Child Health Status and Inequalities in the Indian Sundarbans

IntroductionThe Government of India has taking initiatives since the First Five Year Plan (1951-56) to improve child health in India. The Ministry of Health and Family Welfare has sponsored special projects under the Maternal and Child Health programme, including the Oral Rehydration Therapy programme, the Universal Immunisation Programme and the Maternal and Child Health Supplemental programme. Since 1996, all these programmes are integrated as Reproductive and Child Health programme. In 1976, the Department of Women and Child Development initiated the Integrated Child Development Services (ICDS). In the ICDS programme, anganwadi centres (AWC) provide children supplementary nutrition up to age six years and take care of their health and pregnant and lactating mothers.The Indian Sundarbans, one of the world heritages, is a unique biosphere reserve of mangrove forests spread across more than hundred islands (see Figure 1). Most of the region is intersected by tidal rivers or estuaries and innumerable narrow tidal creeks, and made it largely formidable and inhospitable terrain. The Sundarbans, famous for its iconic Royal Bengal Tiger, is also home of almost four-and-a-half million people living in abject poverty, chronic deprivation and acute suffering from climatic adversities. The geographical challenges are part of the lives of the Sundarbans' population who subsist primarily on agriculture, fishing and collecting forest products.Child health is extremely vulnerable in the Indian Sundarbans region due to its spatial geographical accessibility problems, climatic challenges and economic vulnerability. It is important to study child health as today's children will be tomorrow's citizen. Only if the children are healthy, they will be able join their hands to boost up a country's income (GDP) in future. Also from a household's perspective, investing in the health of a child will be beneficial for the parents in their old age. Due to children's rapid growth and physiological and cognitive development, they are exposed and more vulnerable to ... physical environmental hazards compared to adults (1).The 1,000 days, from start of a woman's pregnancy and her child's second birthday is a unique window of opportunity to make the children healthier and prosperous in future. This 1,000 day window can also improve society's long-term health, well-being and prosperity (2). Improved child health during these 1,000 days has an intense impact on a child's cognitive ability to grow. It also helps to increase productivity of a child and secure economic prosperity of their families and economy. This paper, hence, will try to see the child health status in the first 1,000 days in the Sundarbans. It will also try to see the inequalities in child health in this area.MethodsThe study is based on the data collected in a primary survey in the Patharpratima block (see Figure 2) of South 24 Parganas district of the Sundarbans during April-May 2012 (henceforth called FHS-IIHMR Survey 2012). Patharpratima was selected because it is an ideal mix of deltaic (less accessible) and nondeltaic (more accessible) habitations among all the 19 blocks of the Sundarbans (3).It is also one of the six blocks most vulnerable to climatic shocks. The typical deltaic topography, geographical hurdles, and multi-ethnic composition of the population in this block make it appropriate to study the critical healthcare issues which are typically associated with the remote islands of the Sundarbans. Total population of the selected block is about 330,000, spread across 15 Gram Panchayats (GPs). Ten of these GPs are water-locked (deltaic) while the other five are non-deltaic.The household survey was carried out by twostage stratified purposive random sampling using structured questionnaires. The study area has been divided in to two strata, i.e., deltaic and non-deltaic regions. From each stratum, villages are sampled according to probability proportional to size (PPS sampling). …