From the south to the northeast, health professionals and social scientists working at the grassroots report that adivasis are at the bottom of the nutritional ladder, worse off than dalits in most cases. Where adivasis retain control over even a small piece of land, there is some food security. It is the landless who are on the brink of starvation
It’s official now. India’s adivasi people are the worst-off in the country. Activists have known this for decades. And now survey after survey confirms this. In the latest such survey, a comparison of the nutritional status of children in nine states found that adivasis are below the national average in every state, and at the bottom of the nutritional ladder in all except Uttar Pradesh and Jharkhand. Of course, this is not news to those working in the field. Here’s a bird’s eye view of malnutrition in India from informed experts.
Dr Narayanan Devadasan, founder, Institute for Public Health, Bangalore,regularly visits remote corners of the country, teaching, training and researching health issues. “This is purely anecdotal,” he says, “but if you take India as a whole, adivasis are definitely the poorest. However, if they have even a small patch of land on which to grow food, they can manage.” Deva often visits Chhattisgarh. “In the poor districts of Sarguja, Jashpur and Korea, you don’t see large-scale malnutrition. But in Gudalur, in the Nilgiris, Tamil Nadu, though the adivasis have higher incomes, where they are totally wage-dependent, where people don’t grow food, I see severely malnourished children as well as emaciated adults. Consistently, all over the country, when people have a tiny plot of land and can grow their staple food, there’s less malnutrition. “Malnutrition is not just lack of food, it is multi-factorial. It means that people are losing control of their livelihood,” Deva concludes.
“The government’s focus is on children under 5, and on anaemia in pregnant women. In our poorest states, I have seen large numbers of emaciated adults with a body mass index of less than 18 (the normal range is between 18 and 25). These people subsist on unacceptably low amounts of food -- they are in a state of starvation. After 64 years of independence, 42% of our children and 50% of our women are malnourished. Nothing has changed.”
Back in Gudalur, Dr Shylaja Menon, founder of Gudalur Adivasi Hospital, is appalled at the existence of malnutrition in a relatively better-off community. “To me, with wages of Rs 150 per day, going up to Rs 300 in the coffee/pepper season, plus free rice, there shouldn’t be malnutrition in this region.” Here the culprit is more likely a combination of widespread alcoholism and badly planned nutrition. “The men spend money on alcohol, leaving little money for the women to buy food. The women bear the burden of taking care of the family. They are exhausted and depressed and don’t have the energy to feed their children. A malnourished child has no appetite, no interest in food. You need to actively feed that child every two hours, or it won’t eat. The women don’t have the energy to pursue the feeding plan. The mood in our villages is one of depression. Alcohol ruins the family; the men are violent and abusive. It takes its toll on the women.”
We visit the Srimadurai area in the Nilgiris. In Gundur village we meet Kulathi, from the Paniya tribe. Her twins Divya and Kannan are both severely malnourished. Her older daughter is 15 years old. Her husband is the only earning member and the entire village is extremely poor. Kulathi is lethargic, she is most likely anaemic. Her nutrition during the pregnancy was probably poor, and having twins didn’t help. They have no land of their own. The hut is basic, badly maintained, with just a few pots and pans. Not a hint of any luxury item here.
Nearby, in an interior forest village, I see adivasi women with cell phones. One mother placates her whining child with a Rs 10 note. He returns from the local shop with a plastic packet of Lays crisps. Nutrition-wise, a piece of chikki or a handful of masala peanuts would have provided him much-needed protein. But junk food has entered every nook and corner of almost every village.
Uma, our health worker, shows us a list of 12 children categorised as malnourished. Two have fathers who are alcoholic. Another had a father whose death was alcohol-related. A few mothers had TB, others were anaemic. All of these affect pregnancy and result in malnutrition. Older children also suffered when the mother had another child; when the mother became pregnant again, the older child stopped breastfeeding.
