Tackling malnourishment in India: a matter of palpable urgency

The challenge is enormous but the National Nutrition Mission gives us hope

Runa Shamim | November 23, 2018


#National Nutrition Mission   #health   #malnutrition   #Nutrition   #ICDS  
Illustration: Ashish Asthana
Illustration: Ashish Asthana

Good nutrition is crucial to individual and national development, and is one critical area where India’s progress is slow even after nearly a half-century of respectable agricultural productivity growth and two decades of post-reform economic growth and prosperity. India today faces a crisis of the triple burden of malnutrition characterised by under-nutrition, over-nutrition and micronutrient deficiencies. A large part of the country continues to consume non-nutritious, non-balanced food either in the form of under-nutrition, over-nutrition or micronutrient deficiencies. It is important to understand in addition to lack of nutritious food there are diverse sets of interlinked processes involving healthcare, education, sanitation, hygiene, access to resources and women empowerment that drive malnutrition. 

 
It’s tough to address this complex scenario but we can be more hopeful now, with the start of central government’s National Nutrition Mission (Rashtriya Poshan Mission) 2017-18, a $1.4 billion, three-year effort to address malnutrition through better integration and stronger monitoring of various government programmes that affect young children, adolescent girls and mothers. 

Critical problem
Poor nutrition includes a wide array of effects including:
intrauterine growth restriction (IUGR) resulting in low birth weight; 
underweight, a reflection of low weight-for-age; 
stunting, a chronic restriction of growth in height indicated by a low height-for-age; 
wasting, an acute weight loss indicated by a low weight-for-height; and less visible micronutrient deficiencies.
 
The topline facts as per the National Family Health Survey-4 (‘India Fact Sheet’) reveal malnutrition and anaemia rates are high among children: 38.4 percent of children under age five are stunted, 35.7 percent are underweight and wasting affects 21 percent. As many as 58.4 percent of children aged 6-9 months and 53.2 percent of women in the age group 15-49 years suffer from anaemia, and women have lower than normal levels of blood haemoglobin. The data also highlights improvements needed in infant and child feeding and micronutrient intake. 
 
On the other hand, overweight and obesity affect almost 20.7 percent of women and 18.6 percent of men, and are directly associated with non-communicable diseases. India has the largest number of adults with type-2 diabetes in the world and this number is growing rapidly having doubled over the past two years. Population-based studies conducted on metropolitan cities reveal that nearly 25-30 percent children in private schools are either overweight or obese. 
 
A DownToEarth, March 2016 report states that children who are malnourished from an early age are severely disadvantaged in their ability to learn. The World Bank estimates that malnutrition costs the country’s economy $12 billion a year in lost productivity and higher healthcare spending. An ASSOCHAM EY joint paper has said that “nearly 4 percent of India’s GDP is estimated to have been lost due to malnutrition”. Thus, malnutrition’s economic costs are substantial and improving nutrition is therefore as much – or more – of an issue of economics as one of welfare, social protection and human rights. 
 
A progressive solution
Empowering women to make right choices for their health, and that of their children is crucial to solving this challenge. The first 1,000 days from conception till the child is of 24 months are a critical window of opportunity for preventing malnourishment and its long-term consequences. Improved knowledge, access to recommended services, personal hygiene, and balanced diet are suggested interventions for better nutrition in women and children. A UNICEF report of 2013 demonstrates continued investments in nutrition-specific interventions to address malnutrition through community engagement and delivery strategies that can reach vulnerable segments of the population at greatest risk can make a great difference. 
 
Additionally, this improved access if linked to nutrition-sensitive approaches – ie, women’s empowerment, agriculture, food systems, education, employment, social protection, and safety nets – can greatly accelerate progress. 
 
Similarly, Transform Rural India Foundation’s health and nutrition interventions that focuses on the first 1,000 days interventions aim to bring about changes by adopting scientific practices around health, nutrition and hygiene through the collective action of self-help groups (SHG) across rural Madhya Pradesh, Jharkhand, West Bengal, Chhattisgarh and Odisha. Recently, it celebrated a nutrition week (‘Poshan Maah’) in coordination with frontline functionaries of Integrated Child Development Services (ICDS) scheme, government high schools and the health department. A wide range of activities on essential nutrition aspects (rally, recipe demonstration, nutrition and health education sessions with mothers) were organized. The details of the events were widely disseminated through social media and efforts were recognise by the government.
 
Also, nutrition is top on the government’s agenda and its Rashtriya Poshan Mission has set aggressive targets to reduce stunting, under-nutrition, anaemia among young children, women and adolescent girls and low birth weight by 2 percent, 2 percent, 3 percent and 2 percent per annum respectively. It will monitor food programmes and other initiatives, including the national campaign against open defecation, a practice that contributes to malnutrition by encouraging the spread of diarrhoea and internal parasites. More than 10 crore people will benefit by this programme.
 
A model to learn from
 
It is well known that good nutrition depends not only on people’s access to a wide variety of foods, but also on the care they receive and the environment in which they live. A number of countries and programmes have used this broader understanding of nutrition to make progress. 
 
It would be worth referring to ‘Nourishing Millions: Stories of Change in Nutrition’, published by International Food Policy Research Institute in 2016. The stories in it examine interventions that address nutrition directly – such as community nutrition and feeding programmes for infants and young children – as well as nutrition-sensitive policies related to agriculture, social protection and clean water and sanitation. 
 
The authors consider the range of efforts to combat malnutrition in all its forms, including severe acute malnutrition (SAM), stunting, micronutrient deficiency and overweight and obesity. They shed light on nutrition success stories on the ground in places ranging from Bangladesh, Brazil, Nepal, Peru, Thailand, Vietnam and Ethiopia to Odisha in India. These stories demonstrates two important paradigm shifts such as community based initiatives directly targeting nutrition and health of mothers and children and adoption of the multi-sector approach that fostered improvements in services, sanitation, wealth and parental education. The book also examines how nutrition ‘champions’ emerge and drive change. These narratives provide insights into what works in nutrition, what does not, and the factors that can contribute to success in implementing nutrition-relevant programmes to accelerate and scale up impact on the ground. The stories, all evidence-based, aim to improve understanding of the key factors that seem to drive reductions in poor nutrition and how enabling environments and pro-nutrition policy and implementation processes can be cultivated and sustained. 
 
Shamim is with Transform Rural India Foundation’s Health & Nutrition Council.
 

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