On a cold January morning in Ayadhnagar village in Uttar Pradesh’s Hapur district, a group of 10 children huddled around a bonfire outside their anganwadi centre. Despite the warmth of the fire, they shivered. The bare and dusty centre did not have mats for them to sit on and some of them were not wearing slippers.
Anganwadi centres function under Integrated Child Development Services, a four-decade-old government programme aimed at improving the nutritional and health status of children below the age of six.
Under the nationwide programme, children between 3-6 years get a hot cooked meal at the centre, while families are given take-home rations for children under the age of three. The programme also provides take-home rations to pregnant and lactating women.
In Uttar Pradesh, the hot cooked meal is usually khichdi or halwa. The children in Ayadhnagar would have relished it on this winter morning, but instead they were given a laddoo each and sent home by noon.
Within India, Uttar Pradesh has the highest rates of stunting of children below the age of 5, as per the Annual Health Survey released in 2014. Stunting or low height for age is caused by not having nutritious food over a long period of time and by frequent infections. The effects, which include delayed motor development and impaired cognitive function, are largely irreversible.
Compared to other Indian states, more children in Uttar Pradesh are underweight, with low weight for age, a risk associated with child mortality.
The ICDS programme is barely functional in Uttar Pradesh, said activists in the area. Not only do anganwadi centres lack basic facilities, state government officials concede that hot cooked meals have not been prepared for at least a year, if not more.
The officials blamed this on budgetary cutbacks by the central government, which covers half the cost of running the supplementary nutrition programme under ICDS. Since it came to power in 2014, the National Democratic Alliance government has been whittling down the budget for the programme, only increasing allocations In February this year.
Many states have made up for union government cutbacks by putting their own resources in the programme. Uttar Pradesh, however, has failed to even match the centre’s contribution.
Dipa Sinha, assistant professor of economics at the School of Liberal Studies in Ambedkar University in Delhi, filed an application under the Right to Information Act seeking information from the Ministry of Women and Child Development on funds allocated to the supplementary nutrition programme. The reply by the ministry showed that in 2015-’16, Uttar Pradesh that spent about Rs 3,035 crores had contributed only about 33% of the expenditure, while the centre has contributed 67%. In the same year, Punjab had contributed approximately 74% of the ICDS budget, Tamil Nadu 52% and Orissa 51%.
Scroll.in contacted Anand Kumar Singh, the director of ICDS in Uttar Pradesh, about budgetary constraints, but did not get a response.
New nutrition programme
Instead of investing more resources to make ICDS work, the state government launched the Hausla Poshan Yojana in August 2016. The scheme provides high-calorie nutritious foods such as ghee, fruit, curd and a hot cooked meal to underweight children and pregnant women.
Officials of the state government claimed the scheme was launched because the ICDS programme was not working well. “All the children were not getting hot cooked meals,” said Kamran Rizvi, the director-general of the State Nutrition Mission.
But activists said the new scheme was a charade to influence voters ahead of the state assembly elections. “If they have money to start a new scheme, they could have put that money in ICDS,” said Sinha.
The greater tragedy is that even the new scheme has stopped functioning.
The Hausla Poshan Yojana was launched with an annual budget of Rs 800 crore, said Rizvi. This is meant to cover over 14 lakh severely malnourished children and 10 lakh pregnant women in the state.
Under the programme, severely malnourished children are entitled to half a kilogram of desi ghee per month, glucose biscuits or other nutritious snacks, a fruit and a hot cooked meal everyday. Pregnant women get a midday meal thrice a week which includes curd, ghee, fruit and a hot cooked meal. The nutritional support is supposed to cover 60% of the calorie requirements of both pregnant women and children.
The expenditure per day comes to Rs 14 for a severely underweight child and Rs 19 for a pregnant women. This is much higher than the ICDS allotment of Rs 9 for a severely underweight child and Rs 7 for a pregnant woman.
The money released for the scheme is jointly operated by the village pradhan and the anganwadi worker. The meal is cooked using the infrastructure of the midday meal programme for school children, and not of the anganwadi. “The hot cooked meal was not running well in the ICDS programme, whereas the midday meal programme was,” said Rizvi. “Why duplicate efforts?”
In Jaunpur in eastern Uttar Pradesh, an anganwadi supervisor, who did not want to be identified, said this arrangement allowed the village pradhans to control the funds. The anganwadi workers were asked to get women and children to the village primary school where the meals were cooked. Few women turned up.
By the government’s own admission, the scheme has worked unevenly. “It ran well in Bundelkhand and other parts of eastern Uttar Pradesh,” said Rizvi. “In western Uttar Pradesh, where people are not as poor, the anganwadi workers deliver the desi ghee, fruits and curd to the homes of pregnant women. A meal is not high on their agenda.”
In Baksha village in Jaunpur, many pregnant women said the only nutritional support delivered to their homes was a packet of fortified food powder or panjiri each, which consists of roasted wheat and micronutrients.
At anganwadi centres, the workers displayed photographs of pregnant women being fed under the scheme at the centre. They did not know children were also entitled to the meals.
But, even this practice has stopped.
