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Model city Ahmedabad's 50% construction workers' children underweight: Oxford study

By Rajiv Shah
A recent study published in the “International Journal for Equity in Health” has found that high levels of malnutrition has found the proportion of stunting (40.5%) and wasting (22.1%) among migrant children in the “model city” Ahmedabad were “close to the national average”, but the “proportion of underweight children (50.4%) was considerably higher.”
Carried out by scholars Divya Ravindranath, Jean-Francois Trani and Lora Iannotti, titled “Nutrition among children of migrant construction workers in Ahmedabad, India”, the study is based on field work between May 2017 and January 2018 at five construction sites in Ahmedabad, involving “anthropometric measurements” of 131 under five children (male: 46%, female 53%), using “the UNICEF framework on undernutrition” to examined “the underlying causes of poor nutritional outcomes”.
Using qualitative methods such interviews, focused group discussions and participant observation at the field sites, all in Hindi or Gujarati, the study regrets: “Strikingly, despite the high proportion of undernutrition among children, an overwhelmingly large number of mothers did not consider their children to be malnourished.”
The study, whose sample consists of mainly children from districts within the states of Gujarat and Rajasthan, as also those coming from Madhya Pradesh, Chhattisgarh, Bihar and West Bengal, the study says, “Largest group of children were from Scheduled Tribes (ST), while the others belonged to Scheduled Castes (SC) and Other Backward Classes (OBC).”
According to the study, “Approximately 70% of the mothers reported that their households undertook seasonal migration. They returned to their villages periodically for agricultural work, weddings, festivals, and other cultural events.” Residing at “multiple locations”, as they moved from one construction site to another at the end of each project cycle along with their little ones, “the duration of stay at each site usually spanned between three months to over a year based on the size of the project.”
“In terms of wage patterns, mothers received between Rs 250–300 (minimum wage is Rs.306 per day). However, wages were usually paid to the family as a unit and were collected by the male head of the family”, the study underlines, adding, “It was common practice for households to take kharchi – a form of cash advance (from their own monthly wages), to meet weekly expense of food, medical care, remittances and debt repayments.”
The authors say, “A majority of mothers (66%) did not know their age. Similarly, most mothers (72%) noted that they had never attended school.” Finding a positive relationship between mothers’ schooling and child stunting”, the study adds, “Over half of the mothers were underweight or suffered from low body mass index (BMI).”
Providing details of perception of nutrition and morbidity among mothers, the authors say, “When we asked mothers if their child was well nourished, all mothers except four replied in the affirmative.” Yet, most mothers “reported that their children fell ill very frequently. Diarrhoea, cold, cough and fever were cited as the most common ailments. These illnesses were mostly associated with lack of clean drinking water or change in weather.”
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The study says, “Over three-fourths of the mothers interviewed reported breastfeeding their children since birth. The frequency of breastfeeding ranged between 2 and 6 times in a day. Women reported several barriers to breastfeeding at the construction site.” One mother has been quoted as saying: “When we are at work, we cannot come often to feed the child. The contractor doesn’t allow us.”
“Though breastmilk was the chief source of diet for infants, most mothers reported giving their children water or water mixed with sugar, especially in summer to beat the heat”, the authors say, because they think “milk is not enough when it is so hot” and “you have to give something more otherwise the child is always crying.”
During home visits, the authors observed that the meals in the households comprised of “a combination of dal (lentil), chawal (rice), or roti (flat bread) made of corn/wheat flour, sabzi (vegetable curry) usually made out of tomatoes, onions and eggplants that were easy to clean and cook”, regretting, “None of the households reported the consumption of fruits, eggs or leafy greens.”
Say the authors, “A large majority of households complained that the cost of food items was much higher in the city, which prevented them from consuming greater variety of food.” A father stated that milk is “available in the shop, but it costs more. For our three children we need one full packet. In the village we have a cow at home so we don’t spend that much.” And a mother added, “We try to buy what we can. But it costs a lot of money.”
The authors note, “The temporary housing structures in labour colonies were built in unused parts of the construction site, too close to a dump yard as we saw in one case or next to scrap materials. At one of the construction sites, the labour colony was built on undulated land, which flooded during rains.”
They add, “Though there were toilets in the labour colonies, parents did not always encourage children to use them either because they were very crowded or not well-maintained. As a result, children especially the younger ones, defecated in the open right next to their house where the mother could clean easily.”
“Similarly”, the authors say, “Access to portable water was a cause of concern. At two labour camps, we observed that parents brought home drinking water from an uncovered tank that was used for bathing and washing. One mother remarked: ‘We always find insects in the water. What can we do? We drink this only’.”
As for access to healthcare, the authors say, “Households had to locate private medical care services every time they moved within the city. They found localized services more convenient in terms of timings and distance, than government run hospitals that were not always located in their immediate vicinity.”
A mother complained to the authors, the government hospital is “very far” and it would take them “full day” for visiting the facility: “The lines are very long there for everything. They make us wait to even get what is in the parchi (prescription)”. Comment the authors, “In addition, the popular belief among parents was that private hospitals provided “better” medical care than government hospitals.”

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