Corporate provision of Spirulina supplements for children with malnutrition in anganwadis in Karnataka – a critique
Background of the ICDS program
The Integrated Child Development Services (ICDS) Scheme was started in Karnataka on the 2nd of October 1975 as a pilot project in T. Narsapura, Mysore district, with around 100 anganwadis. Since then the program has expanded and has aimed to meet the nutrition needs of pregnant women, nursing mothers, adolescent girls and children below 6 years of age. The objectives of the ICDS are to improve the health and nutritional status of children 0 – 6 years, to lay the foundation for proper physical, psychological and emotional development of the child, to reduce the incidence of mortality, morbidity, malnutrition and school dropout, to achieve effective co-ordination of policy and implementation among various departments to promote child development and to enhance the capability of the mother to look after the normal health and nutritional needs of the child, through proper health and nutrition education.
Supplementary nutrition is to be provided to the beneficiaries under the ICDS programme with revised feeding norms of 500 calories of energy and 12-15 gms of protein to 0-6 years children, 600 calories of energy and 18-20 gms of protein to pregnant women/lactating mothers/adolescents girls, 800 calories of energy and 20-25 gms of protein to severely malnourished children as a supplement to their normal intake, as envisaged in the schematic guidelines. Supplementary nutrition is to be given for 300 days in a year at a cost of Rs. 6.00 per beneficiary per day for normal children and Rs. 7.00 per beneficiary per day for pregnant/nursing mothers/adolescent girls and Rs. 9.00 to severely malnourished children.
In 2001, the Supreme Court, in the public interest litigation PUCL vs Union of India and Others, Writ Petition (Civil) 196 of 2001 (1), and in the context of meals for children under the Integrated Child Development Services (ICDS) scheme, passed orders that contractors should not be used to provide supplementary nutrition to the ICDS; village communities, mahila mandals and self-help groups should be given preference for preparing food to be served under the ICDS. As regards midday meals for schools, the Supreme Court ordered that women from marginalised communities be hired to cook the meals. These orders were primarily based on the fact that malnutrition is rarely recognised as a serious health condition by people and communities; that people and communities where malnutrition occurs have the biggest stake in the health of their children; that participating in the reduction of child malnutrition through cooking meals will help people understand the nutritional requirements of their children as well as give children a balanced meal based on local food diversity; and, in the case of midday meals, cooking and eating meals together will help school children and communities not just improve their nutrition but also help to eradicate social discrimination based on caste, ethnicity and religion. (PUCL Vs. Union of India & others, 2005)
In Karnataka, 137 Mahila Supplementary Nutrition Production & Training Center’s (MSPTC) were to be promoted by the Department of Women and Child development (DWCD) for manufacture and supply of Supplementary Nutrition Production (SNP) food items to ICDS beneficiaries. Each MSPTC consists of women members ranging from 22-32 from the most vulnerable sections of the society such as widows, destitutes, physically challenged, mothers of the beneficiary children, poorest of the poor and the members of the Stree-shakti groups etc. The MSPTC is expected to function at taluk level to facilitate easy distribution of SNP food items at AWCs. Through MSPTC, ready to eat/ ready to cook food is supposed to be provided to all beneficiaries for 6 days in a week. (Department of Women and Child Development, 2012)
The menu would be selected by the committee constituted under the chairmanship of Deputy Commissioner of the district, namely and ranges from wheat rava, rava laddu, rice kichdi, sprouted green gram, chitranna, rice and sambar etc.
Under the Kshera Bhagya scheme, 6 months to 6 year old children are to be provided 150 ml of milk for three days a week (15 gms skimmed powder and 10 gms sugar). Severely malnourished children are to be provided egg for three days and 200 ml milk for three days. Children who do not consume egg are to be provided six days of milk. Moderately malnourished children of five backward districts viz. Bidar, Gulbarga, Raichur, Koppal and Yadgir are to be provided egg for three days and 200 ml of milk for three days and children who do not consume egg are to be provided six days of milk.
A new scheme has been proposed by the Government of India called “Multi- Sectoral Nutrition programme’ to address the maternal and child malnutrition in selected High burden districts. The main aim of the scheme is to ensuring strong nutritional focus through Institutional and programmatic convergence and empowering families and communities for improved care behaviour. The district nutrition council will be formed in all the 4 high burden districts. For this Rs.155.32 lakhs has been allocated. Since the ICDS Scheme is based on the strategy of an intersectoral approach to the development of children, coordination of the efforts of different programmes and Departments at all levels is seen to be necessary. As per the ICDS guidelines “For the ICDS to achieve its objectives, an effective synergy is required between the Ministry of WCD and the Ministry of Health & Family Welfare, Department of Elementary Education, Department of Drinking Water Supply, M/Panchayat Raj to meet the requirements of health, sanitation, drinking water, pre-school education etc. Similarly, synergy is necessary between different Departments in the States also.” (Department of Women and Child Development, 2012)
The Govt. of India has also decided to set up a regular monitoring and supervision mechanism of ICDS Scheme through NIPCCD, in addition to the existing M&E Unit in the Ministry of Women & Child Development, with the objective of identifying the strengths and weaknesses of the already existing monitoring system to determine strategy to be adopted to develop effective monitoring mechanism at all levels; i) to study convergence of services provided under other schemes of the department; to analyse the services delivered under the ICDS at all levels; to identify the bottlenecks/problems of the scheme and initiate action for corrective measures; to test the accuracy of the data received at the national level; to prepare detailed recommendations for improving the efficiency and effectiveness of the scheme; and to document some of the Best Practices at the state level. The new Monitoring and Supervision set up will be a three-tier system, monitoring at National level, State level and Community level. (NIPCCD, 2013-14)
History of malnutrition in Karnataka
According to RTI information, more than 21 lakh children in the state are mildly malnourished, 12 lakh are moderately malnourished (DNA, 2012). Field experience leaves no room for doubt that these numbers would account for only the tip of the iceberg. Karnataka ranks 11th in the India State Hunger Index.
