Delhi`s Children. Summer 2011 - Save the Children`s Resource Centre

EVERY ONE
SUMMER 2011
Gurinder Chadha visits
the Delhi slums
Shabana Azmi speaks
out about India’s
invisible mothers
Jharkand: a model
for reducing
child mortality?
Delhi’s
children
Acclaimed photographer Raghu Rai
captures their plight
Welcome
Here we bring to you the new, exciting Summer issue of EVERY ONE
magazine. Thank you all for your feedback. This has helped us to
make it even more engaging.
The year began with renewed resolve to further our efforts to
benefit the children we work for. The campaign had an exciting
start, with the Save the Children team taking part in the Jaipur
Literary Festival to highlight our campaign activities, alongside
authors, artists and participants. We also made our presence felt at
the Indian News Television Awards, where over 500 media people
stood up in silence as a show of support.
While public and celebrity support is vitally important, it is also
crucial to have community voices at the centre of what we do. In
this issue we hear a mother speak about the time she lost her child
because she could not afford medical care. She raised a poignant
question, fighting back her tears: “Why do we have government
hospitals if they do not help the poor?” It is a harsh reminder that
we have miles to go before we sleep.
Throughout the magazine, we also take you closer to the issue
of child survival through news, features and editorials. We include
stories from the villages of Bihar and Jharkhand. There’s an article
by our celebrity supporter Shabana Azmi, plus an interview with
film director Gurinder Chadha on her recent visit to India.
Our efforts will continue to carry voices from the villages to the
corridors of power. And we will rely on your support to press for
change for India’s children.
08
10
Pragya Vats
Campaign Manager
[email protected]
22
contentS EVERY ONE SUMMER 2011
UPFRONT
04 News and views
Shabana Azmi on India’s invisible
mother and much more...
FEATURES
08 Health Worker
Looking at life through the eyes of a
community health volunteer
10 Bihar shocks
We investigate a place where the
disparity between economic growth
and child mortality is staggering
EVERY ONE/SUMMER 2011
16 Raghu Rai
A snapshot of life on the streets
for Delhi’s children through
this acclaimed photographer’s lens
22 Lessons learned
Strategies for cutting child mortality
from Jharkand, a place that’s in the
news for all the wrong reasons
PEOPLE
26 Back chat
CONTACT US
Get involved
n Tell us what you think about the
issues discussed in this magazine:
[email protected]
n Check out the EVERY ONE India
microsite: http://every-one.in/
n Visit the Save the Children India
website: www.savethechildren.in
Director Gurinder Chadha takes time
out from movie making to visit the
Delhi slums. Here we find out why
03
UPFRONT: NEWS
FOTO: Xxxxxxxxx
“Child Mortality:
Does it actually
matter what
the middle
classes think?”
Ben Hewitt at Save the
Children gets riled up
about our need to mobilise
the middle classes – and
points to a sense of hope
A RECENT survey reveals that eight out of
ten people among the middle-classes in cities
across India underestimate the levels of child
mortality. Although nearly 60 per cent
of those surveyed felt that the problem of
child mortality was “very serious”, a staggering
eight out of ten did not know that nearly 2
million children under the age of five die every
year. This is the highest anywhere in the world.
This is a crucial insight for Indian
organisations like Save the Children, who
have made it their mission to tackle these
high levels of child mortality. But does it
actually matter what the middle classes think?
Well, we think it does.
The middle class in any country hold a hugely
influential role in society. And at the moment
there is very little pressure from this group
for change. This is largely due to a lack of
awareness of the scale of the problem and
a general feeling this is not affecting them.
There is also little knowledge of how
simple the solutions are. We don’t need a
major expensive technological breakthrough.
We simply need skilled personnel available
to support mothers during childbirth, early
postnatal care, preventive and curative
treatment for pneumonia, diarrhoea and
malaria; and support for nutrition, including
exclusive breastfeeding. Other countries –
many of them poorer than India – are making
dramatic changes. And the performance of
some of India’s states, like Kerala and Tamil
Nadu, shows what others could accomplish by
pursuing similar approaches.
We might now be saving tigers or turning off
our lights, but we still haven’t taken to heart
the fate of our own children – this is unusual for
a nation that prides itself on its love of children.
04
For campaigners, this is a challenge. We
need to bring child and maternal survival in
to the discourse on economic growth and
national pride. Surely rates of mortality are
a much more telling indicator of development
progress than per capita income. We need to
be linking the child and maternal survival
cause to questions like, ‘What are the rewards
of economic growth, if we’re not creating a
better society?’.
The Government’s 12th Five Year Plan is
the right moment for India’s political leaders
to demonstrate leadership on this issue. The
change needs to happen in every village, district
and state with high child mortality. And there
needs to be pressure for this to be a national
political priority.
If the middle classes were to mobilise around
this in support of a real social movement
from States and Districts across the country
in support of all mothers and children, faster
change is made possible.
This is why organisations working to tackle
child and maternal mortality are working
alongside politicians, business leaders, media,
film makers, celebrities and musicians to make
the issue heard. We are trying to link the more
affluent communities to those facing the reality
of high child mortality.
It is encouraging that when faced with the
information about the scale of the problem, 74
per cent of those surveyed said they would be
somewhat likely or very likely to do something
about child mortality, and 83 per cent had hope
that the situation can be fully solved.
We are seeing evidence of this already. Save
the Children’s own Facebook network in India
includes thousands of young new supporters;
our twitter campaign to help children hit by
the emergency in Leh was supported by
Bollywood stars and generated thousands
of hits on our donation pages; schools and
colleges are starting their own campaigns
about the issue, and new partnerships with
media and businesses are raising awareness
across the country.
