Khaknar block, Bhuranpur district, Madhya Pradesh / 2014
by Action Against Hunger France (ECHO)
The overall objective of this Link NCA was to provide a greater level of understanding regarding the possible causes of child undernutrition in the operational ACF-India area of Khaknar block, Bhuranpur district, Madhya Pradesh. In the Burhanpur district, ACF is working closely with the National Rural Health Mission (NRHM) and the Integrated Child Development Services (ICDS) at the district and village level. Its actions are focusing on the prevention and detection of acute malnutrition, referral of children with severe acute malnutrition (SAM) to nutrition rehabilitation centres (NRCs) and doing follow-ups with an integrated IYCF approach.


Caregivers’ level of education

Caregivers’ level of education, particularly for women, is known to have an impact on nutrition and child health status and is an important factor influencing child undernutrition. It is also often viewed as a proxy for socioeconomic status and improved care practices.

Illiteracy and school dropout rates are generally high in India, especially in rural areas. “Caregivers’ level of education” had been validated has a hypothesis to be field tested.

Quantitative results showed a high rate of illiteracy among caregivers (59.68% [95% CI, 51.92% - 67.44%]) while average education levels among those who attended school remained relatively low (7.36 years completed [95% CI, 6.92-7.8]). Although quantitative results and grey literature tends to show that caregivers’ level of education has an impact on child health and nutrition status, qualitative enquiries have demonstrated that communication between mothers in the community and involvement of frontline workers have a positive impact on the  knowledge of mothers. Indeed, mothers explained being conscious of the difficulties they might face to understanding certain issues or finding adequate information. To counterbalance these potential difficulties, mothers have seeked advice, especially regarding reproductive health and care practices, from the those in the community who might have a better understanding, i.e. community health workers (Anganwadi workers), mother-in-laws or women who have attended high school.
Low income

In the given context, low income was a major contributor to a large scope of risk factors: from inadequate food diversity to the high workload of women.

The majority of the studied population were casual labor workers with work opportunities highly dependant on seasonality. The peak of employment is correlated with the monsoon season, when families usually save money to last for the whole year. Afterwards employment opportunities decrease until the summer season when casual work opportunities are nearly inexistent. At this time of the year, families have to rely upon their savings, and resource management should be carefully monitored to avoid important family depletion before the next monsoon season.

In 2005, the Indian government enacted a labor law and social security measures that aimed to guarantee a “right to work” and insure livelihood security in rural areas: the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). The act enacted the right to at least 100 days of wage employment per fiscal year for every household whose adult members volunteer to do unskilled manual work.

Qualitative enquiries show that although the MGNREGA act was well known by the population, households were largely reticent to enter in the scheme as long payment delays had been reported (one week to three months) and they feared not being able to cope financially during this period. Due to these concerns, communities were not motivated to volunteer for job opportunities provided by the MGNREGA and many families remained in a difficult situation during the summer. Lack of efficient implementation of the MGNREGA was considered an important pathway to low income.

Migration and under-nutrition

In the early stages of the Link NCA, migrant groups were identified as possible nutrition vulnerable groups due to living conditions during migration. The study revealed that reasons for migration differed from one household to another, with traditional migration differing from occasional migration. 

Traditional migrants mainly considered relocation as a strategy for household wellbeing growth, while occasional migrants seem to move in order to better cope with external economic shocks. Traditional migrants are following long standing and established routes towards being less dependant on contractors and stronger social networks. Living conditions, employment opportunities and wages are well identified results and migrants can plan their yearly expenses accordingly. Occasional migrants are pushed into migration due to the absence of coping mechanisms against external economic shocks. One of the main reasons for migrating was due to the delay of the monsoon season and therefore they faced a longer period with very few employment opportunities. Groups having difficulties coping would ask for advances on wages and would then migrate to reimburse their contractors. Unlike traditional migrants, these groups often end up in areas that are unfamiliar to them, with no social networks and difficulties accessing basic services.

The qualitative study also demonstrated a correlation between access to land and migration, with more migration from dry areas not benefiting from a good irrigation systems.

An important added value of this Link NCA was to identify more precisely the nutritionally vulnerable groups and to inform on the local phenomenon of migrations.

Full report Link NCA Madhya Pradesh Case Study, Madhya Pradesh, India, 2014