A plan that focuses on targeting and triaging the most vulnerable — a strategy that keeps them at the centre without silos — might just be what we need to move one step forward in improving the wellbeing of people.
It seemed like a data anomaly when we looked at the temporal pattern of malnourishment in the tribal sub-division of Dharni in Maharashtra’s Amravati district. An April peak in the number of children with Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) surprised us. The common sense of nutrition discourse dictates that the peak should be in monsoon when diarrhoea takes over, or in winter when hypothermia is the devil for children. We re-checked our data and went back to previous years — this only seemed to confirm our findings. Every year, for at least the past three years, numbers had peaked in April. And, this was no small peak. The numbers went up more than five times suddenly, with two tribal blocks having more SAM and MAM children than the rest of the 12 blocks combined. The numbers kept reducing steadily all year round before peaking again in April.
What was happening? After some discussions, we realised that several families were returning to Dharni from migrated places in March for Holi (the biggest festival here), then going back to fulfil contracts, only to come back “permanently” in the kharif season when cropping begins (there was a smaller peak at June). Our later pursuits revealed a more direct correlation in Nandurbar, a tribal district in Maharashtra, where a 2018 UNICEF study had followed the same cohort of children, before and after migration. SAM numbers increased fourfold, MAM too doubled — at least half of the migrated children. Given the geographical complications of migration as well as a lack of data, such studies have been few.
Migration became the buzzword during the Covid pandemic in cities. However, rural migration has continued for years. In tribal areas especially — owing to lack of industry, issues with forest rights, or its implementation, and lack of irrigation facilities — migration extends to six to eight months a year.
The first question that I asked myself was that if people are staying somewhere else for over half a year, wasn’t that place as much their home? Multiple government schemes — for strengthening education, health, connectivity, water supply, electricity — work on the assumption that people are going to stay in villages to reap the fruits of what this capital and operation will sow. This assumption falls flat in high migration areas and the understanding of an inter-relationship between long-term nutrition, migration and livelihood (including, most of all, MGNREGS) goes askew.
We decided to work on our findings last year and asked a few questions: Where were people migrating from the most? How many? Which were the highest-density in-migration places? We did get some answers, but they seemed vague. It stood out that in our nutrition surveys, the lack of migration data inflated the denominator (number of children being measured), especially because new births kept adding to it, leading to data that did not accurately reflect the situation. Since we were in the middle of migration season, we decided to meet these migrated families.
Three things that changed everything I have ever understood about migration came from field visits. The most distinct memory I have is of an interaction with a brick kiln owner who shook his head when I asked him “Kitne bacche honge idhar (how many kids are here?)”. He said “Ham bacche nahi ginte kyunki voh idhar kaam nahi karte (we don’t count children because they don’t work here).” No wonder, then, that there was an invisible set of people — especially pregnant/lactating women and children — who were not of any “use” here. We met many families. Coming face to face with our own prejudices was also important. We believe migration to be a bad thing, but here were multiple families being provided guaranteed wages — the word “guaranteed” being especially important because many people told us they would be happy to not work here if they got assured MGNREGS work back home.
The second learning happened when we met a nine-month-old who was due for MMR vaccination but wasn’t given the dose because he wasn’t due for it back home, and by the time he would go back, he would have missed it. Our assumption is that this time period of six to eight months must be leaving many children and pregnant women unvaccinated. This is not due to the lack of health or nutrition infrastructure or indifference — it is because of a lack of knowledge of these beneficiaries being here. Most of these brick kilns are around 1-2 km outside the villages and until there is intimation of some government contact, it is difficult for both giver and receiver to get in touch.
Portability as a concept is not new. But my third learning was that we have to start thinking about a system that does not rest completely on demand. Our questions — do you take ration from shops? Do you take your kids to anganwadis? — were answered in the negative. It did not surprise me. A Korku tribal population distress-migrating in a predominantly Marathi belt: Think of the bargaining power, especially of women and children. It doesn’t take much to join the dots.
Our learnings led us to start working on a migration tracking system as well as strengthening MGNREGS. But these inter-relationships need a deeper dive, especially in tribal areas, which constitute a higher density of malnutrition. SAM and MAM are the tip of the iceberg when we talk about nutrition. A long-term reduction in stunting and underweight and improving health will need us to understand the interplay of nutrition, livelihood and poverty. A plan that focuses on targeting and triaging the most vulnerable — a strategy that keeps them at the centre without silos — might just be what we need to move one step forward in improving the wellbeing of people.
Written by Mittali Sethi
Source: Indian Express, 2/12/22