With the spirit for progress that currently
exists it is truly possible for India to become a
child survival champion and show the rest of the
world how to bring about large-scale changes
that save the lives of mothers and children. n
music for change
An ensemble of around 100 drummers and
string musicians from across the country
let the crescendo of their music do the
talking in a special concert at Purana Quila
in Delhi, playing together to highlight
the urgent action needed to meet the
Millenium Development Goals.
Save the Children was represented by
two community members, Sangeeta and
Sunita, who presented the Civil Society
Charter of Demands and shared the stage
with Ms Sayeda Hameed and actor Preity
Zinta. The event was aired live on Zee
News and Doordarshan.
“We are so happy to share the platform
with Syeda Hameed and Priety Zinta,”
beamed Sangeeta and Sunita. Sunita is
an inspiring mother who benefitted from
Save the Children’s health work in Sanjay
Colony and Sangeeta is a health worker.
EVERY ONE/SUMMER 2011
Community mothers demand
action from the government
Nearly 1000 mothers across Delhi, Rajasthan, West
Bengal and Bihar shared their challenges before a
panel of experts in advance of a global meet on the
issue of Maternal and Child survival held in Delhi.
One mother, Munni Devi, took to the stage and
shared her experience. When her child had a fever
she rushed her to a government hospital. She
was asked to pay for her medicines but couldn’t
afford them. Later that night her child died. She
fought back tears and asked, “Why do we even have
government hospitals if they do not help the poor?”
Dr. Syeeda Hameed, member Planning
Commission, revealed the first public commitment
to child survival after the event: ”1 per cent of gross
domestic product (GDP) is allocated to healthcare.
We propose to allocate 2-3 per cent.”
Munni was refused treatment and asked for
a bribe. She gave one bribe but was still not
treated, so went home to give birth in the slums.
Celebrity television anchor Natasha Kaplinsky
sees Save the Children India’s work first hand
Natasha Kaplinsky, a popular face on British
TV and a mother of two, visited India along with
Justin Forsyth, Save the Children UK CEO. The
three-day trip gave them a glimpse of government
healthcare facilities and showed how communities
in the slums of Delhi and rural Rajasthan live.
Justin and Natasha visited one of the biggest
government healthcare facilities in the national
capital, Safdarjung Hospital, where they witnessed
the birth of a baby. They also visited Tonk, a village
in rural Rajasthan, where Save the Children runs a
baby centre where mothers can take their children
for advice on nutrition and illnesses.
Deeply moved, Natasha later wrote a blog for
a UK tabloid: “Like every mother, I think my
children are the most beautiful in the world
– fragile treasures to be cosseted against the
dangers life throws at them. Yet, standing in
India watching the women queue with their
babies for vaccinations, it struck me how different
two lives can be. The things I fuss about in
everyday life are suddenly so insignificant.”
News in brief
Filmmakers
put on a show
Save the Children partnered with the
UN millennium campaign, Oxfam
and Wada Na Todo in organising a
two-day film festival called ‘Eight’,
which showcased eight films on the
Millennium Development Goals.
These films were directed by
international filmmakers Mira Nair,
Gael Garcia Bernal, Abderrahmane
Sissako, Jan Kounen, Gasper Noe,
Jane Campion and Wim Wenders.
Bollywood actor and EVERY ONE
campaign supporter Kunal Kapoor
inaugurated the film festival.
Celebs come together
The mother’s day special event, ‘Walk
with the Angel’, bought together a
large group of eminent personalities,
such as Dr. Najma Heptullah
(member, Rajya Sabha), Feroze
Gujral (model and media personality),
Lushin Dubey (theatre actor and
director), Sonalika Sahay (model)
and many more. All of these mothers
appealed for more heath workers in
the country. When institutional care
is not available or poor in quality,
it is critical to have health workers
rooted in the community to reach
out to mothers and their newborns.
Many also made individual pledges
as part of their commitment to
support the cause.
Say it with art
Ben/Save the Children, Children photo: Zishaan/Save the Children
On Mother’s Day, Save the Children
– in partnership with Department
of Women and Child Development
and the Govt. of Rajasthan – brought
together seven female artists for a
three-day Artist Camp called ‘The
Shades of Motherhood’.
Renowned Sculpture Artist
Padamasree Arjun Prajaapati
demonstrated the art of clay
modelling through Mother and Child
sculpture and called it ‘Vatsalya’.
Chief Minister of Rajasthan,
Mr. Ashok Gehlot invited Save
the Children representatives and
the women artists to exhibit the
paintings at his residence. It was an
opportunity to brief the Chief Minister
about Save the Children, especially
on Newborn and Child Survival.
Deeply moved by the paintings,
the Chief Minister interacted with
the artists to understand the mood
and theme of each display. At the end
of the event, he pledged his support
for the cause. The sculpture of
Mother and Child was gifted to
the Chief Minister.
EVERY ONE/SUMMER 2010
05
UPFRONT: NEWS
FOTO: Xxxxxxxxx
Celebrity mothers come
together to voice their concern
over the growing number of
children dying in India as a
result of malnutrition and lack
of basic healthcare facilities.
These stories tell you why...
SURMA, MOTHER OF
PARMESH, RAJASTHAN:
“I had one son, Parmesh, but I lost
him about four months ago. He
was four years old and he was in
school, in class 1. He liked to study.
He doesn’t like to be in the fields.
He just liked to go to school and do
his homework. I was happy when he
learned to write his name, started to
talk some Hindi and started to learn
ABC. He got sick one day. We didn’t
have money to pay for doctor. It took
time to arrange money and he died.”