On the 5th of May 2011, a local news channel in Karnataka brought to light the starvation deaths in the state, implicating both the health department and the Women and Child Department. This was converted to a Public Interest Litigation (Writ Petition No.38 1571201 1 (PIL)) and a nine member committee was constituted under the Chairmanship of Hon’ble Mr. Justice N.K. Patil, Judge, High Court of Karnataka, to document the factors contributing to the unacceptable levels of malnutrition in Karnataka and submit a report. The report brought out certain key points.
The Comprehensive action plan report on prevention of malnutrition of children in Karnataka submitted to High Court of Karnataka on 23-8-2012 gave some recommendations, while acknowledging that malnutrition is widespread among the disadvantaged in Karnataka, with severe and long lasting consequences. The causes of malnutrition were stated to be numerous, intertwined with each other and hierarchically related, with the most immediate determinants being poor diet and illness, which are themselves caused by a set of underlying factors influenced by basic socioeconomic and political conditions within which poor families are attempting to raise children. An accurate understanding of the relationships among these various causes of malnutrition and the relative contribution of each is essential for the design of efficient and effective programmes to reduce malnutrition and its consequences.
The action plan report states that the Central and State Governments cannot neglect or fail to provide basic healthcare needs such as shelter, clothing, nutritious food, pure drinking water and timely medical treatment as a Constitutional duty. (Comprehensive Master action plan report, 2012)
The state was asked to ensure co-ordination between various departments such the Department of Women and Child Development, Department of Health and Family Welfare, Department of Medical Education, Department of RDPR and Urban Development department of Government of Karnataka. This was especially in the context of the usual piecemeal and knee jerk responses by the State that completely failed to provide the requisite social, medical and nutritional inputs for a comprehensive approach to child health and nutrition. The role of the nutritional Rehabilitation Centre was also stressed upon. The committee strongly recommended that locally available, seasonal, freshly cooked and hot meals be made available to children in anganwadis as advised by nutrition experts and doctors and inclusive of carbohydrates, proteins, fats, vitamins and minerals. The recommendations also include the setting up of a regional nutrition council for the purpose of research and to recommend the nature of nutritional needs. (Comprehensive Master action plan report, 2012)
In April 2012, Christy Friedgram Industries (CFI) was investigated by the Lokayukta police for fraudulent practice in the supply of supplementary nutritional foods to anganwadis under the ICDS and found to have an elaborative system of deception in place. Former employees of CFI disclosed that the company had violated several norms. Their contract was to capacity build 137 MSPTCs at the taluk level in the state of Karnataka, and not as a contractor for food supply. In accordance with Supreme Court directives the state government, in its agreement with CFI had stated that the company would be paid for raw material supplied to MSPTC and also paid a profit of Rs. 1 /kg of food supplied. The rest of the profit was to be shared among the members of the MSPTC. To avoid the MSPTC being involved in details such as funds received, indents, supply, turnover (at the rate of several crores annually), CFI had ordered its employees to hire women who were uneducated and semi-literate. Although the women were mentioned as the President, Vice president and Treasurer on paper, in reality, they had no idea about what was happening and were only paid a salary for loading and unloading the food, mixing different items and packing the food. These centres were also deliberately located at remote areas so that ‘it was not accessible for inspection by government officials’. This was in connivance with the Department of Women and Child Development officers, at a time when the state was reporting two to three deaths every day due to malnutrition. (Chandrashekar, 2012)
The mid-day meal scheme which costs the state government Rs. 600 crore per year was meant to provide basic nutrition for children below the age of six. Instead sub-standard food was given for the children. The Director Shyamala Iqbal received Rs. 20 lakh per month as a bribe while the Deputy director Usha Patwari and Assistant director Muniraju received Rs. 15 lakh per month from CFI for their tacit involvement. This extended to all levels of staff even below these officials. Following complaints from the gram panchayats, Nina Nayak, the chairperson of the Karnataka State Commission for Protection of Child Rights, submitted a report and forwarded the issue to the Lokayukta for investigation. There were also letters written by parents complaining about their children falling sick after consuming the food provided by CFI in the anganwadis. Earlier the government owned Karnataka State Agro Corn products limited (KSACPL) used to manufacture and supply energy foods to anganwadis since 1973. After 2001, when DWCD handed over 50% of the energy food supply contract to CFI, KSACPL started making losses and shut down in April 2012. (Khan, 2012)
Concerned over the reports of fraud and tardy implementation of the ICDS scheme, the Supreme Court had issued a directive in September 2004 prohibiting the use of contractors in the supply of mid-day meals under the scheme. As a novel way of bypassing the Supreme Court directive, CFI in collusion with the DWCD officials, entered into a five year contract in 2007 with a budget of Rs. 600 crore for building the ‘capacity of the self-help groups.” (Chandrashekar, 2012) All they did was build their own capacity at the cost of the most vulnerable and marginalised children in the community.
