EDITORIAL ANALYSIS: Malnutrition in India is a worry in a modern scenario

Source: The Hindu

• Prelims: Current events of national importance(Different social service Schemes, NFHS)
• Mains GS Paper I & II: Social empowerment, development and management of social sectors/services related to Health.

ARTICLE HIGHLIGHTS

• India’s greatest national treasure is its people especially women and children but even after 75 years of independence, a majority of them do not get the required diet to meet their nutritional needs.
• A Child’s nutritional status is directly linked to their mother. Poor nutrition among pregnant women affects the nutritional status of the child and has a greater chance to affect future generations.
• Undernourished children are at risk of underperforming in studies and have limited job prospects.
• This vicious cycle restrains the development of the country, whose workforce, affected mentally and physically, has reduced work capacity.
• India’s family planning programme has improved access to contraceptives. This has led to a reduction in the Total Fertility Rate from 4 in 1990-92 to 2.0 in 2019-21, according to the National Family Health Survey (NFHS).
• According to NFHS-5 and the 2022 report by the United Nations Population Fund, there is a rise in adolescent childbearing in some States such as Tripura and Meghalaya.

INSIGHTS ON THE ISSUE

Context

National Family Health Survey (NFHS)

• It is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• It comprises detailed information on key domains:

1. population
2. Health
3. Family Welfare

• Associated domains:

1. Characteristics of the population
2. Fertility
3. Family planning
4. Infant and Child mortality
5. Maternal and Child health
6. Nutrition and Anemia
7. Morbidity and Healthcare
8. Women’s Empowerment etc.

• It also provides data by socio-economic and other background characteristics which are useful for policy formulation and effective programme implementation.
• The main objective of successive rounds of the NFHS has been due to its reliable and comparable data relating to health and family welfare and other socio-economic emerging areas in India.

NFHS-5 Report:

• The NFHS-5 National Report lists progress from NFHS-4 (2015-16) to NFHS-5 (2019-21).
• The scope of NFHS-5 was expanded by adding new dimensions in the earlier round of the survey (NFHS-4) such as:

1. Death registration
2. Pre-school education
3. Expanded domains of child immunization
4. Components of micro-nutrients to children
5. Menstrual hygiene
6. Frequency of alcohol and tobacco use
7. Additional components of Non-Communicable Diseases (NCDs)
8. Expanded age range for measuring hypertension
9. Diabetes among all aged 15 years and above.

• It provides information on important indicators which are helpful in tracking the progress of Sustainable Development Goals (SDGs) in the country.

• Key Highlights:

1. While there has been some progress in tackling malnutrition among children and women over the past decade, the improvement has been modest at best.
2. While there was some reduction in stunting rates (35.5% from 38.4%in NFHS-4) 13 States or Union Territories have seen an increase in stunted children since NFHS-4;this includes Gujarat, Maharashtra, West Bengal and Kerala.
3. India also has the highest prevalence of anemia in the world(Anemia is defined as the condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal).
4. The NFHS-5 survey indicates that more than 57% of women (15-49 years) and over 67% children (six-59 months) suffer from anemia.
5. The Total Fertility Rate (TFR), has further declined from 2 to 2.0 at the national level between NFHS-4 and NFHS-5.
6. There are only five states in India which are above replacement level of fertility of 2.1. These states are Bihar, Meghalaya, Uttar Pradesh, Jharkhand and Manipur.
7. Bihar and Meghalaya have the highest fertility rates in the country, while Sikkim and Andaman and Nicobar Islands have the lowest.
8. In rural areas, TFR has declined from 7 children per woman in 1992-93 to 2.1 children in 2019-21.
9. The corresponding decline among women in urban areas was from 7 children in 1992-93 to 1.6 children in 2019-21.
10. Muslims’ fertility rate has seen the sharpest decline among all religious communities over the past two decades.
11. 23.3% of women surveyed got married before attaining the legal age of 18 years, down from 26.8% reported in NFHS-4.
    The figure for underage marriage among men is 17.7% (NFHS-5) from 20.3%in NFHS-4.
12. 66.3% women who are employed use a modern contraceptive method, compared with 53.4% women who are not employed.
13. NFHS-5 shows an overall improvement in Sustainable Development Goals indicators in all States/Union Territories (UTs).

