By Aniruddha Ghosal
The 30-year-old gingerly stepped onto the weighing scale. “Thirty-one kilograms,” the doctor said and asked her to sit down. Neither of them knew that she was pregnant.
All of four-feet and ten-inches, Jayati (name changed to protect her identity) is the mother of two. It took her four hours to walk from her home, atop one of the many forested hills of Odisha’s Raygada district, to reach the clinic run by the NGO Swasthya Swaraj. Her story, like so many others in Odisha’s tribal villages, is also the story of malaria, malnutrition and mothers desperate to break the vicious cycle that is increasingly made worse by climate change.
In the past two years, Jayati has made this journey multiple times, for different ailments. In April 2016, she was diagnosed with clinical malaria and was found to be dangerously anemic. Two months later, she got malaria again. In December 2016, she was diagnosed with tuberculosis. In 2018, she gave birth and arrived at the clinic in June 2018 for postnatal care. “My body aches and I also have a fever,” she told the doctor, who asked the nurse to run a few tests. A little while later, the nurse returned with Jayati, her face ashen. “She’s pregnant and wants an abortion. But she will have to ask her husband first,” the nurse said.
The doctor, who didn’t wish to be named, explained that it wasn’t the history of malaria or tuberculosis that worried him the most. But her weight. “She is severely malnourished,” the doctor said, adding that this wasn’t uncommon in the district. “It is almost the norm,” he said.
The Malnutrition and Malaria Connection
For decades, the tribal districts of Odisha have been synonymous with famine and drought. But malnutrition is not the same as starvation. It is more insidious, impacting the function and recovery of almost every organ in the human body – from loss in muscle function, weakening the respiratory system, to a direct impact on a person’s immunity. Malnutrition also impacts consequent generations. The weight of the child at birth is dependent on factors ranging from maternal nutrition, to gestation at birth, and the mother’s age. It is likely, the doctor said, that “Jayati’s parents were undernourished”, and there is a risk to her child. “It is a cycle and one which is very hard to get out of. Because it is entirely based on inequality,” the doctor said. Additionally, the village is in the heart of the red corridor – the area in India impacted by Left Wing extremism – and officials admitted that doctors were often too afraid to work in the area and for decades health care in the region was ignored.
In August, a special report on climate change and land by the UN Intergovernmental Panel on Climate Change (IPCC) in Geneva warned of desertification and degradation due to climate change and said that food security will be impacted. Recently, the Lancet Countdown Report 2019 on Health and Climate Change found that the average yield potential of maize and rice declined almost 2 per cent in India since the 1960s. In India, malnutrition accounts for 68% of the deaths of under-five children and was responsible for 17.3 per cent of the total disability-adjusted life years (DALYs) -- a measure of overall disease burden, said a study published in September. Dr. Shobha Suri, senior fellow with the Observer Research Foundation and an expert in nutrition said stressed on the need to break this intergenerational cycle of malnutrition, poverty and disease by improving “maternal nutritional status and pregnancy outcomes. “It is crucial to prioritize adolescent health in order to break the intergenerational cycle of malnutrition,” she said.