In Raichur district alone, in April – August 2011, 2689 children died due to acute malnutrition and this is only the official data. Shouldn’t criminal charges have been been filed against CFI and the DWCD? In 2012, when Shyamala Iqbal’s house was raided, they found 900 grams of gold, diamonds worth Rs. 4 lakh, bank deposits worth Rs. 65 lakh, documents of ownership of three flats and a Toyota Innova. A faction of the pro-Kannada outfit, Karnataka Rakshana Vedike was roped in for proper distribution of the bribe money, with officers coming in the first week of every month to collect there share. The contract was finally cancelled in June 2012. (Khan, 2012)
The Government Order (GO) of May 31 admits that there had been serious flaws in the execution of the agreement by the company, ranging from deviously retaining control over Mahila Supplementary Nutrition Production and Training Centres to flouting stipulated standards in maintaining quality of food supplied to anganwadis under the Integrated Child Development Scheme. The food supplied by the company “did not have stipulated amount of protein and calories and used colours that were not permitted”. An earlier inspection had found that there was “no hygiene maintained and food contained ‘coliform bacteria’. Contrary to the terms of the agreement, the food quality and infrastructure was not certified by a competent authority” (Bagashree, 2012)
Clearly the DWCD has neither the moral consciousness nor the diligence to ensure that their primary roles as caretakers of women and children are placed on top priority. Money making even at the cost of thousands of deaths of children due to malnutrition is still top priority. How can these agencies that have such low standards for themselves and such poor ethics be expected to ‘monitor and supervise’?
Soon after the fiasco with CFI, the government signed a contract with the mining company Vedanta to provide mid-day meals to two lakh children in four districts. This 12 crore deal was not only in violation of law (as the SC ruling of 2004 mandates no middlemen) it was seen as a part of Vedanta’s PR exercise in the wake of controversies surrounding its mining operations in Odisha. When a PIL was already in the High court against the state government for involvement of middlemen as evidenced in its MoU with CFI, it is indeed surprising that the state is ready to enter into an agreement with an agency of such disrepute as Vedanta. The MoU of the state government with Vedanta came under severe criticism. (The Hindu, 2012), (Newzfirst, 2012)
In December 2013, the death of a 6-year old child Kum. Meghala in July 2013, was protested by various activists and organisations, and thereafter highlighted in the media, to draw the attention of the State Government to rampant malnutrition, denial of care and inability to access essential services such as health, nutrition, pension and disability services by marginalised communities. (Kurup, 2013), (Dewan, 2014)
A public hearing was held on 12th of December 2013 in D.J. halli in the presence of representatives from the Karnataka State Minorities Commission, State Human Rights Commission, Karnataka State Commission for Protection of Child Rights, Office of the Commissioner for PWDS, the Advisor to the Commissioner of the Hon’ble Supreme Court in the Right to Food case (W.P. No 196/2001), NGOs and Civil Society Organisations. Officials from various departments participated as respondents in the Public Hearing and included the Deputy Tehsildar, the District Disability Welfare officer, the Deputy Director of Department of Women and Child Development, the Corporator, the MOH (MCH&PN) of BBMP, the RCH officer, of Bangalore urban and several others. (The Hindu, 2013), (Indian Express, 2013)
At the public hearing, the DWCD officials informed the Jury that the Spirulina foundation has been distributing spirulina to children in the anganwadis. According to the respondents, this supplement has been advised for usage from the Department of Women and Child Development (DWCD). The company had apparently approached the department offering to distribute the spirulina free of cost to the government which was found to be a good reason by the DWCD to include the drug in the regular care of the under 6 children. The Jury took objection to this and said that children from poor communities are not guinea pigs and any intervention that lacks an evidence base should not be introduced in the community. For such purposes there are clinical trials across the country and necessary laws that support. Adv. Clifton D’Rozario said that there is a clear treatment protocol recommended by the Justice NK Patel committee and this should be followed rather than some intervention just because it is free.
The recommendations by the jury to the BBMP’s health department, the Department of Health & Family Welfare and Autonomous government health institutions in Bangalore city stated clearly that on no account should irrational, unscientific elements such as spirulina or commercial fortified biscuits be introduced into the treatment protocol for children with moderate/ SAM.