SANGEETA DEVI, BHADASH
VILLAGE, BIHAR:
“My first baby was born at home and
died because of unsafe facilities.
I did not know of hospitals then.
There were no facilities available for
deliveries. That’s why I lost my child.
We also didn’t go for vaccinations.
We didn’t know about vaccinations or
hospitals then.”
PROMILA, SANJAY COLONY, DELHI:
“I wanted to have my baby at home.
My husband didn’t allow me to
go to a hospital. Hospitals are no
good, they treat us quite badly and
cost money. If they are so good,
why couldn’t they save my son? We
lost my son Arjun to pneumonia
or typhoid. I don’t remember what
they said. They couldn’t save him.
I lost the child before Arjun just a
few hours within delivery. They told
me the baby was upside down in
my stomach and he didn’t come out
properly. But the hospital could have
done more for Arjun. He was only
three months old when he died.”
MANJUSHA DEVI, PEERNAGRA
VILLAGE, BIHAR:
“At the time of my first delivery, my
baby died after 5-10 minutes. I didn’t
know what happened to the baby and
why the baby died. During my first
birth there was no ASHA here. I
didn’t know why my baby died. For
my second baby the ASHA was here
and we got knowledge and we went
to the government hospital. This
helped to make sure the mother
and baby remained healthy.”
06
Media fraternity stand
in silence in support
of child survival
Save the Childre participated at the Third News
Television Awards. The event brought together the
who’s who of the media world and took place at
a glittering evening at the Convention Hall of Hotel
Ashok in the capital. The emcees of the award were
the duo Kavita Kausik and Manish Paul, popular
faces on Indian television.
Save the Children was promoted as a cause
partner in all their branding, including web space,
and the campaign film was shown repeatedly.
Talking about Save the Children’s campaign,
the emcee urged 500 odd participants to stand
up in support of the cause.
All stood in silence to rue the fact a child
dies almost every 17 seconds in India because of
reasons ranging from diseases to malnutrition.
A festival with a social message
Save the Children participated in the Desert
Festival in Jaisalmer and organised interactive
puppet shows and displayed messages to
spread the importance of care for mother and
babies in order to reduce child mortality.
Health and hygiene issues like
immunisation, diet for pregnant woman,
institutional delivery, early and exclusive
breast feeding, malnutrition and handwashing practices were covered in these
shows.
Also present on the occasion were
authorities from the Border Security Force
(BSF), Air Force, RTDC and the District
Administration. The event garnered
impressive media coverage.
EVERY ONE/SUMMER 2011
India’s invisible mothers
Shabana Azmi acclaimed actress and social campaigner
It’s a little known fact that Mumtaz
Mahal, Moghul Emperor Shah Jahan’s favourite
queen, died due to complications related to
repeated childbirth. The Taj Mahal, for all its
beauty, is a grim reminder that even today
there are thousands of women in the country
who continue to die during childbirth.
Even after 400 years we seem to have done
little to improve the health of mothers in our
country. India is a country that lives in several
centuries simultaneously, and so it is with
maternal health.
If statistics are anything to go by, we have
more than 68,000 women in our country dying
every year in childbirth, so in India a women
dies while giving birth every eight minutes.
So, on the one hand, India is marching into
the 21st century with its head held high as it
becomes a global power. And on the other, a
new report from Save the Children says India
ranks number 73 out of 77 middle income
countries when it comes to the ‘the best place
to be a mother’.
That’s really shocking. The number of
women we lose due to pregnancy related
issues in one week in India is more than all
of Europe in a whole year. If I were to say it in
different words, the number of women we lose
Our neighbours Nepal and Bangladesh have
made remarkable progress. Deployment of
50,000 Female Community Health Volunteers
has helped Nepal cut maternal deaths by half
in 20 years and be on track to meet the UN
Millennium Development Goal 4 of reducing
childhood mortality by two thirds by 2015.
Bangladesh has already cut under-5
mortality by 64 per cent since 1990, and is also
on track to meet the goal of reducing child
deaths by two-thirds. Female fieldworkers
who make home visits have played a critical
role in delivering family planning services and
reducing the number of high-risk pregnancies
in Bangladesh. In another project supported
by Save the Children, home visits by female
community health workers reduced newborn
deaths by 34 percent in rural communities.
This cannot be dubbed a health issue alone,
though. We also need to invest in education of
girls because there is a definite link between
status of women, literacy levels and health. So
we need to invest in our girl children and we
need a commitment to our mothers because
that is the only way our country can move
forward in real terms.
What is shocking is that we can often
become numb to large numbers and worse
still, this becomes sidelined as a ‘women’s
issue’. It ends up as nobody’s concern. Who’s
agenda should it be – women’s or society as a
whole? EVERY ONE’s. Women cannot wait.
Shabana Azmi supported our
petition for an increase in
healthcare investment at the
recent Budget.
“The number of
women we lose each
year due to pregnancy
related issues is the
same as having 400
air plane crashes”
in one year in India due to pregnancy
related issues is the same as having 400
plane crashes.
But because it is the poor rural women
who are dying, nobody is paying any attention.
Surely, this must change. Surely, we need
to focus on giving our mothers the best
healthcare possible, and women need to be put
on the frontline of the healthcare programme if
this country is to make any true progress.
There is also a critical role for female health
workers in the fight to reduce maternal,
newborn and child mortality. Evidence shows
that countries that train and deploy more
frontline female health workers have seen
dramatic declines in maternal, newborn and
child mortality.
EVERY ONE/SUMMER 2011
07
Hard graft: Kumari
feeds one-year-old
Shivam. Each day she
knocks on 40 to 50
doors to meet and
advise pregnant women
and mothers about
keeping healthy.