Dr Premila Nair, who has monitored and trained the Gudalur health workers for almost two decades, says: “Between 1998 and 2000, we were worried because of a surge in the incidence of severe malnutrition in our under-5 children. With our adivasi health staff, we drew up an emergency action plan to combat this problem. We actively involved parents and other carers, the entire area team, thalaivars (village heads), health volunteers and hospital staff, so that everyone understood the gravity of the situation. We made sure that more than one monitoring visit was made to the family by the team, and that there was supplemental feeding of sattu mavu,a high-protein, calorie-dense mixture of ragi, green gram and groundnuts with added jaggery for iron and coconut oil which provides high-density energy. We made sure they received their immunisations, and were de-wormed every six months. The government programme of six doses of Vitamin A to prevent night blindness was ensured, because of the bonus it gives in enhancing immunity against respiratory infections. Every malnourished child was brought to hospital for a thorough check-up for treatable causes of malnutrition, like tuberculosis. In six months, we were able to bring about a sustained improvement in nutrition levels.
“Now, in 2012, the figures for severe malnutrition have, surprisingly, almost doubled despite improvements in many other health parameters like increase in hospital deliveries, reduction in maternal and infant mortality, and greatly improved figures for antenatal care. The worrying thing is it’s not an income problem. We have to look at the social, economic and cultural factors. We try to impress on the families that Grade 3 malnutrition is an emergency -- two bouts of diarrhoea and the child can die. The health worker needs to spend time with each family and find out the causes of the severe malnutrition and talk to them, explain the urgency of the situation. Fifty per cent of our mothers are undernourished and anaemic, as a result of which their children have low birth weights. The issue is complex and has to be tackled from many angles.”
There’s a huge divide between north and south India. While lack of money is definitely not an issue in Gudalur, the poverty in the tribal belts of Jharkhand, Chhattisgarh and Madhya Pradesh is stark.
Dr Prabir Chatterjee has worked at the grassroots for many years. He now visits West Bengal and Jharkhand as a Unicef consultant. “In West Bengal, at least 40% of the population is malnourished, worse than neighbouring Bangladesh. Adivasis are generally worse-off than others. In Bengal, the BMI is not as bad as in Jharkhand and Bihar except among the adivasi population.
“CINI (Child In Need Institute), which has worked for many years on child nutrition, was running a nutrition rehabilitation centre in six or seven blocks. Recently, the government started nutrition rehabilitation centres in many states for severely malnourished kids. Children are encouraged to spend 14 days as in-patients. They are tested for TB, low haemoglobin and worms, and given high-calorie cereals and milk. A social worker and nurse help prime the mothers about subsequent care and feeding. The child is sent back home when it is better and follow-up is monitored.
“Among the Grade 3 kids, I always noticed a few Santhals. Adivasis never get ICDS centres because their mohallas are small. Pradhan had 60 centres in tribal villages. They weighed all the children; the adivasi kids were worse-off than the others.
“In Jharkhand, people sell their ration cards to the local mahajan for Rs 100, to buy food. Though Jharkhand is supposedly an adivasi state, the ICDS officials are all dominant-caste, city-based people who impose their vegetarianism on the adivasis, discouraging eggs and meat in favour of rice. This is less nutritious than adivasi food which is often maize and forest-based produce like fish and game. The anganwadi will introduce the kids to polished rice and change the child’s food habits. As a result, adivasis now eat a lot of rice, which gives them energy to work but very little protein.”
In Cachar district of Assam, a tea garden was closed for four months, recently. The labourers were abandoned, not paid their wages, bonus or dues, including provident fund. In spite of lower-than-minimum wages, workers went back to the tea garden when it re-opened on February 8. But in the four months when there was no work, 10 plantation workers died of hunger.
Government welfare schemes are non-functional and starvation deaths continue to be reported every day. An investigative report stated that contributory causes for all the deaths were starvation, malnutrition and lack of medical care.