Subsequently, BBMP withdrew all notices regarding supply of spirulina in anganwadis and stopped supplying the tablets to mothers and children. (MFC, 2013)
In this backdrop, the government’s decision to take ‘help’ from corporates such as Beacon to fight malnutrition using spirulina comes as a shock. (Ashvini, 2016) The newspaper article and the website of these companies manufacturing spirulina states that the Government has launched the Balposhna scheme in March of 2016 to supply 2gm of spirulina for 180 days to 25,000 children across the state. As announced in the state budget, the department has decided to administer Spirulina to severely malnourished anganwadi children in the state. The plant-based dietary supplement will be supplied to the children in sugar-coated granular form. According to the department’s data, there are 23,295 “severely malnourished” children, but, it has set aside a budget of Rs 3.6 crore for administering Spirulina to 25,000 children. In its concept note, the department has stated that the pilot programme carried out by it, in association with JSW Foundation in Sandur taluk in Ballari, has brought down malnutrition levels from 33 per cent to eight per cent. Following this, a decision was taken to supply Spirulina to all the districts in Karnataka. The department will be also adopting the module experimented by the three corporates – JSW Foundation, Scania and Biocon Foundation. It will be administering two grams of Spirulina per day per child for 180 days, as recommended by JSW Foundation.
According to sources, the concept is being treated with scepticism by many in the department, especially with regard to sourcing Spirulina. There are apprehensions that the dietary supplement will be procured from a single source. This development seems to be that private agencies, particularly the pharma industry, now directly use the state machinery to access their potential clients.
Biocon Foundation, that runs a large pharma industry in Karnataka claims that they had started administering spirulina to malnourished children in the Badami taluk of Bagalkot, as early as 2012 much before the government started doing so, and that they are working with the Women and child department to help the state achieve ‘long term solution to malnutrition”. Spirulina apparently comes in the form of granules which may be sprinkled over the food or eaten directly. The Biocon Foundation claims that “growing spirulina is easy, and it is a very cost effective way of fighting malnutrition’. The Foundation directly identifies children with moderate and severe acute malnutrition and directly supplies the bottles to mothers. Anganwadi workers are used to ‘sensitize mothers about the importance of dietary supplements.” They are apparently ‘more than happy’ to share their model with ‘more corporates and encourage them to come forward to help the cause’. (Ashvini, 2016)
The Spirulina Foundation based in Tumkur claims to have given Spirulina to malnourished kids in Utharakhand, Tumkur, Hassan, Bijapur and even in Devdurga of Raichur, in association with Govt of Karnataka with their latest intervention being in DH Halli. When BBMP officials were questioned about spirulina being distributed to children in DJHalli their response was that it was given ‘free of cost’ and therefore permission was granted. Is this the responsibility of the government? Will they allow anything to be given to children in anganwadis if it is given free of cost? Who will become accountable if the children develop complications? Will these ‘free supplies’ not come at some cost at some point in time?
Literature review on spirulina
In 1982, K.C. Laboratories of Klamath Falls, Oregon, and its president, Victor H. Kollman, began selling Blue Green Manna products (derived from another type of alga) with claims that they were effective against a wide range of health problems. In 1983, the FDA began legal action to stop the scheme, but marketing of the products did not stop. Finally, in 1986, at the agency’s request, a U.S. District Court judge issued a permanent injunction ordering all parties involved to stop manufacturing, distributing, and selling blue-green algae harvested from Klamath Lake, Oregon. At the trial on January 9, 1986, the government showed that taken at the recommended dosage of 1.5 grams, its value as a nutrient is negligible. Further, the cost of the defendant’s products, which exceeds $300 per pound, is so high as compared to other sources of the same nutrients that it is apparent that these products are not intended to be used as a food. (Barrett, 2007)
In 1985, the judge had ruled that the products were misbranded and unapproved new drugs, and had issued a preliminary injunction against their sale.
Stating that Kollman had attempted to mislead not only the court but also purchasers of the products, the judge concluded that a permanent injunction was necessary to prevent the defendants from “benefiting from their past violations by meeting the demand they had created for their products.” In other words, even if questionable claims were stopped, people who believed the previously made claims would still buy the products.
Although the judge’s ruling appears to have ended the sale of Manna products, a similar line called Super Blue Green Algae is still marketed by Cell Tech Inc., a company headed by Kollman’s brother Daryl. In 2003, a California judge ruled that 30 of Cell Tech’s claims has been deceptive and ordered the company to stop making them.
Algae products contain no nutrients that are not readily available from food or ordinary dietary supplements that cost much less.
Improperly processed spirulina may contain significant amounts of cyanotoxins which can accumulate in the body over time. One study reported the presence of lead up to 5.1 ppm in a sample from a commercial supplement.
Spirulina is a form of cyanobacterium, some of which are known to produce toxins such as microcystins, BMAA, and others. Some spirulina supplements have been found to be contaminated with microcystins, which can cause gastrointestinal disturbances and, in the long term, liver cancer. The effects of chronic exposure to even very low levels of microcystins are of concern, because of the potential risk of cancer.
These toxic compounds are not produced by spirulina itself, but may occur as a result of contamination of spirulina batches with other toxin-producing blue-green algae. The U.S. National Institutes of Health describes spirulina supplements as “possibly safe”, provided they are free of microcystin contamination, but “likely unsafe” (especially for children) if contaminated. Given the lack of regulatory standards in the U.S (and India), some public-health researchers have raised the concern that consumers cannot be certain that spirulina and other blue-green algae supplements are free of contamination.
Heavy-metal contamination of spirulina supplements has also raised concern. The Chinese State Food and Drug Administration reported that lead, mercury, and arsenic contamination was widespread in spirulina supplements marketed in China.
