Consider this: Cuba, unlike India, is not a rising economic superpower. MNCs are not falling over each other to invest in Uruguay, the way they are in India. Sri Lanka has not seen runaway economic growth that India has witnessed in the last two decades. But at least mothers in these three – and 73 other ‘less developed countries’ – are better cared for than mothers in India.

This is probably yet another ‘national shame’. Remember prime minister Manmohan Singh famously described the incidence of malnutrition among children (47 percent) as a matter of national shame? The mothers of these children are not in any better position either, going by the latest report of the global voluntary agency Save the Children. India is placed 76th among 80 less developed countries in an index on the State of Mothers.

Read the full report from Save the Children here
Read key findings and recommendations below

Among those doing better than India are nations like Kazakhstan, Mongolia, China (14), Thailand (16), Kyrgyzstan (26), and Uzbekistan (31).

In fact, mothers from only Papua New Guinea, Pakistan, Cote d’Ivoire and Nigeria are worse placed than their Indian counterparts. This is the bottom line of two decades of economic reforms.

More shocking is the fact that India has actually slipped from the 75th position last year. Compare this with the achievement of Afghanistan, which has lifted itself by a notch in the rakings of the least developed countries, doing better than Niger – despite the ravages of war and the apparent lack of any governance structures in most parts of the nation.

Good news from Bihar

The only good news from India comes from – well, where else – Bihar. The Save the Childten report on State of Mothers 2012 notes:

“India’s Bihar State – one of the poorest in the nation – is at the forefront of the battle against vitamin A deficiency, which afflicts up to 62 percent of preschool-aged children in rural India. The state set the ambitious goal of reaching out to all children, beginning with those traditionally excluded from services – children from the lower castes and minority groups – in which malnutrition and mortality rates are often highest. More than 11,000 health centers and 80,000 anganwadis, or child development centers, serve as core distribution sites for vitamin A supplements in Bihar. In addition, more than 3,400 temporary sites were organized to deliver vitamin A within small, isolated communities. Frontline health and nutrition workers and community volunteers in the 38 districts of Bihar were trained to administer preventive vitamin A syrup to children and to counsel mothers on how to improve the vitamin A content of their children’s diet. In 2009, Bihar’s vitamin A supplementation program reached 13.4 million children under 5, protecting 95 percent of children in this age group against the devastating consequences of vitamin A deficiency. [Reference: UNICEF. Tracking Progress on Maternal and Child Nutrition: A Survival and Development Priority] In 2010, national coverage for India as a whole was estimated at only 34 percent. [UNICEF. The State of the World’s Children 2012. Table 2, p.93]”

It’s time we learnt from Bihar, if not from Cuba, how to take care of young mothers.

PTI reports:

Better to be a mother in China or Sri Lanka than India: report

New Delhi: India appears not to be a happy place for women to become mothers, as it has been ranked 76th among 80 “less developed” countries, even below some of the poor African nations, according to a report released to mark the Mothers’ Day being celebrated across the world today.

The State of World’s Mothers 2012 report by international child rights NGO ‘Save the Children’ has seen India slipping one position down from the 75th spot of last year’s report.

According to the report, which looks at how good the life of a woman or a mother is around the globe, one out of every 140 women in India runs the risk of dying during childbirth, which is a much higher figure compared to neighbouring nations such as China and Sri Lanka.

In China, one in 1,500 women runs the risk of maternal death, while it is one in 1,100 in Sri Lanka and one in 180 in Myanmar.

The study also found that less than half (49 per cent) of women in India use some form of modern contraceptives and only 53 per cent of births are attended by skilled health workers, which is the fifth lowest in all of Tier II countries.

With 43 per cent of underweight children in under-five age group, India has the highest rate of child malnutrition of all Tier II countries and the second highest rate in the world (tied with Yemen) after Timor-Leste.

“Even though India has made efforts to improve maternal health by encouraging institutional deliveries and taking other measures, the benefits have not yet appeared to bring about a shift,” CEO of Save the Children India, Thomas Chandy said.

“This report shows that even now almost half of our births take place in the absence of skilled health personnel. This has a direct bearing on mothers’ health and, due to the strong dependence of children on mothers, also on children’s health,” he said.