Making a
difference
How investment in one health worker can
positively impact the whole community
08
EVERY ONE/SUMMER 2011
Case Study
I’m 27 and a community
health volunteer. I live in Sanjay Colony. Here, I give
pregnant women and children under two healthrelated information. I weigh them and monitor their
height and weight, and I inform communities prior
to the mobile health clinic’s arrival. That means
people who are sick can be treated properly and get
medicines easily.
There are very few hospitals, and the ones that
are around are private. There are quacks (untrained
doctors) but no qualified doctors in the community,
and if people go outside the community it costs
them a lot of money. Because of that they can’t get
proper treatment for themselves or their children.
For pregnant women, the distance to hospital is an
important factor, meaning they can’t go at all. These
are the health issues we face here.
Since July I’ve been working as a community
health volunteer, and it’s really great that I’m able
to give people information that helps them lead a
more hygienic life. They’re getting their kids proper
treatment, they’re going to the right doctors and I
like that. All these things make me feel good.
My name is Sangeeta ,
Small things, huge difference
One thing that used to bother me was that people
weren’t aware of basic health and hygiene. That
encouraged me and made me go out and raise
awareness. There were widespread cases of vomiting
and diarrhoea, and mothers were running to the
doctor every other day with sick children. It really
made me sad seeing children getting sick all the time
and people not knowing what to do. Now that I’ve
gained more knowledge I find it easy to spread the
word. All this encourages me to do what I do.
People are getting their children vaccinated, but
before they didn’t. Now they know that if they don’t
give their children a vaccine the child will get ill.
They know which vaccines a child should get up to
the age of five. They also know why the mother’s
milk is best for the baby in the first six months. They
used to give the baby water and other things, but
now they know that if they give anything other than
the mother’s milk the baby will become ill. They now
know the reason for these diseases. All these things
give me a lot of satisfaction.
There’s been a big improvement through my work
because people have changed their ways. There are
fewer infant deaths. Before, they didn’t keep their
houses clean and hygiene was quite poor, but now
they do and their surroundings are cleaner than
before. They know that if they clean their house the
child won’t get sick.
community who can provide all kind of information
about healthcare That’s why a community health
worker is hugely important.
Sanjay Colony is my area and I do around 40 to 50
door-to-door visits a day. I follow a system where if
I’ve done here to here on one day, then the next day
I’ll do the other side. I try to cover as large an area as
possible in a week or 10 days. I try to cover 2000-2500
houses in the community. I generally go around after
9.30 or 10am because by then everyone’s finished
their household chores. It’s easier for me to meet
with them.
Suppose we see an infant in the house that’s a
day old baby, then we provide information to the
mother on the advantages of exclusive breastfeeding.
We’ll talk about immunisation and we tell pregnant
women when to get check-ups done, why they should
take folic acid and iron tablets, how it benefits them
and the importance of tetanus injections. We then
talk about the importance of hygiene. If we meet
old women or mother-in-laws we tell them how to
take good care of their grandchildren. Or, if we come
across STI (sexually transmitted infections) patients
we can tell them how to get proper treatment and
what the consequences are if left untreated.
At our door-to-door visits we place emphasis on
general healthcare, what to eat and drink, what to do
and what not to do so your child stays healthy.
Whenever I step out, someone or other meets me
and along the way I give them health information.
Everyone around here knows me. All the old people
and the young children, and I feel really good. I’m
walking around and kids stop and talk to me.
I’d like to thank all those people who are
supporting us because it’s only with their help we’re
able to save children’s lives in this area and the death
rate is going down. n
Mobile health: Save
the Children supports
a mobile health clinic
that visits communities
once a week.
Passion for life
I really hope to continue to work like this in the
future so that no child dies. Our role as community
health volunteers is very important. If we don’t
work on raising awareness of healthcare and
hygiene, then day by day the number of deaths of
both mothers and children will only increase. If
they don’t have a guide, someone to show them
the way then the community will suffer. And it
won’t be just one community’s problem but every
community’s problem.
There should be at least one person in every
EVERY ONE/SUMMER 2011
09
Shocking stats: Out of every 1000 children born
in Bihar, 85 die before their fifth birthday. A third
of deaths are because of malnutrition. Here,
children in Bhadash get food every day as part of
a preschool programme run by the government.
Bihar:
The Inequality
Conundrum
Feature
Despite staggering
economic growth,
Bihar has one of the
highest rates of child
mortality in India.
We investigate why...
Shireen Vakil Miller is
the Advocacy Campaign
and Communication Director
at save the children. here
she shares her comments...
Bihar ha s been in the news recently for recording
an average growth rate of 11.3 per cent for the
period between 2004 and 2009. Much has been
written about the quality of governance and the
improved state of roads. This is commendable, and
no mean feat for a State that had almost become a
“development outcast”.
On a recent trip to Bihar I was pleasantly
surprised to note the great improvement in providing
schools and the huge effort made to tackle the
complex issue of child labour.
The script for Bihar’s success story is incomplete,
though. The State has the dubious distinction of
having one of the highest rates of child mortality in
India. Out of every 1,000 children born in Bihar, 85
will not live to see their fifth birthday (according
to the third National Family Health Survey). The
deaths of a third of these children are associated
with malnutrition. In fact, the Citizen’s Alliance
against Malnutrition states that over 58 per cent of
children in Bihar are malnourished. And the State,
despite spending crores of rupees on improving the
roads, has failed to utilise funds allotted to it under
the Integrated Child Development Services (ICDS),
which is mandated with tackling under-nutrition
among children under six years of age.
