- Prelims: Current events of national importance(Different social service Schemes,WHO, micronutrients, MGRS, Anemia FAO, GHI, NFHS-5, ICDS, Mid-day meal scheme etc)
- Mains GS Paper I & II: Social empowerment, development and management of social sectors/services related to Health.
ARTICLE HIGHLIGHTS
- India uses the globally accepted World Health Organization (WHO) Growth Standards to measure malnutrition.
- The WHO standards are based on a Multicentre Growth Reference Study (MGRS) that was conducted in six countries between 1997 and 2003 (Brazil, Ghana, India, Norway, Oman and the United States).
INSIGHTS ON THE ISSUE
Context
Malnutrition:
- Malnutrition is the condition that develops when the body is deprived of vitamins, minerals and other nutrients it needs to maintain healthy tissues and organ function.
- Malnutrition occurs in people who are either undernourished or over nourished.
Importance of nutrition during adolescence period:
- Adolescence is a pivotal period of cognitive development.
- It improves the access to nutrition during this “second window of opportunity of growth”.
- It compensates for any nutrient deficiencies acquired during early developmental stages in the girl child.
- Adolescent health is a significant indicator of women’s labor force participation in India in the long term.
- As better nutrition improves every young girl’s prospect to participate in productive activities.
Determinants of undernutrition are:
- Food intake
- Dietary diversity
- Health
- Sanitation
- Women’s status
Measures of childhood undernutrition are based on anthropometric standards such as:
- Height-for-age (stunting/chronic undernutrition)
- Weight-for-height (wasting/acute undernutrition)
Multicentre Growth Reference Study (MGRS):
- It was conducted in six countries between 1997 and 2003
- Brazil, Ghana, India, Norway, Oman and the United States.
- The purpose was to determine the pattern of growth (from birth to five years) of children who did not face any known deficiencies in their environments.
- The MGRS took a prescriptive approach, with the specific aim of setting growth ‘standards’ (how children ought to grow
- provided they have a healthy environment) and not growth ‘references’ (how children of the reference group grow).
- The sample for India in the MGRS was drawn from a set of privileged households living in South Delhi
- children who met all the eligibility criteria for the study including
- having a favorable growth environment
- being breast-fed
- having non-smoking mothers.
- children who met all the eligibility criteria for the study including
Difference between MGRS and Other Surveys:
- An adequate number of equivalent samples are difficult to find in large-scale surveys in India given the high levels of inequality as well as the underrepresentation of the rich in these datasets.
- For instance: Among children (six-23 months) in households of the highest quintile in National Family Health Survey (NFHS)-5 (2019-21)
- only 12.7% meet the requirements of a ‘minimum acceptable diet’ as defined by WHO.
- Almost all mothers in the MGRS sample had completed more than 15 years of education (in 2000-01)
- 7% of women in NFHS-5 had completed 12 or more years of schooling.
- The study norms of the WHO-MGRS are different from these prevalence studies.
- For example: MGRS included a component of counseling to ensure appropriate feeding practices
- It is missing in the NFHS or Comprehensive National Nutrition Survey.
- The MGRS sample was for the purpose of setting prescriptive standards, most of the sampling concerns are resolved.
- Difference in genetic growth potential of Indians with respect to others and the influence of maternal heights on child growth.
- Maternal height is a non-modifiable factor for the growth of her child.
- Low average maternal heights are a reflection of the intergenerational transmission of poverty and poor status of women
- therefore, a measure of an environment of deprivation.
- Replace: An appropriate indicator of a deficient environment, such as stunting,
Why WHO-MGRS seems to be more appropriate?
- A number of countries with similar or even poorer economic conditions, including those in the South Asian region, have shown higher improvements in stunting prevalence using the same WHO-MGRS standards.
- Regional differences within India, both in the prevalence of stunting as well as increases in adult heights
- It indicates that some States such as Odisha, Chhattisgarh, Tamil Nadu and Kerala are achieving much faster reductions than others.
- Gene pools shift at the population level with greater socio-economic development
- Demonstrated by the growing average heights of countries such as Japan
- It refutes the immutability of genetic potential.
What are the issues India is facing currently?
- Inappropriately high standards leading to a misdiagnosis of the situation
- Resultant potential overfeeding of misclassified children under programmes of the government to address undernutrition
- Resulting in an increase in overweight and obesity.
- Increasing burden of non-communicable diseases (NCDs) in India.
- Dietary gaps in children
- Poor coverage of schemes such as mid-day meals and supplementary nutrition in anganwadis
Way Forward
- The quality of the meals under the schemes must be improved to ensure that they are not cereal-heavy
- Include all nutrients, and contribute to dietary diversity.
- Recommendations such as including eggs in meals for children and pulses in the Public Distribution System must be acted upon urgently.
- Along with improving diets, multiple interventions such as better sanitation, access to health care, childcare services and so on are required for better nutritional outcomes.
- Using the appropriate standards is important for international comparisons and intra-country trends
- An advantage that would be ok lost with any new country-specific standard.
- Indian Council of Medical Research has constituted a committee to revise the growth references for India.
- Committee has recommended a detailed rigorous study to be conducted across the country to examine child growth with the purpose of devising national growth charts, if necessary.
- Acquiring newer, and more precise information on child growth is a welcome move
- Considering our high aspirations of reaching development to every last person by 2047
- It seems logical to stick to the aspirationally high but achievable standards suggested by the WHO-MGRS.
QUESTION FOR PRACTICE
Can the vicious cycle of gender inequality, poverty and malnutrition be broken through microfinancing of women SHGs? Explain with examples.(UPSC 2021) (200 WORDS, 10 MARKS)