By far the most frequently cited danger of spirulina is heavy metal toxicity or poisoning depending on where the algae was grown and in how it is harvested. Spirulina is an algae, and algae grows on lakes, ponds and in man-made ponds. If the water it’s grown in contains heavy metals such as mercury or lead, the little spirulina algae will absorb the metals. Then when they are harvested and dried into a supplement, the metals remain inside the supplement. In the Indian context where lakes are the easiest point of disposal of industrial waste and the complete lack of regulation, it is highly likely that the water that the spirulina is grown in would be highly contaminated.
It is recommended that to be on the safe side, pregnant and nursing women should avoid taking spirulina supplements, since unborn babies and infants are at high risk for brain and nervous system damage if exposed to heavy metal toxins. Most of the safety concerns arise from encountering a counterfeit production, but sometimes the known producers may also under-look the contamination of their farms, and may actually sell a spirulina that is dangerous for the health. The spirulina plantations are not as easily maintained as let’s say, the vegetable plantations. Because the vegetables can be simply rinsed with water and peeled off – that’s a bulletproof protection, which spirulina does not have, as it’s all composed just of single cells. Moreover, the spirulina is an absorbent, and may attach to heavy metals so it makes it quite vulnerable to pollution. The open farms are more often subject to pollution, though the quality producers probe in compliance for safety standard all the batches of harvest by means of chemical analysis and would not allow stocking from a deviated harvest
“2 grams of spirulina do not contain enough protein or other macronutrients necessary for a child’s needs. A child will have to be fed atleast 400 gms of spirulina for that. Just giving an egg a day to children or one carrot or even green leafy vegetables (that can be grown abundantly in a variety of climate conditions) provide better nutrients when compared to Spirulina.” Veena Shatrughna, ex Director National Institute of Nutrition, Hyderabad
The fact that corporates have independently decided to start supplying spirulina tablets to severely malnourished children in anganwadis since 2012 brings to the fore several questions.
- Can corporates such as Biocon, Jindal Steel works, Scania independently access anganwadis and unilaterally begin to distribute spirulina tablets?
- Will they be held liable in the event of adverse drug reaction, death or disability of the child?
- What is the need for elaborate systems of ICDS administration when corporates can bypass all of them and audaciously distribute any tablet or product as they wish to children?
- As long as children are within the four (or less) walls of the anganwadi, is the Women and Child Department not responsible for their well-being? Are they not to take action against agencies such as these, which take the law into their own hands?
- Biocon has recently obtained permission for a 1060 crore pharmaceutical project. Can Biocon also start distributing drugs to children at the anganwadis in the same way that they are distributing spirulina?
- While the Foundation claims that spirulina is a cost effective way to fight malnutrition, has there been any cost benefit analysis of spirulina as opposed to healthy nutritious cooked food?
- The claims made by the spirulina companies that 1 gm of spirulina is equal to 1 kg of fruits and vegetables. Does this mean that owners of these companies and foundations such as Biocon replace the diets of their own progeny with spirulina tablets and do away with fruits and vegetables?
- Are children so dispensable that they can be given any product without any cognizance or recognition by formal body? Why is the National Institute of Nutrition not being consulted?
- Biocon foundation claims that growing spirulina is easy and is a very cost effective way of fighting malnutrition. What is Biocon’s credibility to make such statements? Isn’t that the prerogative of a well-established scientific body such as the National Institute of Nutrition?
- There have been no tests in India on spirulina’s value in Indian climatic conditions. If spirulina is being classified as a food, then it will have to meet the standards of Food and Safety. If it is considered a drug, then it would have to pass the requisite clinical trials.
- When there are well established research bodies of the government, what is the locus standi of a pharmaceutical company such as Biocon to distribute spirulina to the most marginalised children and make claims about its benefit? Have they published studies in peer reviewed journals regarding this? Have they obtained clearance from the food and safety department for this? Have they run their ‘evidence’ past the National Institute of Nutrition?
- Does Biocon have a formal permission from the ICDS department to distribute spirulina to children, particularly to children who are severely malnourished and already vulnerable to organ damage?
- A letter (F.No. 5-9/2005/ND/Tech (Vol.II) dated 24th February 2009 from the Ministry of Women and Child Development on Revised Nutritional and Feedling norms for Supplementary nutrition in ICDS scheme states that States/UTs with the support of Food and Nutrition Board should ensure the quality of supplementary nutrition being provided under SNP with reference to norms of food safety as well as nutrient composition. The supplementary nutrition should conform to the prescribed standards laid down under the Prevention of Food Adulteration Act and the Integrated Food Law to ensure consistent quality and nutritive value of the intervention per servicing. FNB in collaboration with the State Government/UTs will carry out periodic checks to ensure that prescribed standards are adhered to and quality and nutritive value of supplementary nutrition is maintained. Has the supply of spirulina by these corporates been sanctioned by the Food and Nutrition Board? Has it passed prescribed safety norms?
- It was in the same year that the contract with Christy Friedgram was terminated, that Biocon Foundation claims to have started giving spirulina tablets to children with moderate and severe malnutrition. Why has this pharma company been allowed to bypass the Supreme Court directive? Once aware that greedy corporates are trying, by hook or crook, to access funds intended for children, did the DWCD not feel a need to take stringent action against Biocon Foundation for accessing children who are in the anganwadis and therefore the direct responsibility of the DWCD?
