SHIVPURI, India Crying as she is put on an electronic scale, two-year-old Rajini's naked shrivelled frame casts a dark shadow over a rising India, where millions of children have little to eat.
The children are scrawny, listless and sick in this run-down nutrition clinic in Madhya Pradesh with its intermittent power supply. If they survive they will grow up shorter, weaker and less smart than their better-fed peers.
Rajini weighs 5 kg, about half of what she should.
"She's as light as a leaf, this can't be good," says her grandmother, Sushila Devi, poking her rib-protruding stomach in the clinic in Shivpuri district.
Almost as shocking as India's high prevalence of child malnutrition is the country's failure to reduce it, despite the economy tripling between 1990 and 2005 to become Asia's third largest and annual per capita income rising to $489 from $96.
A government-supported survey last month said 42 percent of children under five are underweight -- almost double that of sub-Saharan Africa -- compared to 43 percent five years ago.
The statistic -- which means 3,000 children dying daily due to illnesses related to poor diets -- led Prime Minister Manmohan Singh to admit malnutrition was "a national shame" and was putting the health of the nation in jeopardy.
"It is a national shame. Child nutrition is a marker of the many things that are not going right for the poor of India," said Purnima Menon, research fellow on poverty, health and nutrition at the International Food Policy Research Institute.
India's efforts to reduce the number of undernourished kids have been largely hampered by blighting poverty where many cannot afford the amount and types of food they need.
Poor hygiene, low public health spending and little education and awareness have not helped. Age-old customs discriminating against women such as child marriage have also contributed, but are far harder to tackle, say experts.
In addition, shoddy management of food stocks, subsidised carbohydrate-rich food that fuel and fill the poor rather than truly nourishing them and real shortages in its poorest states have worsened the problem.
At the Shivpuri clinic, health worker Rekha Singh Chauhan tends to emaciated young children in a ward with a ganglion of electrical wires running across its paint-chipped walls.
"We only have a handful to take care of now, but come April, the cases will shoot up," says Chauhan, adding that diseases such as diarrhoea and malaria will cause an influx of sick underweight children with the onset of summer.
"The situation becomes bad. Three children are made to share a bed and many have to sleep on the floor."
That picture jars with an India clocking enviable 8-9 percent growth over the last five years that has put money in the pockets of millions of its people and fuelled demand for everything from cars and computers to clothes and fancy homes.
It has also catapulted the country onto the world stage, boosting its claim for a bigger role on forums such as the U.N. Security Council. This month, it moved closer to buying new fighter jets worth a whopping $15 billion.
Yet while the urban middle classes dine in swanky shopping malls where eateries offer everything from sushi to burritos, millions of children are dying due to a lack of food.
Last month's report by the Indian charity Naandi Foundation, the first comprehensive data since a 2005/6 study, said India's "nutrition crisis" is an attributable cause for up to half of all child deaths.
Yet India's public spending on health, estimated at 1.2 percent of its GDP in 2009, is among the lowest in the world.
"This isn't a quick-fix that we're looking at here, it's not a magic bullet," said Jasmine Whitbread, CEO of Save the Children International.
"Not just in India, but in countries around the world, we know that you can't just rely on trickle down. There have to be policies in place, there have got to be political choices that prioritise malnutrition."
In Shivpuri, an impoverished tribal-dominated district in Madhya Pradesh, that reality is on full display.
The region's malnutrition level for children under five matches the national average, but child mortality rates are worse at 103 deaths per 1,000. The national average is 66 deaths per 1,000, according to U.N. children's agency, Unicef.
Most of the children here are from India's most marginalised and poorest communities, such as tribals and lower castes where literacy is poor and poverty high.
Their mothers are themselves often undernourished, forced into early marriage when they reach puberty, and give birth to underweight babies with weak immune systems.
Illiteracy or lack of awareness takes its toll as well. These mothers do not breastfeed, offering buffalo milk and contaminated water instead and making their children prone to illnesses like diarrhoea, which prevents nutrient absorption.
Mostly living on less than $2 a day, these families can hardly afford anything beyond wheat chapatis that are devoid of much-needed protein and other nutrients.
India's neglect of its young - 48 percent are stunted, 20 percent wasted and 70 percent anaemic - will have serious repercussions. The World Bank says malnutrition in the poorest countries slashes around 3 percent from annual economic growth.
Malnourished children will struggle at school, if they go at all, and earn 20 percent less during their working life and are more prone to infections, including HIV, and death.
Human development goals, signed up to at the start of the millennium by 192 U.N. members, including India, are also at risk.
Reducing child malnutrition by half and child mortality levels by two-thirds of 1990 levels are unlikely to be met by India by the 2015 deadline, say experts.
In comparison, neighbouring China has already achieved its target on malnutrition and under-five child mortality goals as its economic growth has been more broad-based, focusing on health, sanitation and small holder production.
While India has several schemes already running to battle malnutrition, the Indian government is now vaunting a multi-billion-dollar food subsidy programme as a possible solution.
But the Food Security Bill, which guarantees cut-price rice and wheat to 63.5 percent of the population may be more a political gimmick, experts worry, than about providing nutritious food to those who need it most.
"The Food Security Bill is a very good development, but it is a food security bill, not a nutrition security bill," said Lawrence Haddad, director of the U.K.-based Institute of Development Studies.
For the children at Shivpuri's nutrition centre, government plans mean little unless they put enough of the right food in their stomachs.
"You see her arms? They are almost the width of my thumb," says Jharna, as she carried her limp, emaciated one-year-old grand-daughter, Sakshi, into the clinic. "She is too weak. She can't even sit by herself."
(Writing by Nita Bhalla; Editing by John Chalmers and Sanjeev Miglani)
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