The ANT (, as its name suggests, covers the northeast. Its founder, Dr Sunil Kaul, says: “Being an advisor to the government is frustrating. No one listens to us.” He shrugs. “Two years ago, the Supreme Court commissioner ordered an inquiry on right to food violations and the starvation deaths here. The government of Assam did not respond. They never respond. You may find small pockets of malnutrition in Arunachal Pradesh, Nagaland and Mizoram but by and large people have control over their land and still produce their own food. The really pathetic people here are the adivasis from Jharkhand, Orissa and Andhra Pradesh who were brought in 100 years ago by the British as tea plantation labour. They are despised, ill-treated and live in abject poverty. There’s huge malnutrition among them. And organised discrimination against them -- they come under the Plantation Act and get about Rs 50 a day. Not even minimum wages. They are the poorest, most hungry, most discriminated against people I know in the northeast.”
In the west, in prosperous Gujarat, Martin Macwan, dalit leader and founder of Navsarjan Trust, Ahmedabad, says: “We run skills-training classes. The kids write daily diaries. The adivasi girls write that at home they often eat only one meal a day. I was shocked. I’ve never seen a dalit kid this hungry, though I have been working the length and breadth of Gujarat for 25 years. The adivasis are the poorest people in this state, and their nutrition is also pathetic.”
Soumik Banerjee works with Santhals and Paharias in Godda district, Jharkhand. “I’ve monitored under-3 children for over three years. More than 50% are malnourished. The BMI of over 80% is below 18. Most of the women weigh 30 to 35 kg. More than three-fourths are anaemic. We’ve seen 22 maternal deaths in the last 10 months, all termed ‘controversial deaths’. NGOs are afraid of announcing them because of the adverse repercussions. The reasons for starvation are poor rainfall and hence dwindling or failed crops.
“Mining is taking away land from the adivasis. The government staff is indifferent. Schemes like the ICDS and midday meals are riddled with corruption. People are lucky if they get 50% of the loans or food meant for them. They survive at a subsistence level because of the forests. Their diet is all rice. No pulses, fat or protein. Infant and maternal mortality here is three times the state average.”
From Rajasthan, the same bleak scenario emerges. Dr Narendra Gupta from Chittorgarh reports: “Hunger deaths among Sahariya adivasis from Kota and Baran districts hit the newspaper headlines recently because of the high concentration of acutely malnourished kids. In south Rajasthan, from Udaipur, Banswara, Tungapur and Pratapgarh districts, the most severely malnourished kids are from the Bhil and Meena tribes. Poverty is widespread, government infrastructure very weak, the PDS hardly works, and access to forests is severely restricted (adivasis got their food primarily from forest resources, in happier times). People have no alternative but to provide cheap labour wherever it’s available. Migration is common. There’s little choice. Many young kids around 9 to 10 years old go to north Gujarat to cross-pollinate the BT cotton grown there. The cotton-growers prefer children’s nimble fingers. These kids are often malnourished. We work in 66 villages. We found 62% of the kids underweight. Shockingly, 42% of girls and 18% of boys were categorised as ‘severely acutely malnourished’. This means they can’t eat normal food and must have specially prepared ‘ready-to-use therapeutic food’. If we look at the larger picture, that’s 82% of girls and 60% of boys. We also discovered 60% of women were anaemic and 30% were severely anaemic. Their kids will have low birth weights, and the cycle continues. Indeed, adivasis are the most excluded group in the country.”
Kerala, our southernmost state, with 100% literacy, prosperity and awareness, is no different when it comes to adivasis. When I arrived in the Nilgiris in 1984, the adivasis in Kerala were in a far better state than their neighbouring Tamil Nadu relatives. The scenario has changed drastically. As the rest of the state grew more prosperous, Kerala’s adivasis have been exploited and excluded. They are definitely the poorest people in Kerala today.
This bird’s eye view of the hunger and nutrition status of adivasis comes from doctors, health professionals and social scientists who have worked among them for over a decade. It is a dismal scenario. A wake-up call straight from the grassroots. It needs urgent solutions.
(Mari Marcel Thekaekara is Founder-Associate Director of ACCORD, an organisation that works with the tribals of Gudalur, Tamil Nadu. She is a frequent contributor to The Hindu and Frontline and was a columnist for New Internationalist, UK. She is the author of Endless Filth, a book on the safai kamdars of Gujarat, published by Books for Change)
Infochange News & Features, July 2012