Reasons for prevalent malnutrition in India:

• Monoculture agricultural practices: While foodgrain production has increased over five times since Independence, it has not sufficiently addressed the issue of malnutrition.
• Poverty: Though poverty alone does not lead to malnutrition, it affects the availability of adequate amounts of nutritious food for the most vulnerable populations.
• Lack of sanitation and clean drinking water: Lack of potable water, poor sanitation, and dangerous hygiene practices increase vulnerability to infectious and water-borne diseases, which are direct causes of acute malnutrition.
• Migration: Seasonal migrations have long been a livelihood strategy for the poorest households in India, as a means to access food and money through casual labour.
  • However, children and women are the most affected, suffering from deprivation during migrations impacting their health condition.
• Gender injustice: There is a correlation between gender discrimination and poor nutrition.
  • Malnourished girls become malnourished adolescents who marry early and have children who become malnourished, and so the cycle continues.
• Lacunae at policy level: There is a lack of real-time data that brings all these factors together to show the extent of India’s malnutrition.
• Lax implementation: Providing nutritious food to the country’s children is more a matter of political will and effective policy implementation at the grassroots level.
  • For example, the Acute Encephalitis Syndrome (AES) outbreak in Bihar marked the failure of the Integrated Child Development Scheme (ICDS) in the state.

What steps need to be taken:

• There is a greater need now to increase investment in women and children’s health and nutrition to ensure their sustainable development and improved quality of life.
• While the Government’s focus has been on the consolidation of several programmes to improve outcomes, there is a need for increased financial commitment.
• Utilization of funds, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilized.
• India must adopt an outcome oriented approach on nutrition programmes.
• Parliamentarians should begin monitoring needs and interventions in their constituencies and raise awareness on the issues, impact, and solutions to address the challenges at the local level.
• There has to be direct engagement with nutritionally vulnerable groups (this includes the elderly, pregnant women, those with special needs and young children), and contribute toward ensuring last mile delivery of key nutrition services and interventions.
• With basic education and general awareness, every individual is informed, takes initiatives at the personal level and can become an agent of change.
• Various studies highlight a strong link between mother’s’ education and improved access and compliance with nutrition interventions among children.

Government Schemes to Tackle Malnutrition:

• Integrated Child Development Services (ICDS) Scheme
• National Health Mission (NHM)
• Mid Day Meal Scheme
• MGNREGA

POSHAN Abhiyaan:

• Also called National Nutrition Mission, was launched by the government on the occasion of the International Women’s Day on 8th March, 2018.
• The Abhiyaan targets to reduce Stunting, undernutrition, Anemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
• It also targets to bring down stunting among children in the age group 0-6 years from 4% to 25% by 2022.

Sustainable Development Goals:

• The United Nations (UN) launched the 2030 Agenda for Sustainable Development.
• There are 17 goals and 169 specific targets to be achieved by 2030.
• SDGs are not legally binding.

 Way Forward

• We must ensure our young population has a competitive advantage; nutrition and health are foundational to that outcome.
• There should be a process to monitor and evaluate programmes and address systemic and on the ground challenges.
• Recommend that a new or existing committee or the relevant standing committees meet and deliberate over effective policy decisions,monitor the implementation of schemes, and review nutritional status across States.
• Building capacity among health workers, addressing intersectionality,engaging men in the discourse of family planning, and drafting innovative solutions through effective public and private partnerships can greatly improve access to family planning services and the overall health of our younger population.
• There is a need to strengthen the coordination of all its aspects, focusing on planning, programmes, monitoring, training and procurement.
• The quality of care in family planning must be a major focus area to ensure the success of family planning programmes.
• There is a need for greater male participation both as enablers and beneficiaries and also address the sexual and reproductive needs of the youth.
• It is imperative for the government to ensure the prioritization of family planning in the national development agenda.
• Family planning is crucial for the achievement of the sustainable development goals, and subsequent efforts need to be made to improve access and strengthen the quality of family planning services.

QUESTION FOR PRACTICE

The country’s response to its burden of malnutrition and growing anemia has to be practical and innovative. Critically analyze.

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