No single measure would do more to reduce disease and save lives in the developing world than bringing safe water and adequate sanitation to all.nbsp;– Kofi Annan former UN Secretary-General

Malnutrition is one of India’s most serious development challenges. It impedes growth development and cognitive abilities in children the health of women and immunity and productivity. Although India’s economic growth has been remarkable a vast number of children are malnourished and around 48 million children or two in every five under the age of five years are stunted making the country home to the largest number of stunted children in the world.

Scientific studies have established the link between the high rate of child malnutrition and the poor sanitation. As regards malnutrition the issue is not merely lack of food but rather the absence of proper sanitation as well. Nobel Laureate Angus Deaton and Jean Dreze have documented the state of nutrition in India. They have observed that lsquo;Our work highlighted that malnutrition is not just about a lack of calories and certainly not about a lack of cereal calories but is more about the lack of variety of diets — the absence of leafy vegetables eggs and fruit. It is also crucially linked to inadequate sanitation to the fact that women often do not get enough to eat when they are pregnant and to poor maternal and infant health services.rsquo;

Malnutrition has an irreversible effect on health and human development. The initial 1000 days of one’s life-span from the day of conception till heshe turns two years of age are considered a critical lsquo;window of opportunityrsquo; when poor nutrition can result in stunted growth diminished immune response impaired intellectual ability poor school performance and lower economic productivity. India loses over 1.2 billion in gross domestic product GDP due to vitamin and mineral deficiencies among its population according to a World Bank report titled Nutrition in India. It has mentioned significant direct and indirect economic losses due to under-nutrition. These include direct productivity losses estimated at more than 10 per cent of lifetime individual earnings and 2-3 per cent loss to the GDP. Indirect losses are the result of poor mental development and schooling and increased cost of healthcare.

Indeed India is slipping into a vicious cycle of malnutrition. More than half the women of child-bearing age are anaemic and 33 per cent are undernourished according to NFHS-3. A malnourished mother is more likely to give birth to a malnourished child. The resulting malnutrition seems to have knock-on effects on health making one vulnerable to infection and other diseases. The World Health Organisation WHO estimates that globally 50 per cent of malnutrition cases are associated with infections caused by unsafe water inadequate sanitation or insufficient hygiene. Frequent illness saps the nutritional status of those who survive locking them in a vicious cycle of recurring sickness and faltering growth. Repeated bouts of diarrhoea and other infections during early childhood can hinder physical and cognitive development. The constant flow of germs and bacteria from poor or no sanitation forces children’s bodies to divert the energy and nutrients away from growth and brain development to prioritise infection-fighting survival. Moreover starving children lack the crucial ldquo;gut bacteriardquo; that is needed to digest food.

The Rapid Survey on Children RSOC commissioned by the Union Ministry of Women and Child Development in 2013 reveals that 38.7 per cent of children in the age bracket of 0 to 59 months are stunted indicating chronic malnutrition 29.4 per cent children in the same age group were found to be underweight and 7.9 per cent were ldquo;wastedrdquo; indicating acute malnutrition. Stunting is associated with an under-developed brain and learning capacity and increased risk of nutrition-related diseases. Prime Minister Dr Manmohan Singh had once called stunting among Indian children a lsquo;national shame.rsquo;

Malnutrition is the key reason for deaths. About 3500 children die in India every day. This is the equivalent of fatalities in ten Boeing 737 crashes. Diarrhoea caused by poor sanitation lack of hygiene and unsafe water is one of the leading causes of child mortality. Moreover diarrhoeal diseases inhibit nutrient absorption leading to starvation despite consumption of sufficient nutrition. Once malnutrition sets in the victim’s resistance to subsequent infections gets substantially reduced. In the words of Victor Aguayo Chief of Child Nutrition and Development at UNICEF-India ldquo;The child may eventually die of a disease but that disease was lethal because the child was unable to fight back due to malnutrition.rsquo;

The disconnect between wealth and malnutrition is so stark that economists have concluded that economic growth does almost nothing to reduce malnutrition. It is prevalent in relatively prosperous states as well. Surveys reveal that Maharashtra has 25.2 per cent underweight children while Gujarat has 33.5 per cent. Similarly Maharashtra has 35.4 per cent stunted children and Gujarat has 41.8 per cent. At the national level a third of stunted children come from the richest families. Globally Indian children are on an average shorter not only than children in the poorer sub-Saharan African SSA countries; they are among the shortest in the world. This puzzling reality is known as the lsquo;Asian enigmarsquo; that can hardly be explained in terms of genetic differences. As Amartya Sen had once described it : ldquo;rsquo;This is India’s defective development.rdquo;

The Swachh Bharat Mission launched on 2 October 2014 by the Prime Minister has set the target of ending OD by October 2019 the year that marks the 150th anniversary of Mahatma Gandhi. Success of the mission will ultimately depend on the change of behaviour and mindset of the people. Cleaning up the mess will call for the construction of septic tanks. In India there is no separate policy or regulation for septage management. The country has not seen much success in the disposal of domestic wastewater. It is also equally important to manage animal wastes. nbsp;The country generates over 1000 million tonnes of cattle waste annually. But most of it remains poorly managed leading to contamination.

Safe drinking water proper sanitation and hygiene can prevent malnutrition and the stunting in children by preventing intestinal diseases known as environmental enteropathy and diarrhoeal ailments. The new global index report entitled the Water Sanitation and Hygiene WASH Performance Index 2015 developed by the Water Institute at the University of North Carolina USA shows that India has performed poorly when it comes to water accessibility and water quality. The Swachh Bharat initiative can attain fruition if the people take a pledge — ldquo; I will neither litter nor let others litter.rsquo;

The writer is a retired IAS officer.