The anomaly between impressive economic
growth and the appalling rates of child mortality
and underweight children is not peculiar to Bihar.
The country as a whole has recorded an impressive
economic growth (real GDP per capita grew by 3.95
per cent per year between 1980 and 2005). Yet, the
percentage of underweight children under 3 went
down by just six per cent from 52 per cent in 1992-93
to 46 per cent in 2005-06. Evidence suggests that
for every 3-4 per cent increase in per capita income,
underweight rate should decline by one per cent. This
has not been the case in India.
At the present rate of progress, India will reach
the Millennium Development Goal 1 target on
eradicating extreme hunger only by 2043. Surely
we can’t wait that long?
Community help:
Anganwadi worker
Sangeeta serves
food to the children.
In spite of impressive
schemes like the
Integrated Child
Development Scheme
(ICDS), there has been
no major impact.
Helpless: Rambha and her baby girl Rani.
Rambha lost a baby girl to what she thinks was
malnutrition. She worries about the health of
her one year old Rani, who is also quite thin, but
says there is nothing she can do.
16
EVERY ONE/SUMMER 2010
Simple facts: Malnourished
children are more likely to die
as a reΩsult of common and
easily preventable childhood
diseases than those who are
adequately malnourished.
Feature
At the present
rate, India will
reach the Millennium
Development Goal of
eradicating extreme
hunger by 2043. Surely
we can’t wait
that long?
”
”
Follow through: India has good policies and schemes in place but poor
implementation leads to poor impact.
As we move to greater economic growth rates, the
challenge we face is to make this growth more inclusive.
Children especially must see the benefits of this growth
now if we are to sustain economic growth in the future.
The reality in 2011 is that almost 50 per cent of India’s
children are malnourished. In the nation’s capital alone,
42.2 per cent of children under five are stunted and a
shocking 26.1 per cent are underweight.
Malnutrition stunts physical, mental and cognitive
growth and makes children more susceptible to
respiratory and diarrhoeal illnesses. Malnourished
children are more likely to die as a result of common and
easily preventable childhood diseases than those who are
adequately nourished. According to a UNICEF report,
1.95 million children below the age of five die annually in
India, mainly from preventable causes that are directly or
indirectly attributable to malnutrition. The children who
survive the ravages of malnutrition are more vulnerable
to infection, do not reach their full height potential
and experience impaired cognitive development. This
means they do less well in school, earn less as adults and
contribute less to the economy.
Share the wealth
While we have impressive policies and schemes such
as the ICDS, these have not made a significant impact.
The ICDS needs to reach the poorest and most excluded
groups who need it the most, both in rural and urban
areas. This is not the case, however. Only 28.4 per cent
of children under six are able to access services provided
by an anganwadi centre. Just in Delhi alone, for example,
only 8.4 per cent of children under six have accessed an
anganwadi centre.
India spends less than five per cent of the annual
budget on children. The 2009-10 Union Budget
earmarked 4.15 per cent on children! This, in a country
where 447 million people are aged 18 and below! Of the
14
total budgetary allocation on children, a mere 11.1 per cent
is for child health schemes.
It is the poorest children in the poorest communities
who experience much more malnutrition than their
better-off counterparts. And yet, existing national
nutrition plans barely tackle the socio-economic causes
of the problem.
There is an assumption that economic growth will
solve the problem of malnutrition but, in fact, economic
growth often fails to reduce poverty. The economic causes
of malnutrition are set to deepen: food prices remain high
and are expected to stay high, the economic downturn is
pushing millions more into poverty and climate change is
causing an increasing number of extreme climatic events
that devastate livelihoods and lead to destitution.
Looking to the future
We have good policies and schemes in place. The time
has come to implement these and more importantly,
monitor their implementation. A task group on nutrition
was set up by the Prime Minister’s Office in October 2008
but it appears that it has not yet met. We know which
districts are hardest hit. We need to reach those districts
and build the capacities of local health and nutrition
workers to deliver effective services. We need to ensure
greater convergence between the ministries that have
responsibility for tackling malnutrition so that we have
integrated plans at the district and panchayat levels to
reach the communities that need it the most.
In the third century BC, Patna was the greatest city
in India; the seat of the Maurya dynasty with Emperor
Ashoka at the helm. Ashoka was arguably one of our
greatest and most forward-thinking leaders, who believed
in inclusive development. If Bihar pays attention to social
development and ensures its economic growth benefits its
most excluded groups and minorities, it may yet again lead
the way for other States. n
EVERY ONE/SUMMER 2011
Feature
National shame: India has a vast burden
of malnutrition among children and
mothers, and the Prime Minister has
called it a national shame.
Good results: Pinky
Devi received the
food ration from the
Anganwadi worker
for her son Satyam
Kumar who was
malnourished.
Now he is well.
Poverty in India
According to the World Bank, nearly 42
per cent of the population in India live in
absolute poverty, which means they survive
on less than 1.25 US dollars per day.
That means that one third of the world’s
poorest people live in India. Almost half of
all children in India are underweight.
The Indian government’s estimate,
however, is that this figure is barely 30
per cent, the reason being that they set a
limit for absolute poverty at an income of
approximately 0.40 US dollars per individual
and day. Almost half of all children in India
are underweight.
The world
The differences between the poorest and
the richest are increasing in more than half
the countries in the world. However, if this
imbalance is measured in the world as a
whole, it becomes apparent that it is larger
globally than in any individual country.
Of the world’s population, the richest per
cent earn as much as the combined
earnings of the poorest 57 per cent.
The 25 million richest people in the USA
have a higher income than the combined
income of a third of the world’s population.