Dr. Veena Shatrugna, ex director of the National Institute of Nutrition, categorically states that spirulina is not listed on any of the Foods of Nutritive value in India and in terms of protein, vitamins and minerals, locally available animal and plant foods including nuts and berries are far superior to spirulina. A study done by the National Institute of Nutrition was abandoned mid-way because levels of beta carotene (precursor to Vitamin A) dropped to 40% on children who were given a trial of spirulina.
Radha Holla who is the Campaign Coordinator for International Baby Food Action Network and the Breastfeeding Promotion Network of India states that the “Government is abdicating its responsibility to guarantee the food and health rights of its people by entering into partnerships with the commercial sector. Corporations are only too happy to capitalise on malnutrition by supplying pre-mixed food packets to anganwadis instead of hot cooked meals, trumpeting their social responsibility even as they create markets for their fortified foods and use nutrition education to build brand loyalty for the future.”
She says that “rather than investing in structural changes that improve people’s access to diverse foods, the primary response of the government appears to be to view malnutrition as an opportunity for the private sector to make profits”.
The Supreme Court orders are being ignored by government ministries and departments. In the case of hot cooked meals, contracts are being given to large non-governmental organisations like Naandi Foundation and ISKCON’s Akshaya Patra, to supply schools with such meals, thereby ignoring the spirit of the order that relates to providing livelihoods for women from marginalised communities, and removing social discrimination.
Radha Holla describes how commodification of malnutrition can be done in several ways. Firstly, malnutrition can create markets for specific products — products that reduce iron deficiency (caused mainly by reduced consumption of iron-rich foods), products that provide high levels of energy and/or protein to reduce undernutrition (caused mainly by lack of food), and so on. Secondly, malnutrition can be used to greenwash corporations that are being targeted for abusing people’s right to health, environment, livelihood, shelter, etc. Thirdly, corporations use ‘nutrition education’ to build brand loyalty for tomorrow. This is the same instance with Biocon Foundation, Jindal Steel works and Scania distributing spirulina to children with malnutrition. (Holla, 2012)
She also describes how the Global Alliance for Improved Nutrition (GAIN) has been a leader in using malnutrition to create markets for the food industry. GAIN, along with its partners Unicef, Micronutrient Initiative, and others, has also been instrumental in getting several states to shift from using paediatric drops for iron supplementation, to Sprinkles, with technical assistance from H J Heinz. (Holla, 2012)
Private companies have hijacked the government’s flagship program with contractors in Maharashtra alone controlling Rs. 1000 crore worth of supplies. A report by the SC Commissioner’s office disclosed that ‘the contractor – corporate lobby has a firm grip over the ICDS ration supply business, worth Rs. 8000/- crore, with specific reference to Karnataka, Uttar Pradesh, Meghalaya and Maharashtra. The commissioners recommended that an independent investigation be conducted under the apex court’s supervision to investigate the possible nexus “between politicians, bureaucrats and private contractors in the provisioning of rations to ICDS, leading to largescale corruption and leakages”. (Sethi, 2012)
Vedanta is another example of the commodification of malnutrition for greenwash. The giant mining corporation has taken over the running of over 3,000 anganwadi centres in Orissa and Rajasthan, of which approximately half are in the Kalahandi and Rayagada districts of Orissa, catering to over 75,000 children below five years of age following national and international protests against the company for attempting to take over the natural resources of the tribal people of these districts. (Foil Vedanta, 2010), (Infochange, 2009)
In yet another clear instance of greenwash, Nestle, the leading violator of the International Code of Marketing of Breastmilk Substitutes globally, has entered into PPPs with four agricultural universities in India to take up nutrition education programmes for adolescent girls in government schools. The Alliance Against Conflict of Interest, an informal network of food rights and health activists, medical professionals and lawyers, have protested the MoUs between Nestle and Indian public sector universities, calling it particularly reprehensible as “Nestle is facing a criminal case in India for violation of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as amended in 2003 (IMS Act)”. (Sharma, 2011),(AACI, 2013)
One of the key objections to the use of eggs for children with SAM in anganwadis is that they are likely to have a fragile gastro-intestinal system that may not be able to tolerate eggs. It has almost become an important reason to do away with eggs completely from the diet. It is this pre-conceived notion that egg being non vegetarian is bad for the child and spirulina being vegetarian is good for a child that has destabilised the notion of nutrition in the country and subjected our most marginalised children to a series of experimental and mostly unestablished interventions. Christy Fried Gram have been supplying to
There are several reports about the poor state of functioning of anganwadis all over Karnataka. Eggs are not being given to even severely malnourished children in spite of strong recommendations that they should be given to all children considering their high nutritive value (Kulkarni, 2013), (Aji, 2013), (Mohan, 2015) . Eggs are complete foods and contain…………….Considering that malnutrition related issues are highest in those children that culturally are used to eating eggs, there should be no problem in giving eggs to these children. However in keeping with the larger Hindutva narrative, neither do the brahmin people in power eat eggs nor do they allow children and families from marginalised communities to do so (Mohan, 2015), (Johari, 2015). Their nutritional guidelines revolve around cereal and pulses and all the children’s menus include rice or a rice product. This not only damages the nutrition of entire generations of families but undermines the role of the family as nutrition provider by constantly classifying foods as pure and impure, traditional foods are rapidly being replaced by the more acceptable junk foods and manufactured foods. A mother who gives her child spirulina will be more appreciated in the current society than a mother who feeds her child wholesome food of animal and plant origin. Just as health and education is being taken away from the families and communities and shifted away so that people are placed in positions where they have to spend, the same is happening with nutrition where local foodstuffs are undermined and undervalued and packaged foods particularly those marketed by large multinationals are being given social sanction.
