Children
ate food near a road in Hyderabad, October 3, 2011. Photo by: Noah
Seelam/Agence France-Presse/Getty Images
India is
poised to launch one of the biggest food subsidy programs ever attempted, but
some experts say it will fail unless major steps are taken to improve
sanitation.
“In the
absence of focus on sanitation, what we have is taxpayer-funded diarrhea and
little else,” Pavan Srinath, policy research manager at the Takshashila
Institution, a think-tank, said of the program that the government says will
cost about $20 billion a year.
The
government approved the National Food Security Law last
week. As Parliament is in recess, the law is classed as an ordinance, or
temporary legislation, until Parliament reconvenes and votes on it at the end
of the month or early August. The passing of the law is expected to be a
formality.
Under the
program, the government will sell very cheap rice, wheat and other grains to
around 800 million poor Indians, or around 70% of the population.
In
addition to the critics who say the program is misdirected and a bid by the
ruling Congress party-led government to win votes, health experts say the
subsidies overlook the problem of poor sanitation.
A lack of access to toilets means that hundreds of
millions of people defecate in the open in India. As a result, children
are exposed to bacterial infections and parasites that can damage the small intestine and reduce or stop its capacity to absorb
nutrients needed for growth and development, no matter how much food is
consumed.
Unicef
says there are 61.7 million stunted children in India, more than anywhere else
in the world. The government estimates that around 20% of children under five
are wasted, or too thin for their height and 43% are underweight for their age.
In a recent paper in Economic and Political Weekly,
Robert Chambers from the University of Sussex in the U.K. and Gregor von
Medeazza from Unicef India said the link between sanitation and under-nutrition
has been largely overlooked, describing it as a “blind spot.”
Last
month, Rural Development Minister Jairam Ramesh was quoted in the media as saying: “I don’t see the
same degree of political enthusiasm on sanitation. I think we neglect this at
peril… When we talk about sanitation, we can only giggle.”
Gagandeep
Kang, professor in the Department of Gastrointestinal Sciences at Christian
Medical College in Vellore, is involved in an international study funded by the Bill and
Melinda Gates Foundation to look at how pathogens damage children’s guts,
leading to malnutrition.
“You
can’t argue sanitation alone is going to lead to people not being malnourished.
Nor is food alone going to lead to every single child growing fine. It has to
be a combination of both of those,” she said.
According
to research by Dean Spears, a visiting economist at
the Delhi School of Economics, there is less stunting of children in Indian
districts with toilets. Improved sanitation meant infant mortality decreased by
four per 1,000 and children’s height increased, he said.
The World
Health Organization says diarrhea is a leading cause of malnutrition
in children under five. More than 800,000 children in that age bracket die
every year from diarrhea globally, according to Unicef. A quarter of these deaths happen in India.
A survey
from 2011 found that nearly 80% of Indian children with diarrhea did not wash
their hands with soap after visiting the toilet.
The
challenge the government faces is finding a way to get more Indians to use
toilets, which some have said is a culture problem. “The biggest thing about
sanitation is individual behavior,” Mr. Srinath said.
“It’s an
individual choice. Most people in India don’t want to spend money to build a
toilet,” he added.(Atish
Patel is a multimedia journalist based in Delhi. You can follow him on
Twitter @atishpatel.)