Source: UNDP
15
Photo feature
16
The shocking truth:
Street children in Delhi,
where the infant mortality
rate has doubled in the
last two years. Do the
children pictured here
really have a fair chance?
C
Barn 1/2010
Photographer Raghu
Rai has spent over
four decades charting
the changing faces of
India, from Mrs Gandhi
and Mother Teresa to
the victims of Bhopal.
In these images he
visited the Delhi slums
on behalf of Save the
Children to capture the
critical health issues for
the people living there
WORDS: Rajdeep ROY CHOWDHURY
Delhi’s
Children
Barn 1/2010
17
Railway children:
Migrant families
come to Delhi in the
hope they will make
more money to
support themselves
and their children.
The reality: they end
up pitching camps
next to dangerous
railway lines.
The gift of
knowledge:
Minika does not
know her baby is
malnourished. The
main underlying
cause of child
deaths is undernutrition.
18
EVERY ONE/SUMMER 2011
Photo feature
Overcrowding: Crowded
living spaces in Sanjay
Colony, where a single
room serves as the
kitchen and bedroom.
The smoke from indoor
cooking can cause
pneumonia in children.
India has the highest
number of cases of
childhood pneumonia
in the world, accounting
for over 19% of all
newborn deaths.
Basic human needs: A child drinks
water from a pump outside Bhagwanpura. The lack of hygiene, mainly due to
poor access to water and sanitation, is a
direct cause of high child mortality rates.
Water torture: Family life under the Okhla flyover in New Delhi. There is no water and sanitation. Diarrhoea
transmitted through faeces-infected drinking water is the biggest killer of children under five in India.
EVERY ONE/SUMMER 2011
19
Wealth inequality:
Families living under
the Nehru Place
flyover. Nehru Place
is a business district
located in Delhi’s richest
locality. Under-five
mortality is 300% higher
in the poorest 20%
of the population
compared to the richest
20%. Every child is
born with the right to
survive – but not an
equal chance. In reality,
children in the poorest
communities of India
are most likely to die.
Rations: This single
water source serves a big
cluster of families. Water
flows here for only forty
minutes every morning,
before it is switched off.
No turning back:
Anil is eight or nine
months old, but he
is the size of a twomonth-old. Without
adequate nutrition,
the body makes a
choice – it decides
not to grow so that it
can stay alive. After
the age of two, any
growth slowdown
as a result of
malnutrition cannot
be reversed.
20
The message: EVERY ONE of
us can play a part in relieving
child poverty. EVERY ONE of
our goals is achievable.
Tough start: Sunita is glad to be in a public
hospital where she can receive professional
care for the birth of her baby. She is one of the
lucky ones. India ranks 73 out of 77 middle
income countries in an index of ‘best place to
be a mother’ according to Save the Children.
EVERY ONE/SUMMER 2011
It’s the young that
suffer: Sheila’s child
was only 1.7 kilograms
at birth. One in three
malnourished children
in the world is an Indian.
Photo feature
Save the
Children would
like to thank
Raghu Rai,
India’s most
celebrated
photographer,
for capturing
these images.
Raghu Rai has
played his part
in the campaign.
It’s time for
EVERYONE
to join in.
EVERY ONE/SUMMER 2011
09
”Amazingly, they have
witnessed a 45 per
cent reduction in
newborn mortality ”
Insight
Lessons in
cutting child
mortality
From Jharkhand, we find tales of change that spell
new promise for women and children
writer: divya gupta
Divya Gupta is an independent journalist who
works with Save the Children to raise awareness
of issues around child mortality
L argely thanks to recent news reports, Jharkhand’s
West Singhbhum district conjures up certain images
in the mind – Naxalite-dominated, tribal-populated,
mineral-rich… From distant and urbane Delhi, it
sounds like the badlands.
A three-hour drive from Ranchi to Chakradharpur
town, or ’CKP’ as it’s known in the district, presents
an entirely different picture. A tranquil and lush
green landscape reveals itself along a seemingly
endless natural tunnel formed by sal and banyan
trees that flank an undulating and windy road. No
other car or person is visible for a mile at a stretch
sometimes. Barring the occasional slowdowns at
security checkpoints manned by personnel in khaki
uniforms, there is no visible sense that what has
been termed India’s “gravest internal security threat”
may be inches away in the woods.
It is to counter a more visible internal threat that
West Singhbhum and its neighbouring districts have
been positively cited of late...
Between 2005 and 2008, as many as 193 villages
in the West Singhbhum and Saraikela districts in
Jharkhand, and Keonjhar in Orissa, witnessed a 45
per cent reduction in newborn mortality, a 20 per
cent reduction in maternal mortality and a 57 per
cent reduction in post-partum depression.
The reductions are all the more striking because
they have occurred against the backdrop of two
A mother from the
tribal community of
Jharkhand holding
her newborn baby.
She is one of the many
women benefiting
from information
provided by the
field workers of the
organisation.
Field workers
analyse feedback
put forward by
mothers from the
tribal community.
Care for mothers and
babies is only possible
when decision makers
in the family are
influenced.
States that have routinely recorded some of the
highest infant and maternal mortality rates in the
country. Along with Uttar Pradesh, Bihar, Rajasthan,
Madhya Pradesh, Assam, Andhra Pradesh and
Chhattisgarh, the States of Orissa and Jharkhand
account for a lion’s share of the approximately
million infant deaths and 80,000 maternal deaths
that occur annually in India.
