Insights into Editorial: Food first: on child nutrition
The central principle that should guide the Centre in improving maternal and child nutrition is that early childhood is the foundation for the health and well-being of an individual.
Tinkering with the existing national programme of providing hot-cooked meals to children three to six years old, and take-home rations for younger children and pregnant and lactating mothers is fraught with danger.
Attempts to substitute meals or rations with factory-made nutrients will inject commercialisation into a key mission, and upset the nutritional basis of the scheme.
The newly-formed inter-ministerial National Council on India’s Nutrition Challenges has chosen to continue the current practice, overruling the Minister for Women and Child Development.
Many children died of malnutrition in India and yet Women and Child Development Ministers over the years haven’t decided what food to give children in anganwadis. This is worrying.
How many more children must suffer from stunted growth before the Minister in charge of their welfare decides on whether to serve them hot-cooked nutritious meals or packaged/processed fortified mixes? And why does there have to be a choice between the two? Why can’t India incorporate both? Is it really that difficult to keep a close watch on the quality of food served to children between the ages of three and six as well as take-home ration for pregnant and lactating women?
Apparently, it is. The governments in past as well as in present have always exercised the easy option: dense, fortified food for malnourished children, courtesy the manufacturers.
Data on malnutrition should serve as a wake-up call for the government:
- 38% of children are stunted and
- 7% are underweight in India.
- About 21% of children under the age of five are wasted (low weight for height), according to the National Family Health Survey-4 data.
“The anganwadi system needs revamping. Anganwadis must be limited to pre-school education and playing. They should not just be centres of serving food,” What is more, serving food through anganwadis has not improved the nutritional status of children.
Food at anganwadis is not palatable and a majority of the children don’t eat it. A lost of them waste it. Hence, the switch to DBT.
Some Instances happened in past:
Eight years ago, when malnutrition deaths occurred in some districts in Maharashtra, a simple solution involving a protein-rich diet called Lapsi — a green millet mixture combined with water and milk — was given to malnourished babies.
In Jharkhand, dry rations such as oil, dal, wheat or rice were given to mothers — until the contractor lobby forced the government to shift in favour of processed food.
The point is to address malnourishment through locally produced, diverse food options that the country offers.
Aadhaar Linked as DBT:
The Union government was running two pilot programmes in Assam and Uttarakhand.
“In Assam, they are supplying money needed to buy nutritional food to families of children directly. This has reduced corruption and leakage. In Uttarakhand, we are sending 30 nutritional packets per month to children’s homes directly. These dry food packets can be cooked into tasty, nutrient rich and palatable food by their mothers. Children are enjoying eating them”.
This system has brought down the chances of food being stolen by middlemen. Both the systems are Aadhaar linked. Aadhaar-linking had introduced transparency, reduced bogus beneficiaries and increased efficiency.
It has reduced presence of over 11 lakh bogus children in Maharashtra and over three lakh children in Assam. “We are promoting more institutional deliveries to reduce infant and maternal mortality rate”.
Raising nutritional standards for young children has become a policy imperative only in recent years, with the National Food Security Act, 2013, incorporating the mandate in Schedule II, and the Supplementary Nutrition (Integrated Child Development Services Scheme) Rules, 2017, laying down entitlements.
Food and Public Distribution Ministry emphasis on strengthening these legal guarantees by providing more nutritious hot-cooked meals and rations with the help of local self-help groups is to be welcomed.
If the ICDS scheme, now called the Anganwadi Services Scheme, is to achieve better outcomes, it must focus on the provision of physical infrastructure and funding, besides closer monitoring of the nutrition mission.
Theoretically, the mission covers every child, but in practice it is not accessible to all.
When the Centre recently launched POSHAN Abhiyaan, an integrator that will build capacity among nutrition workers, it acknowledged that while official data show a reduction in some of the depressing aspects of women and child health, the ground reality is far from comforting: the National Family Health Survey-4 shows a drop in underweight and stunted children under five years of age compared to the previous survey, but the absolute numbers are still high.
