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years, in our sample, suffer from endemic malnutrition, are only partially immunised, and are
often dirty and unkempt given the lack of sanitation and hygiene among the poor. They suffer
from poor health; often chronically suffering from ailments like cold, diarrhoea, skin allergies etc.
Local health services that cater to the needs of the child, her mother, and the larger community –
be it the ANM, AWH, or the local doctor – are a shadow of what they are ostensibly supposed to
be on paper. Despite the state of affairs, what the children do not lack is love, affection, and
mental stimulation by the mother, siblings, and other family members. Despite the handicaps –
lack of resources, ill health, inadequate nutrition, lack of sanitation and potable water – majority
of the children are showing visible signs of development – crawling, responding to stimuli etc.
without necessarily conforming to weight/height ratios. Yet, as we very well know that these very
handicaps have a long-term effect and become more evident in children further ahead on the child
development continuum.
Box 8: Quality of care
Quality of care is largely an avoided topic, perhaps because it is seen as a private activity, and one
that is difficult to quantify. Perhaps it has also been avoided out of a proper concern that
emphasising care can too easily become an exercise in ‘blaming the victim’ – or in this case the
victim’s parents. But these cannot be excuses for avoiding an issue, which so largely determines
whether a child is malnourished or not.
Although greater involvement by fathers – in all countries and cultures – is one of the most
fundamental priorities for improving the care and upbringing of children, it is in practice the
mothers who are the principal providers of care. And the first thing to be said is that however
much a mother may love her children, it is impossible for her to provide high quality child care if
she herself is poor and oppressed, illiterate and uninformed, anaemic and unhealthy, has five or
six other children, lives in a slum or shanty, has neither clean water nor safe sanitation, and if she
is without the necessary support either from health services, or from her society, or from the
father of her children.
We are therefore talking as much about care of the mother as care by the mother.
Source: V Ramalingaswami, Jonsson and Rhode, UNICEF 1996
The pre-school period age 3 to 6:
This phase in the life of a child is critical for physical, emotional and intellectual development.
Adequate nutrition, vital for children in this very important stage of development, is unfortunately
deficient in poor households. While children are able to feed themselves, the inability of parents
to provide a balanced diet, or even basic food at regular intervals, emerges as one of the important
areas of concern in this age-group. Preparation to acquire a wide range of skills is influenced by
the extent and quality of nutrition a child has access to her/his interactive experiences. This is also
Educational Resource Unit Page 43 April 2003