As far as the educational status of women is concerned, the average years of formal schooling for women in India is just 10 years, lower than China and Sri Lanka (12 years).

India’s poor performance in providing education to women also places it among the bottom 10 in Tier II countries, Chandy said.

In Asia, Bangladesh and Nepal are rated in the report as “good” for their practices related to infant and toddler feeding; Afghanistan and India are rated as “fair”; Pakistan and Vietnam as “poor”.

Shireen Vakil Miller, Director for Policy and Advocacy at Save the Children, said though exclusive breastfeeding is a critical source of nutrition for a baby, only 46 per cent of newborns in India are exclusively breastfed till six months.

“Globally, exclusive breastfeeding can save one million lives in a year. We urge the government of India to take the findings into account and radically transform the health service delivery system as well as improve education and nutritional status of children in India,” Miller noted.

In South Asia, Sri Lanka, which is ranked 42nd among the less developed countries, remains exemplary with its excellent indicators on women’s and children’s health.

“India should also learn from the examples of countries like Sri Lanka that have invested so well in their public health system,” Miller said. “China, India’s economic rival, is far ahead of India at rank 14, which is an improvement from its 18th rank last year,” she added.

According to the report, Niger has replaced Afghanistan as the worst place to be a mother in the world, while Norway has retained its place on the top of the list which compared 165 countries around the globe.

From the Save the Children report:

Key findings

1. Children in an alarming number of countries are not getting adequate nutrition during their first 1,000 days. Out of 73 developing countries – which together account for 95 percent of child deaths – only four score “very good” on measures of young child nutrition. Our Infant and Toddler Feeding Scorecard identifies Malawi, Madagascar, Peru and Solomon Islands as the top four countries where the majority of children under age 2 are being fed according to recommended standards. More than two thirds of the countries on the Scorecard receive grades of “fair” or “poor” on these measures overall, indicating vast numbers of children are not getting a healthy start in life. The bottom four countries on the Scorecard – Somalia, Côte d'Ivoire, Botswana and Equatorial Guinea – have staggeringly poor performance on indicators of early child feeding and have made little to no progress since 1990 in saving children’s lives.


2. Child malnutrition is widespread and it is limiting the future success of millions of children and their countries. Stunting, or stunted growth, occurs when children do not receive the right type of nutrients, especially in utero or during the first two years of life. Children whose bodies and minds are limited by stunting are at greater risk for disease and death, poor performance in school, and a lifetime of poverty. More than 80 countries in the developing world have child stunting rates of 20 percent or more. Thirty of these countries have what is considered to be “very high” stunting rates of 40 percent or more. While many countries are making progress in reducing child malnutrition, stunting prevalence is on the rise in at least 14 countries, most of them in sub-Saharan Africa. If current trends continue, Africa may overtake Asia as the region most heavily burdened by child malnutrition.

3. Economic growth is not enough to fight malnutrition. Political will and effective strategies are needed to reduce malnutrition and prevent stunting. A number of relatively poor countries are doing an admirable job of tackling this problem, while other countries with greater resources are not doing so  well. For example: India has a GDP per capita of $1,500 and 48 percent of its children are stunted. Compare this to Vietnam where the GDP per capita is $1,200 and the child stunting rate is 23 percent. Others countries that are performing better on child nutrition than their national wealth might suggest include: Brazil, Chile, Costa Rica, Kyrgyzstan, Mongolia, Senegal and Tunisia. Countries that are underperforming relative to their national wealth include: Botswana, Equatorial Guinea, Guatemala, Indonesia, Mexico, Panama, Peru, South Africa and Venezuela.

4. We know how to save millions of children. Save the Children has highlighted six low-cost nutrition interventions with the greatest potential to save lives in children’s first 1,000 days and beyond. Universal coverage of these “lifesaving six” solutions globally could prevent more than 2 million mother and child deaths each year. The lifesaving six are: iron folate, breastfeeding, complementary feeding, vitamin A, zinc and hygiene. Nearly 1 million lives could be saved by breastfeeding alone. This entire lifesaving package can be delivered at a cost of less than $20 per child for the first 1,000 days. Tragically, more than half of the world’s children do not have access to the lifesaving six.