India is already suffering from the casteist nutritional prescriptions of brahmanical nutritionists with an undermining of meat proteins such as beef, eggs, and other locally available meats and vegetables reaffirming the notion of India as a vegetarian nation. (Ilaiah, 2015) (Johari, 2015). The undue reliance of pulses has led to a chronic stunting among Indians particularly the most marginalised communities. This stunting and the low quality of protein in the diet has been causal for the exponential rise in diabetes and hypertension among the lower socio-economic groups. The lack of muscle mass has led to the epidemic of diabetes and hypertension because muscle mass protects against diabetes and helps to metabolise food. Insulin production requires good protein. Beef has high nutritive value and is the staple of a large population of Indians. By giving beef a religious colour, this low cost high protein food is made unavailable to people even to the extent of lynching and violently punishing those who eat beef as they are allowed through the Right to food -fundamental Right under the Constitution. However this right is not only being violated by goons and local thugs but by the State government mechanism itself catering to political games rather than good sense that ensures a healthy well-nourished population. These goons do not target the predominantly Hindu upper caste who export beef. India is in fact one of the largest exporters of beef to other countries and the revenue from beef per year is……………… When Dalits are considered as Hindu for political gain, why are they not considered Hindu when it comes to eating habits? If indeed Dalits are Hindus, then the food of Hindus is beef. It appears that the Dalits classify as Hindus for the vote bank but their diet is not considered Hindu. People have a right to food. Hindus who object to beef eating, can avoid doing so, but to penalise and punish another human for his or her food preference is nothing but dictatorship as part of the mob mentality of keeping the majoritarian vote bank happy. It is important that educated Hindus protest this intrusion into people’s eating habits and focus on a healthy nation with all cultures and religions rather than a sick nation that is unicultural. (Khera, 2015), (Jishnu, 2014)
The Hindutva imagination has taken its hold on the country. The bureaucrats, politicians and even civil society control knowledge. The local eating habits of people are rapidly eroding to be replaced by the brahmanically sanctioned pure foods. These pure foods do not provide the nutrition that a labouring class group needs. (Johari, 2015), (Khera, 2015), (Mohan, 2015), (Ilaiah, 2015), (Anveshi, 2013). The vast knowledge of the marginalised communities about food, feeding ad nutrition are brushed aside as impure. Traditional systems of medicine incorporate a wide range of animal products, and root products, but these are often erased and sanitised to produce a vegetarian ‘ayurvedic’ culling out. This erasure and sanitation of local herbs and food products is undermining the health energy and nutrition of a large section of the population. There is a moral and ethical responsibility of those bureaucrats and others in positions of power to revisit the notion of pure and impure food, and to focus on locally available foods that are most valuable for the health of populations particularly those that are most marginalised and economically unable to procure the more expensive food stuff that upper caste and class elite do.
In India there is a wide range of deficiencies of B complex, Vitamin A, Iron etc. If there is animal protein, iron absorption is much higher. However doctors and nutritionists talk more about iron tablets, iron injections and other supplements rather than a diet rich in animal protein. Indian nutritionists and bureaucrats would rather add chemicals and other additives to food rather than providing those foods that are holistic. Egg is a complete food but the resistance to giving food to children is high. (Khera, 2015). The corporates are the ones who stand to gain the most from this and in fact drive the agenda.
