Ans: 1. Every second tribal child is stunted, and the bulk of them are severely stunted. Mild and moderate stunting is similar in tribal and non-tribal children. But severe stunting is higher (54% vs. 45%) in tribal compared to non-tribal children. The entire difference in overall stunting is on account of the proportion of severely stunted children. 2. Stunting increases with increasing age. One in four tribal children aged 0-5 months is stunted. Stunting and severe stunting double in the 6-11 months period and three out of four children are already stunted at 18-23 months. Stunting among tribal children, 6-8 months old, is higher among children who have not been initiated complementary foods compared to those who have been initiated (36% vs. 24%). However, even among the children aged 6-23 months who are fed complementary foods (6%), stunting is quite high (60%), indicating that much of the damage had already taken place.
Ans: 3. Maternal undernutrition, interpregnancy interval and preference for boys are important determinants of stunting and severe stunting in tribal children. The risk of stunting increases twofold if a mother is stunted or had a pregnancy interval less than two years. Among the tribal children, 68% of the mothers are less than 20 years of age and 48% are undernourished, interpregnancy intervals are narrow and birth orders range from 1-12. The risk of severe stunting is nearly twofold higher for girls aged 6-23 months compared to boys indicating that gender could play a role in caring practices, even among tribal communities. The odds of being severely stunted is 1.8 times higher in tribal children if their mothers are stunted, and 1.4 times higher if the pregnancy interval is less than two years or if their mothers are illiterate. 4. Household poverty is a strong determinant of severe stunting in tribal children. Nearly 90% tribal children in the sample belong to families in the two poorest wealth quintiles, in which risk of severe stunting is three times higher compared to children in the two richest wealth quintiles. Land alienation, displacement and poor compensation, and inadequate rehabilitation provisions are reportedly core reasons for poverty in tribal communities. 5. Traditional healers and language influence behaviours of tribal communities. Reliance on traditional remedies and healers even in life threatening situations delays tribal communities from seeking care. Core reasons for the high reliance are distance from facilities and opportunity cost, loss of wages, and cost of travel time to the facility and medicines. Understanding the local state official language remains a challenge for scheduled tribes, given that each tribe has a language of its own.
Ans: 6. India’s constitutional provisions and legislations protect the rights of tribal children to good nutrition. Poor legislative enforcement protecting tribal rights to land, resources and administrative autonomy, and subsequent inadequate rehabilitation and compensation are among the core reasons fuelling poverty among scheduled tribes, resulting in household food insecurity and undernutrition in their children. These are also core reasons for the increasing civil strife. Of the 76 strife affected districts in the country, 32 are under the Panchayats (Extension to Scheduled Areas) Act (PESA) 1996. 7. Budgets are not a constraint for nutrition programming for tribal children. The Ministry of Tribal Affairs can play a more effective convening role. The annual budget for every state plan and for 28 central ministries has to apportion funds to a separate tribal sub-plan (TSP), which is at least equal to the proportion of the scheduled tribe population. The Ministry of Tribal Affairs (MoTA) under the special area programmes of Special Central Assistance to TSP and Grant under Article 275(1) of the Constitution also provides top-up funds to states under the TSP. Most TSP budget items are focused on infrastructure and miss out on soft components, such as basic outreach services. On the other hand, the TSP infrastructure budget also remains untapped for establishing primary health centres and nutrition rehabilitation centres, or for providing crèches and toilets in remote tribal areas. MoTA is responsible for convening, coordinating and reviewing intersectoral efforts for scheduled tribes, and providing funds to organizations for trainings, research and evaluations and to various national and state commissions set up to monitor schemes and legislations and ensure service safeguards for scheduled tribes. MoTA has the power to advocate for a number of issues with line ministries, which require urgent attention. These include: i) providing a separate chapter in their annual plans for scheduled tribes; ii) designating an officer or cell for scheduled tribes at the state level for intersectoral liaising and monitoring of schemes;
Ans: 9. Partnerships with NGOs and organized community networks can improve outreach, particularly in inaccessible tribal pockets. The study looked at 14 NGOs, some of which have set up secondary-level hospitals, outreach health service outposts and free referral transport in remote forested pockets. In partnership with government, the NGOs run anganwadis, nutrition rehabilitation centres for treatment of children with severe acute malnutrition and primary health centres in the remotest locations. Nearly all the NGOs are engaged in training field functionaries and forming and mentoring women’s groups. As livelihood is a major concern among the tribal poor, the NGOs have also organized thrift and credit self-help groups and supported them with livelihood options. A few NGOs have started crèches as most tribal women work for long hours outside the home. Community involvement to generate demand and participate in improving access to services is an inherent component of NGO programmes. However, the number and geographical coverage of NGOs working on nutrition issues in tribal areas are limited, which reduce further in civil strife affected areas. Nonetheless, there is untapped scope of mainstreaming nutrition issues through the livelihood promotion thrift and credit networks, which have huge penetration in the tribal areas.
