Preventing Malnutrition in India:
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Malnutrition is not an issue that is new rather it has been a major cause of concern for Indians for decades. Children and youth in India suffer from numerous nutritional deficiencies which adversely impact their overall health. UN’s Sustainable Development Goal 2 wants to ensure Zero Hunger, while Goal 3 is good health and well-being for all; these goals are expected to be met by India by 2030.
What is malnutrition?
- Malnutrition indicates that children are either too short for their age or too thin. Children whose height is below the average for their age are considered to be stunted.
- Similarly, children whose weight is below the average for their age are considered thin for their height or wasted.
- Together, the stunted and wasted children are considered to be underweight – indicating a lack of proper nutritional intake and inadequate care post childbirth.
Malnutrition in India:
- Globally, there were 673 million undernourished people, of which 189.2 million (28 %) were in India in 2017-19, as per the combined report of FAO, IFAD (International Fund For Agricultural Development), UNICEF, WFP (World Food Programme) and WHO.
- India accounts for 28 % (40.3 million) of the world’s stunted children (low height-for-age) under five years of age, and 43 % (20.1 million) of the world’s wasted children (low weight-for-height) in 2019.
- As a proportion of India’s own population, around 14 % were undernourished during 2017-19.
- As per the National Family Health Survey (NFHS, 2015-16), the proportion of underweight and stunted children was as high as 35.8 % and 38.4 % respectively.
- In several districts of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and even Gujarat, the proportion of underweight children was more than 40 %.
- Malnutrition was the primary reason behind 69 % of deaths of children below the age of five in India, according to a UNICEF’s The State of the World’s Children 2019 report.
Government Schemes regarding Malnutrition:
- Integrated Child Development Services (ICDS) – A government programme operational in India since 1975, which provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
- National Health Mission (NHM) initially launched in 2013 to address the health needs of 18 states that had been identified as having weak public health indicators, this was later scaled up to the entire nation.
- Mid-Day Meal Scheme which has been implemented since 1995, where a nutritious meal is provided by the school to better the nutritional standing of school-age children nationwide
- Rajiv Gandhi Schemes for Empowerment of Adolescent Girls (RGSEAG) also known as SABLA, was launched in 2011 and aims to improve nutrition and health status of adolescent girls aged between 11–18 years.
- Indira Gandhi Matritva Sahyog Yojna was launched in 2010 with the aim to provide incentives for improved health and nutrition to pregnant and lactating mothers. The scheme also educated the women about the benefits of breastfeeding for the optimal nutrition of their newborns.
- Besides, indirect interventions include Targeted Public Distribution System (TPDS), National Horticulture Mission, National Food Security Mission, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), Swachh Bharat Abhiyan, National Rural Drinking Water Programme, all of which had improvement in nutrition as part of their several objectives.
Causes and Challenges:
- The Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.
- The National Nutrition Mission (NNM- POSHAN Abhiyan) aims to reduce stunting, underweight and low birth weight each by 2 %per annum; and anaemia among children, adolescent girls and women, each by 3 %per annum by 2022.
- Lack of basic facilities in school infrastructure such as separate toilets for girls, as well as the distance between the school and home, are major factors for higher dropout rates among girls.
- Remarkable achievement of the Swachh Bharat Abhiyan, subject to third-party evaluations, is expected to have a multiplier effect on nutritional outcomes.
- Food-based safety nets in India are biased in favour of staples (rice and wheat). They need to provide a more diversified food basket, including coarse grains, millets, pulses and bio-fortified staples to improve the nutritional status of pre-school children and women of reproductive age.
- The challenge has become bigger with the outbreak of COVID-19.
- The biggest problem faced by the Poshan Abhiyan is the population which resides in the harder to reach areas.
- The mothers’ education, particularly higher education, has the strongest inverse association with under-nutrition.
- Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and the sanitation facility.
- Programmes that promote women’s higher education such as liberal scholarships for women need to be accorded a much higher priority.
- State governments need to promote schooling via the provision of separate sanitation facilities for girls in schools.
- Initiatives like the distribution of bicycles to girls in secondary and high schools could help reduce the dropout rates among girls.
- WASH initiatives: safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes.
- It was commendable that the Swachh Bharat Abhiyan to eliminate open defecation and bring about behavioural changes in hygiene and sanitation practices.
- Behavioral change towards personal hygiene still needs to be promoted at the grassroots level.
- Leveraging agricultural policies and programmes to be more nutrition-sensitive and reinforcing diet diversification towards a nutrient-rich diet.
- Bio-fortification is very cost-effective in improving the diet of households and the nutritional status of children.
- The promotion of exclusive breastfeeding and the introduction of complementary foods and a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.
- Aanganwadi workers and community participation can bring significant improvements in child-caring practices and antenatal care for mother and children through comprehensive awareness programmes.
- The Harvest Plus programme of the Consultative Group on International Agricultural Research (CGIAR) has implemented it successfully in many countries around the world.
- The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops such as iron and zinc bio-fortified pearl millet, zinc-bio fortified rice and wheat; iron bio-fortified beans in India.
- GOI have launched a campaign declaring the month of September as “POSHAN Maah 2020”. By inviting citizens to send nutritional recipes, the campaign aims to create awareness about the POSHAN Abhiyan through community mobilisation.
- For “POSHAN Maah” to contribute towards the holistic nourishment of children and a malnutrition free India by 2030, the government needs to address the multi-dimensional determinants of malnutrition on an urgent basis.
- POSHAN Abhiyan is being implemented as a ‘Jan Andolan’ or ‘People’s Movement’ to create maximum awareness towards the problem of malnutrition and address it in a mission-mode.
Good health benefits not only the individual, but the nation as well. India has to utilize its abilities to bring nutrition to the centre-stage in the political discourse around reducing malnutrition. Convergence or coordination amongst all diverse stakeholders will be a key piece in determining the long term success of malnutrition free India.