The Global Alliance for Improved Nutrition (GAIN) encourages the country to give children fortified cereal. GAIN has a great control over the ICDS program. The fortified foods are such that even animals do not eat them. Minerals and vitamins should come from food. The concept of giving a child a healthy well-cooked balanced meal at the anganwadi with enough intake of milk, eggs and meats like beef is completely missing from the national discourse. It is a taboo to talk about beef. The AP food factory was initially set up to prepare animal food and are now involved in making food for children. Children refuse to eat these foods and bagfuls of them are dumped and of such poor taste that thy are not even used as animal fodder. In Karnataka, when the PIL was filed, it is no coincidence that Cristy Fried gram was providing kurkure to the children in anganwadis. These were often rat infested and children in spite of not having eaten at home refused to eat these products. The contract with CFG was subsequently terminated following a general uproar against this
Indian scientists with their narrow caste affiliations have not conducted adequate research on other products that are considered impure. Their focus of research has always been on cereals and pulses. While pulse production is going down, the costs are going up
With the new Companies Bill coming through, making it mandatory for industry to invest in corporate social responsibility (CSR) programmes, a lot of companies in the fast-moving consumer goods (FMCG) segment, as well drug makers, are identifying malnutrition as an area to work on[i]. While FMCG players such as Nestle and Danone, already present in the nutrition segment, are keen to spread awareness and campaign about the issue, pharmaceutical companies such as Glenmark and Biocon, which currently do not have products in the segment, are working in the area as part of their CSR initiative. Glenmark, which recently joined hands with the Ficci Aditya Birla CSR Centre for Excellence to combat child malnutrition, feels there is a need for innovative solution to counter the crisis. “We need to introduce innovative ways to disseminate information on right and healthy practices among rural masses. Time has now come to employ practical solutions rather than theoretical ones to ensure that our children remain healthy,” says Cheryl Pinto, director corporate affairs, Glenmark. While the company has no plans to foray into nutraceutical segment, it says it is committed to work towards the social cause. (Dey, 2013)
Similarly, Biocon, which is currently largely focused on oncology and preventive care-related CSR, is now exploring new areas such as child malnourishment to work on. “When we work on ground, we see there is a need to spread awareness and work in this area. Child malnourishment is a major problematic area in our country and needs to be addressed,” says Rani Desai, head-Biocon Foundation (Dey, 2013). Biocon foundation have access to government date to identify moderate and severely malnourished children, call them to health camps and distribute nutrient supplements to kids depending on their condition. What is the role and responsibility of the government to these children? What legal right does Biocon have to distribute supplements to children? Do the parents not bring the children in the good faith that this is a government initiative? Isn’t the government not responsible for any adverse reactions the children may have? The anganwadi workers are also being used (read abused) by the corporates to market these products to families of these children by making home visits.
While the industry is of the view that resources should be used adequately by the government to cater to rural areas and address the problem, the civil society insists the problem of malnourishment be solved by the government alone as a public service. Alex George, director, Action Aid India, insists marketization of the campaign against malnutrition be barred as that results in introduction of unnecessary products in the market. Some also feel the government needs to address the problem with proper regulations and checks in place. Vandana Prasad, member, National Commission for Protection of Child Rights, says there is a need for a systematic implementation of government programmes to address malnutrition. As a market, the segment is growing rapidly. Currently, the nutraceutical market is pegged at around Rs 1,000 crore with major players from both FMCG and pharma sectors entering the space. (Dey, 2013)
The Biocon foundation, through the government, is providing spirulina for poor malnourished children. Spirulina is not a traditional food in India and has never been advocated for child feeding and figures nowhere in any of the recommendations of the Indian Academy of Paediatrics or the recommendations of the Young Child Feeding Practices report of UNICEF.
The National Institute of Nutrition, in the year 2000 discontinued a trial using spirulina to combat Vitamin A in children because after a month of the controlled intervention, the levels of beta carotene, a precursor of Vitamin A, had dropped to 40% of its value. It is well known, particularly from the unprincipled marketing of baby foods by notorious companies like Nestle that indiscriminate and unregulated marketing leads to families spending precious and precarious resources on supplements and products that in fact lead to deteriorating nutritional status of children and infants. It is also a well-known fact that malnutrition predominantly affects children from marginalised communities. It therefore seems like anything can be given to these children just because they are poor and just because the interventions are ‘free’.
This attempts at supplementing the foods will create a market for Spirulina, and mothers will believe that these supplements are important for child nutrition, not the regular foods. In fact there is a Supreme Court Order against processed foods with the best example being of the infamous Nestle and their baby food products.
Now two years later, Biocon Foundation audaciously informs the media that they have been distributing spirulina tablets all along to children? It is nothing more than a large pharma group distributing drugs to children from the most vulnerable and marginalised communities, while woefully objecting to the government regulating clinical trials. Is this not a trial by Biocon? Isn’t spirulina going to come out in the market shortly, highly priced and with the label that it has been tested on humans? Which humans? At what cost? Who is regulating this?
Why is it that these Biocon distributed spirulina granules or tablets are never sprinkled on the foods of children in private schools? Why would it figure nowhere in the homes and dining tables of the progeny of Kiran Mazumdar Shaw and her friends and relatives? Isn’t there a caste dimension to these clinical trials?
The infamous Program for Appropriate Technology in Health (PATH) clinical trial was conducted in Andhra Pradesh and Gujarat and was brought to a standstill by the death of seven adolescent tribal girls. The children, in the age group 10 – 14 were all from either schedule tribes, schedule castes, Muslims or other backward communities. The children were predominantly tribal, from families displaced by conflict, residents of ashram patashalas (boarding schools), and the vaccine was administered through a camp approach, often with a generic signature from the hostel warden and flouting all norms of informed consent as required in a 4th phase clinical trial. (Sama, 2010), (Dhar, 2013), (The Hindu, 2013). Does this spirulina intervention in Bagalkot, Karnataka by Biocon Foundation, Jindal Steel works and Scania not reek of the same disregard for protocols required before introduction of any drug, especially for children and that too those who are already malnourished and from marginalised communities? Is this not audacious flouting of basic norms of ethics of trials? Why can Biocon and its partners in crime, JSW and Scania not distribute fruits, eggs, milk, meat and green leafy vegetables to children, as part of their Corporate Social Responsibility? Why is even CSR becoming the tool to garner profits? Is there no limit to the greed of corporate entities?
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