Ans: 10. There is a deficiency of disaggregated data on scheduled tribes and a lack of monitoring of the reach of schemes in tribal areas. The reports from the National Nutrition Monitoring Bureau on the tribal population cover only nine states on select nutrition indicators. Tribal research institutes remain untapped for periodic evaluation and dashboard monitoring of basic schemes of various line ministries to ascertain whether the basic services in education, health, or nutrition are reaching tribal areas. 10. Pradan
Ans: 1. Policy space for nutrition of tribal children Make ‘nutrition of tribal children’ a political and bureaucratic priority to stir policy dialogue and coordinated action. The Ministry of Tribal Affairs, the nodal ministry, can convene this effort by ensuring defined roles, accountability, need-based budgeting and performance incentives in programmes for scheduled tribes. A designated officer for scheduled tribes in line ministries will ensure liaising, vigilance and scrutiny mechanisms. 2. Programme flexibility Scope for experimentation with contractual staff, hardship allowances, partnerships and flexi-pools should be an inherent part of programming for scheduled tribes. The innovations in various states demonstrate that differential programming for scheduled tribes is possible. 3. Partnerships are key Civil society and faith-based organizations with established grassroots presence and credibility can increase outreach of services and information on government schemes, generate community demand, and create a cadre of trained foot soldiers to reach out to mothers with timely information, counselling and support in inaccessible terrains, especially those affected by civil strife. Promising innovations with visible impact have always had a core component of formal community engagement in the process of change.. 4. Countrywide tribal nutrition data Given that the National Nutrition Monitoring Bureau conducts tribal nutrition surveys periodically in selected states and blocks, the same may be extended across all Integrated Tribal Development Agencies with involvement of all trial research institutes either under MoTA or Indian Council of Medical Research. 5. Linking livelihood promotion with nutrition promotion Linkage of livelihood promotion and skill development with nutrition programming is an absolute must as is identifying at-risk poor families and improving their access to food and poverty alleviation measures. 6. Communication methods matter Given the low literacy level and poor comprehension of Hindi/text, discourse needs to be interpersonal, visually attractive, respecting and tapping local culture, beliefs and idols, and communicated through community influences, particularly traditional healers. 7. Improve care for pregnant women and children of working mothers Reducing maternal undernutrition and improving complementary feeding practices in children aged 6-11 months are critical to prevent stunting. For this, two approaches can be tested: monthly nutrition assessments of newly wed and pregnant women during monthly Village Health and Nutrition Days; and corrective measures for women identified as undernourished or at-risk. Community nutrition and day care centres can provide meals to pregnant women and breastfeeding mothers, counselling, and linkage to savings groups and livelihoods options. To improve complementary feeding, crèches (by women’s groups or paid workers), where children are fed hot cooked meals,
Ans: Need-based, low cost models including nutrition interventions, along with traditional healers/practitioners and tribal communities, and formal and grantbased tie-ups with NGOs, and women savings and thrift and credit federations.
Ans: • Invest in tribal skill and professional development. • Explore new ways of contractual postings (paramedical, technical, managerial staff). • Evaluate impact and costs before scale up. • Form tribal nutrition task forces and missions within existing structures.
Ans: • Intersectoral action for tribal communities. • Designated tribal officers at the state level. • Tribal nutrition indicators in reviews of state performance. • Programme reporting and expenditure systems made available in the public domain.