An estimated 35.7% children are underweight and 38.4% are stunted in that age group. The body mass index of 22.9% women aged 15-49 indicates chronic energy deficiency.
These figures should cause alarm that even after a long period of robust economic growth, India has not achieved a transformation. To accelerate the pace of progress, POSHAN Abhiyaan should rigorously measure levels of access and quality of nutrition, and publish the data periodically.
In a recent report, Nourishing India, the NITI Aayog refers to acute malnutrition levels of about 25% in some States. There is no quick fix, and the answer to better nutrition lies in fresh, wholesome and varied intake.
About POSHAN Abhiyaan:
POSHAN Abhiyaan was launched on International Women’s day (March 8) in 2018 to boost nutrition among children and women.
- The Abhiyaan targets to reduce stunting, under-nutrition, anemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
- The target of the mission is to bring down stunting among children in the age group 0-6 years from 38.4% to 25% by 2022.
About the mission:
- The Rs. 9,000-crore mission will strive to reduce stunting, under-nutrition, and low birth weight by 2 per cent and anaemia (among young children, women and adolescent girls) by 3 per cent annually over the three-year mission period.
- Anganwadi supervisors have been roped in for the mission.
- The focus of the Abhiyaan is on the first 1000 days of the child and preventive care for adolescent girls, women and mothers.
- Home-based Care for Young Child(HBYC) would be a crucial component of the Abhiyaan.
- In HBYC, ASHAs supported by Anganwadi workers will visit the homes of children aged between 3 to 15 months and sensitise mothers on energy density and diet of child.
Minister Ms. Gandhi wants “energy-dense, factory-made” nutrient packets as take-home ration for pregnant women and lactating mothers as well as children between the age of six months and three years, her Ministry is in favour of “sourcing food items such as dalia and khichdi, prepared with locally available ingredients, from self-help groups”.
While a pre-mix of micronutrients or ready to use therapeutic food (RUTF) – high-energy, micro-nutrient enhanced paste – is sometimes prescribed to treat children under five years who suffer from severe acute malnutrition (SAM), the minister has recommended giving nutrient packets to all pregnant and lactating mothers and children from six months to three years. “Why wait for a child to suffer from SAM?”.
The Minister has suggested that 30 packets for a month can be dispatched to a beneficiary through the postal department.
Take-home rations include wheat, soya and sugar.
Food-based approach agriculture is likely to get a boost and local employment generation is expected to rise. “Every child is not a sick child. Only some SAM children are sick and need special food. If healthy children are given are at the risk of getting malnourished if they don’t get adequate diet and that is what we should be trying to provide”.
The need of the hour is to involve all field functionaries in a productive manner. Consistent monitoring and evaluation of the schemes using technological interventions and real-time data is also important. There is also a need to provide leverage budgets from related departments to develop an integrated plan with cross-sectoral collaboration to achieve nutrition-related targets.
Need for a nodal agency:
Despite thousands of crores of rupees being spent and a number of government schemes working for child development, the status of health and nutrition of children in the country remains abysmal. All nutrition-specific and nutrition-sensitive schemes work in silos. As a result, they are not able to achieve the intended outcome. Therefore, the establishment of a nodal agency that would facilitate coordination of all ministries and departments and execute the schemes in a convergent manner is urgently required.
Money will continue for ICDS and other schemes will also continue. There is no dearth of schemes but lack of creating synergy and linking the schemes with each other to achieve common goal.
National Nutrition Mission through robust convergence mechanism and other components would strive to create the synergy.
Addressing the problem:
- Innovative and successful schemes from different states should be adopted on national level. Like the PHULWARI scheme of Chhattisgarh aims to curb malnutrition by providing balanced and nutritious diets to women of infants and children every day.
- Creating awareness, about the right nutrition.
- Educating mothers about the importance of breastfeeding, informing about immunization
- Popularizing nutritional programmes providing iron folic tablets.
- Effective antenatal care.
Malnutrition makes a large section of society susceptible to diseases and drags them out from contributing in the national progress. The need is to effectively tackle the issue by strengthening government programmes and involve civil society and NGOs to help the cause.