An NGO’s success story
Behind these striking achievements is the work of
Ekjut, a non-governmental organisation run by the
husband-and-wife doctor duo of Prasanta Tripathy
and Nirmala Nair. Lean-built, enthusiastic, and with a
salt-and-pepper moustache, Dr. Tripathi could at first
be taken for an Army officer.
“The way I look at it, it’s just no age to die,” he
says, explaining his motivation. “This work is also
about looking forward to future generations.”
Doctor Nair is his quieter half, but has a resolute
air about her. Both of them spent a substantial chunk
of their early careers at Tata Steel, India’s largest
producer of steel. The company set a high standard
of corporate social responsibility (CSR) in earlier
years but has increasingly come under fire for its role
in environmental degradation and the displacement
of some of the very same marginalised, tribal
communities that Ekjut serves.
“We knew even back then that someday we’d
work closely with communities,” says Dr. Nair, who
worked in the Tata Steel hospital in Jharkhand’s
mining town of Normundai. Dr. Tripathi had
meanwhile helped shape and implement the
company’s CSR initiatives.
Functioning in partnership with the Institute
of Child Health, University College London, Ekjut
received funding from the Health Foundation. It cost
an estimated $33 per daily-adjusted life year (DALY)
24
Field workers use pictures, charts and theatre to raise
awareness on the issue of mothers and newborn care.
saved, compared with the World Bank standard of
$127. It was less for interventions to reduce child
mortality. On April 3, 2010, The Lancet (Volume
375, Issue 9721), the rigorously peer-reviewed
medical journal, featured a lengthy article on the
“Ekjut trial” – as it has come to be known. The same
publication recently ran a report entitled, ‘The
Countdown to 2015: Maternal, Newborn and Child
Survival,’ in which India’s performance in curbing
infant mortality was marked “insufficient,” and its
maternal mortality level was classified as “high.”
Ekjut’s main approach seems dumbfoundingly
simple: piggy-backing on the network of women’s
self-help savings groups in order to discuss child
and maternal health issues. On closer scrutiny,
it becomes clear that a triad of strong guiding
principles has played a critical role in the success:
community mobilisation, participatory learning
and empowerment.
Together we are stronger
At the crack of dawn, about a dozen women
belonging to the Ho tribal community gather
outside one of the mud houses in their village in
Chakradharpur. Seated on a large jute mat, about
half of them hold infants in their arms. Chicks and
EVERY ONE/SUMMER 2011
Insight
Jharkhand is witnessing
slow but steady change.
hens flutter about. Many more babies lay naked on
the mat. And younger children play about too.
Two facilitators call the meeting to order and roll
out a chart with photos stuck on. As the meeting
wears on, infants intermittently cling to their
mother’s breasts. By the end of it, little piles of
tamarind seeds have formed in front of each picture
on the chart. “These tell us the type of problems that
women face in the village,” says Sumitra, a straighttalking star Ekjut employee from the Ho community.
“The more seeds the women pile up in front of a
picture means the more common that problem is in
that village,” she says. “Then we customise our work
for each problem.”
Tamarind seeds in front of picture charts form
just one example from a single meeting. As the cycle
progresses, a series of meetings take place across all
the districts where Ekjut is at work. Now there are
six such districts in Jharkhand and three in Orissa.
The communication tools get more innovative and
the meetings more participatory. They employ
visual cards, dummy dolls, storytelling, street
theatre – and there’s lots of dancing, singing and
talking in-between. The result is behaviour change
that is hard to see and easier to measure, as Ekjut’s
painstaking data collection demonstrates. Still,
some before-after patterns are discernible.
Mothers speak
Junga Saman (30) has mothered eight children, three
of which died of unknown causes. “In my village,
when you have a baby you’re considered dirty,” she
says. “The baby is not breast-fed for days. Both are
kept away from everyone in the house. Often, the
mother only gets to eat bread with salt and garlic.
Earlier, when a problem arose we would pray. Now I
go to a doctor. I also ate spinach, fish and vegetables
EVERY ONE/SUMMER 2011
during and after my recent pregnancy and breast-fed
for six months from the first day.”
Geeta Tiu (32), mother of four, has been attending
Ekjut meetings for five years. “Earlier, we didn’t
clean our hands before cooking and eating,” she says.
“We’d just leave the baby and go off to work. Now we
clean and grow vegetables ourselves. We keep the
water clean in the house. Women in the village help
one another and sometimes pool money to transport
people to hospital and visits to the doctor.”
Shanti Shandal (25), who has two girls, lost a
baby during her first pregnancy. She had a retained
placenta, which a midwife took out by hand –
medically speaking, a strict ‘no.’ She says: “The baby
was born weak and just lay in the cold and cried
all night. I didn’t know at the time that I should
go to the hospital. He died the next day. In later
pregnancies, I went to the anganwadi and took
vaccinations and iron tablets, too.”
Government health officials typically cite
challenging terrain, poor infrastructure and
‘disturbed areas’ as reasons for poor performance in
a range of development efforts. If there is anything
the Ekjut trial shows convincingly, it’s that while
these conditions can pose genuine hindrances, they
can be overcome. This is underscored by the Ekjut
trial’s most telling outcome – the poorest and most
marginalised people benefited the most. There was
a 73 per cent reduction here in newborn mortality
compared to 36 per cent for the general population.
“This was not by design,” says Dr. Tripathi. “But it
shows that if the project design is robust, the poorest
will automatically benefit the most.”
As for the threat from the woods, the State-level
Director of the National Rural Health Mission,
Aradhana Patnaik, says: “Health and education have
never been targeted by Naxalites in Jharkhand.” n
25
back CHAT
“You don’t want
that baby to die”
British Director Gurinder Chadha takes
time out from movie making to visit the
Delhi slums. Here we find out exactly why
FROM TIMES of india ARTICLE
G
urinder Chadha’s first feature
film, Bhaji on the Beach, won
numerous international awards.