5. Health workers are key to success. Frontline health workers have a vital role to play in promoting good nutrition in the first 1,000 days. In impoverished communities in the developing world where malnutrition is most common, doctors and hospitals are often unavailable, too far away, or too expensive. Community health workers and midwives meet critical needs in these communities by screening children for malnutrition, treating diarrhea, promoting breastfeeding, distributing vitamins and other micronutrients, and counseling mothers about balanced diet, hygiene and sanitation. The “lifesaving six” interventions highlighted in this report can all be delivered in remote, impoverished places by well-trained and well-equipped community health workers. In a number of countries – including Cambodia, Malawi and Nepal – these health workers have contributed to broad-scale success in fighting malnutrition and saving lives.

6. In the industrialized world, the United States has the least favorable environment for mothers who want to breastfeed. Save the Children examined maternity leave laws, the right to nursing breaks at work, and several other indicators to create a ranking of 36 industrialized countries measuring which ones have the most – and the least – supportive policies for women who want to breastfeed. Norway tops the Breastfeeding Policy Scorecard ranking. The United
States comes in last.

Recommendations

1. Invest in proven, low-cost solutions to save children’s lives and prevent stunting. Malnutrition and child mortality can be fought with relatively simple and inexpensive solutions. Iron supplements strengthen children’s resistance to disease, lower women’s risk of dying in childbirth and may help prevent premature births and low birthweight. Six months of exclusive breastfeeding increases a child’s chance of survival at least six-fold. Timely and appropriate complementary feeding is the best way to prevent a lifetime of lost potential due to stunting. Vitamin A helps prevent blindness and lowers a child’s risk of death from common diseases. Zinc and good hygiene can save a child from dying of diarrhea. These solutions are not expensive, and it is a tragedy that millions of mothers and children do not get them.

2. Invest in health workers – especially those serving on the front lines – to reach the most vulnerable mothers and children. The world is short more than 3 million health workers of all types, and there is an acute shortage of frontline workers, including community health workers, who are critical to delivering the nutrition solutions that can save lives and prevent stunting. Governments and donors should work together to fill this health worker gap by recruiting, training and supporting new and existing health workers, and deploying them where they are needed most.

3. Help more girls go to school and stay in school. One of the most effective ways to fight child malnutrition is to focus on girls’ education. Educated women tend to have fewer, healthier and better-nourished children. Increased investments are needed to help more girls go to school and stay in school, and to encourage families and communities to value the education of girls. Both formal education and non-formal training give girls knowledge, self-confidence, practical skills and hope for a bright future. These are powerful tools that can help delay marriage and child-bearing to a time that is healthier for them and their babies.

4. Increase government support for proven solutions to fight malnutrition and save lives. In order to meet internationally agreed upon development goals to reduce child deaths and improve mothers’ health, lifesaving services must be increased for the women and children who need help most. All countries must make fighting malnutrition and stunting a priority. Developing countries should commit to and fund national nutrition plans that are integrated with plans for maternal and child health. Donor countries should support these goals by keeping their funding commitments to achieving the Millennium Development Goals and countries should endorse and support the Scaling Up Nutrition (SUN) movement. Resources for malnutrition programs should not come at the expense of other programs critical to the survival and well-being of children.

5. Increase private sector partnerships to improve nutrition for mothers and children. Many local diets fail to meet the nutritional requirements of children 6-24 months old. The private sector can help by producing and marketing affordable fortified products. Partnerships should be established with multiple manufacturers, distributors and government ministries to increase product choice, access and affordability, improve compliance with codes and standards, and promote public education on good feeding practices and use of local foods and commercial products. The food industry can also invest more in nutrition programs and research, contribute social marketing expertise to promote healthy behaviors such as breastfeeding, and advocate for greater government investments in nutrition.

6. Improve laws, policies and actions that support families and encourage breastfeeding. Governments in all countries can do more to help parents and create a supportive environment for breastfeeding. Governments and partners should adopt policies that are child-friendly and support breastfeeding mothers. Such policies would give families access to maternal and paternal leave, ensure that workplaces and public facilities offer women a suitable place to feed their babies outside of the home, and ensure working women are guaranteed breastfeeding breaks while on the job. In an increasingly urban world, a further example is that public transportation can offer special seats for breastfeeding mothers.