest a higher figure. The population is largely tribal communities like Warli, Mahadev Koli, Katkari and Thaker. Odisha: Its 9.59 million tribals making up almost 23 per cent of population, Thirteen of the 62 tribal communities belonging to Particularly Vulnerable Tribal Groups (PVTGs), certain pockets of the state show an alarming rate of malnutrition. As per UNICEF data, about 57 per cent of tribal children in the under-five year segment are chronically undernourished and infant mortality among tribal communities in Odisha is 92, higher than in the rest of the country. As many as 26,184 children suffered from malnutrition and fell in the severely underweight category in 2018. State Women and Child Development (SWCD) department data shows that the number of children suffering from malnutrition is the highest in the districts of Kalahandi (3,114), followed by Kandhamal (2,887) in 2018. 
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In Amatola village, about 56 km from Rajnandgaon, all houses have gardens with creepers heavy with gourds. Despite this, children suffer from acute under-nutrition. Ankit (18 months) lies on the floor. He can’t sit up or stand up for any length of time.
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