Bend it Like Beckham was
a critical and commercial
success, topping the box office charts in
the United States, Australia, New Zealand,
Switzerland and South Africa. And Bride and
Prejudice – a film which marries Jane Austen
with Indian and Western musicals – was the
first film ever to open at Number One in both
the UK and India on the same day. Her next
film – due to be released in 2012 – is an epic
drama on Indian Independence that’s based
on the book Freedom at Midnight.
Many of her films explore the lives of Indians
living in the United Kingdom. But on her latest
trip to India’s capital, she turns her attention to
the plight of some of the poorest people on the
planet – those living in the Delhi slums.
Why? Because she’s supporting Save the
Children’s EVERY ONE campaign.
How long have you been in Delhi?
I’ve been here a few days working with
Save the Children and visiting slum areas.
As part of this, I went to Sanjay Colony,
where 10,000 people live.
Why are you in India?
My goal is to highlight Save the Children’s
EVERY ONE campaign and its aim to cut
infant mortality by two-thirds by 2015.
The campaign was originally prompted
by the Millenium Development Goals
that were put together by The United
Nations. Lots of nations came together
and came up with ten goals that were
to be achieved in the next 15 years. The
statistic to cut global infant mortality
by two thirds was one of them and,
right now, it’s not looking good. In
order for us to achieve that reduction in
India, the rates need to go down by 60 per
cent. Right now, it’s only twenty per cent,
so we’re far too far away from achieving
EVERY ONE/SUMMER 2011
that goal. To turn it around and make a
difference we need to focus on mothers,
babies and pregnant women.
need to raise awareness of these issues.
How does India stand globally?
Not that long. But I’m involved with many
other children’s charities. As a mother,
I’m very concerned about issues to do with
mothers and babies; and particularly girls,
because we are reproducing the next race.
India, unfortunately, is one of the worst
culprits. The rates in Bangladesh and
Sri Lanka are much better. Two million
children die in India every year. And when
you look at it, more often than not it’s for
no real reason. Often, it’s because of simple,
preventable, curable diseases.
One of the things we all are very proud of
is that India is a global powerhouse. But we
have to remember that India’s industrial
growth is also partly due to the migrant
workers who come to cities like Delhi and
Bombay and help to contribute to some of
this industrial expansion. In Sanjay Colony,
for example, a lot of the people have come
from Bihar to work in one of the factories.
But they’re being forced to live in slum
areas that have no sanitation.
When I came to India as a girl, I used to
see people doing their business in nullahs
and stuff. But now, when I see it as a
woman, it’s really not cool – particularly
in a country as advanced as ours.
Every child is our child, so we have to
start taking responsibility. As Indians, we
dote on our children, and as a mother I
know that. When you’re in a slum and
seeing a mother holding her newborn
baby, you don’t want that baby to die!
You want to do what’s best for that child.
That’s why I’ve got involved in this
campaign and that’s why I think we
How long have you been with the
Save the Children campaign?
Any inspiration for a film?
No, no. This is the work I’ve been doing
as a charity project. You already have
Slumdog Millionaire. How many more
films do you want [laughs]? You want
everyone to jump on that bandwagon,
eh? But seriously, who knows?
Are you open to making a film like that?
Who knows? Everything is open, you
know, and I never say never. People are also
always saying, ‘will you ever make a masala
fim?’ And I’m always saying, ‘who knows?’.
I always choose my films based on what
I’m feeling at a particular time.
Was this your first visit to the slums?
I’ve visited them before. It’s always such
a valuable experience. We can’t shut
ourselves off from this. You have to always
remind yourself how much of humanity
lives. And for me, it’s always important
to bring attention to it so that you can
humanise those people.
I approach everything now as a mother.
Everywhere I went, in all the gullies, I saw
mothers with their kids. Everyone was
taking baths, everyone was washing their
bartans. I went into a few homes and I saw
lots of healthy children as well... mothers
sending their children to school, even
though they lived in slums.
But this is all still in such dire
circumstances. So for me, it’s always good
to go back in and see how the other half
lives. I think it’s always important. n
26
*YES, I WOULD LIKE TO CHANGE THE LIVES OF CHILDREN BY DONATING:
20,000 can help in organising a training
program for 50 health workers, here
they will learn spot and treat basic
diseases.
10,000 can help provide a full course
of immunisation vaccines for 10
children against diseases like DPT,
polio, and measles.
To Donate please fill up the details:
SAVE THE CHILDREN, Office: 3rd Floor,Vardhman Trade Centre, 9- 10- 11 Nehru Place New Delhi - 110019.
5,000 can help organise a training for
50 expecting mothers, where they will
learn about child nutrition and
vaccination.
2,500 can provide nutritional
supplements for 5 expecting
mothers over the course of
their pregnancy.
*YES, I WOULD LIKE TO CHANGE THE LIVES OF CHILDREN BY DONATING:
20,000 can help in organising a training
program for 50 health workers, here
they will learn spot and treat basic
diseases.
10,000 can help provide a full course
of immunisation vaccines for 10
children against diseases like DPT,
polio, and measles.
To Donate please fill up the details:
SAVE THE CHILDREN, Office: 3rd Floor,Vardhman Trade Centre, 9- 10- 11 Nehru Place New Delhi - 110019.
5,000 can help organise a training for
50 expecting mothers, where they will
learn about child nutrition and
vaccination.
2,500 can provide nutritional
supplements for 5 expecting
mothers over the course of
their pregnancy.