In Hapur, the Hausla Poshan scheme ran only in September. The district got money to cook hot meals under ICDS only for 15 days in June and 10 days in August, said Premvati, Hapur’s child development project officer. So effectively, children got very few cooked meals throughout the year.
The scheme ran only for two and a half months, Rizvi confirmed. “The supplementary budget for November and December was not released,” he said. The release of funds began again in January 2017, he added, but the code of conduct for the state assembly elections kicked in and the funds could not be distributed.
“That is just nonsense,” said Arundhati Dhuru, and activist in Lucknow with the Right to Food Campaign. “When there is code of conduct you don’t stop breathing, eating or even policing. Everything (programmes) is supposed to go on.”
Flailing ICDS programme
Meanwhile, the ICDS programme continues to struggle. With no hot cooked meals available, many children have stopped coming to anganwadi centres. “I spend nearly one and half hours every day convincing parents to send their children every day,” said Santara, who works as a helper at the anganwadi centre in Katikheda village.
On paper, the Katikheda centre caters to 30 children, but only about 15 children were present that day. Most of them were from the poorest families in the village, said Pravesh, the anganwadi worker.
Priyanshi, 5, said that she had tea and rusk for breakfast. Weighing 14 kgs, the girl was malnourished, the workers said.
The workers were making ladoos from the supplies of take-home ration – the micronutrient-fortified food powder provided under the ICDS. Pravesh, who runs the centre, said that the ladoos were an incentive for the children to come to the centre.
Since 2004, the contract to manufacture take-home ration in Uttar Pradesh has been held by one company – Great Value Foods, owned by the family of Ponty Chadha, the liquor baron who was murdered in 2012. A panel appointed by the Supreme Court to examine the status of ICDS in four states, including Uttar Pradesh, found in 2010 that the food was substandard and low on micronutrients. But this still has not pushed the government to cancel the contract.
No pots to cook
Activists point out that the Uttar Pradesh government has starved anganwadi centres of support. The Rapid Sample Survey of Children in 2013-14 found only 31.1% of anganwadi centres in Uttar Pradesh had a separate kitchen and that in 19.7% food was cooked in the open. Said Dhuru : “There is often no money allocated for cooking pots. I have seen anganwadi workers cook at home and bring the food to the centre.”
For an anganwadi centre to function well, it also needs some facilities and amenities such as weighing scales for babies and adults, medicine kits, drinking water, cooking space, and a toilet.
“There are barely any toys in the facilities,” said Suman who works for a nonprofit in Action India that works on the issue of maternal and child health in Uttar Pradesh. “The anganwadi workers have no tools to engage the children.”
As per the Rapid Survey of Children, only half the anganwadi centres have a baby weighing scale, and about 35% have an adult weighing scale. Only 20% of the centres had electricity connections and only 46% had toilets.
Few nutrition rehabilitation centres
With such a crippling lack of resources, anganwadi centres have not been able to help the severely malnourished children who need their services the most.
All children till the age of six years have to be weighed by the anganwadi workers. The severely malnourished children ideally must be referred to a nutrition rehabilitation centre, often in the district hospital, that looks after the clinical treatment and management of children suffering from severe malnutrition.
For 75 districts, Uttar Pradesh had only 25 nutrition rehabilitation centres in 2015, according to the health department. There are no nutrition rehabilitation centres in Hapur.
“Often nutrition rehabilitation centres are not well connected and many parents do not have the motivation to go there,” said Dr Vandana Prasad, from the Public Health Resource Network that works on malnutrition programmes in Bihar, Chhattisgarh, Jharkhand and Odisha. “If they do manage to go to the centre, they are sent back if they do not fit the criteria for admission in the centre. Even if the child is treated for a few weeks, there is no follow up. Unless the problem of malnutrition is tackled at the community level, it will not work.”
With few resources at hand, anganwadi workers focus their energies on admonishing mothers. While talking about malnourished children, the anganwadi spoke more of laparwahi – carelessness – of mothers not paying attention to their children, than about the food insecurity or bad feeding habits.
In Katikheda village, the anganwadi workers said that Nargis, the mother of two and a half year old Sophia did not pay attention to the child. Sophia weighed little more than eight kgs and suffered from severe acute malnutrition. Yet, all she ate were fried foods and toffees, said her mother. The anganwadi workers asked her mother to not watch television all day.
In the same area, two-year-old Roshan lay in a cloth crib. He was so malnourished that he had not started to walk. His mother Sunita said she could only afford to feed him biscuits with milk and sugar. The child suffered repeated bouts of pneumonia and diarrhoea.
The Samajwadi Party’s manifesto for the Assembly election promises one litre ghee and one kg powdered milk for poor school-going children. But what about the younger children and children who do not go to school liek Roshan, asked Dhuru.
She pointed out that in other states such as Tamil Nadu, programmes such as midday meal and ICDS have political currency, which is not the case in Uttar Pradesh.
“Nobody cares for this lot of children, they are not the vote bank,” said Dhuru. “Unless food becomes a political issue, it’s difficult for things to change in Uttar Pradesh.”
Additional reporting inputs by Supriya Sharma.