Malnutrition

• India ranked 94 among 107 nations in the Global Hunger Index 2020 and is in the ‘serious’ hunger category with experts blaming poor implementation processes, lack of effective monitoring, siloed approach in tackling malnutrition and poor performance by large states behind the low ranking
• Performance on the Indicators:
• Undernourishment: 14% of India’s population is undernourished (2017-19). It was 16.3% during 2011-13.
• Child Wasting: 17.3% (2015-19), it was 15.1% in 2010-14.
• Child Stunting: 34.7%, it has improved significantly, from 54% in 2000 to less than 35% now.
• Child Mortality: 3.7%, it was 5.2% in 2012.

• An average girl child aged less than 5 years is healthier than her male peers. However, over a period of time they grow into undernourished women in India.
• Malnutrition and anaemia are common among Indian adults.
• A quarter of women of reproductive age in India are undernourished, with a body mass index (BMI) of less than 18.5 kg/m (Source: NFHS 4 2015-16).
• Both malnutrition and anaemia have increased among women since 1998-99.
• 33% of married women and 28% of men are too thin, according to the body mass index (BMI), an indicator derived from height and weight measurements.
• Underweight is most common among the poor, the rural population, adults who have no education and scheduled castes and scheduled tribes.
• 2% of women and 24.3% of men suffer from anaemia, and have lower than normal levels of blood haemoglobin.
• Anaemia has increased in ever-married women from 1998-99. Among pregnant women, anaemia has increased from 50% to almost 58%.

Mother’s health:

• • Scientists say the initial 1,000 days of an individual’s lifespan, from the day of conception till he or she turns two, is crucial for physical and cognitive development.
  • But more than half the women of childbearing age are anaemic and 33 per cent are undernourished, according to NFHS 2006. A malnourished mother is more likely to give birth to malnourished children.

Social inequality:

• • For example, girl children are more likely to be malnourished than boys, and low-caste children than upper-caste children.

Sanitation:

• • Most children in rural areas and urban slums still lack sanitation. This makes them vulnerable to the kinds of chronic intestinal diseases that prevent bodies from making good use of nutrients in food, and they become malnourished.
  • Lack of sanitation and clean drinking water are the reasons high levels of malnutrition persists in India despite improvement in food availability.

Lack of diversified food:

• • With the increase in diversity in food intake malnutrition (stunted/underweight) status declines. Only 12% of children are likely to be stunted and underweight in areas where diversity in food intake is high, while around 50% children are stunted if they consume less than three food items.

Lack of food security:

• • The dismal health of Indian women and children is primarily due to lack of food security.
  • Nearly one-third of adults in the country have a body mass index (BMI) below normal just because they do not have enough food to eat.

Failure of government approaches:

• • India already has two robust national programmes addressing malnutrition the Integrated Child Development Service (ICDS) and the National Health Mission but these do not yet reach enough people.
  • The delivery system is also inadequate and plagued by inefficiency and corruption. Some analysts estimate that 40 per cent of the subsidized food never reaches the intended recipients

Disease spread:

• • Most child deaths in India occur from treatable diseases like pneumonia, diarrhoea, malaria and complications at birth.
  • The child may eventually die of a disease, but that disease becomes lethal because the child is malnourished and unable to put up resistance to it.

Poverty:

• • The staff of ICDS places part of the blame of malnutrition on parents being inattentive to the needs of their children, but crushing poverty forces most women to leave their young children at home and work in the fields during the agricultural seasons.
  • Regional disparities in the availability of food and varying food habits lead to the differential status of under-nutrition which is substantially higher in rural than in urban areas.
  • This demands a region-specific action plan with significant investments in human resources with critical health investments at the local levels.

Lack of nutrition:

• • Significant cause of malnutrition is also the deliberate failure of malnourished people to choose nutritious food.

An international study found that the poor in developing countries had enough money to increase their food spending by as much as 30 per cent but that this money was spent on alcohol, tobacco and festivals instead.

• While the deteriorating facets of malnutrition continue to remain a matter of grave concern, the emergence of COVID-19 has only worsened it.
• The partial closure of Anganwadi Centres (AWCs) along with disruptions in supply chains due to subsequent lockdowns has resulted in halting of mid-day meals scheme, reduced access to take home ration (a nutritional measure to supplement some portion of a child’s calorie needs) and restricted mobility to health care services.
• According to a study published in journal Global Health Science 2020, the challenges induced by COVID-19 are expected to push another four million children into acute malnutrition.
• This is also evident from India poor ranking, an abysmal 94th out of 107 countries on the Global Hunger Index 2020.

• Pradhan Mantri Matru Vandana Yojana (PMMVY): 6,000 is transferred directly to the bank accounts of pregnant women for availing better facilities for their delivery.
• POSHAN Abhiyaan: aims to reduce stunting, under-nutrition, anaemia and low birth weight babies through synergy and convergence among different programmes, better monitoring and improved community mobilisation.
• National Food Security Act (NFSA), 2013, aims to ensure food and nutrition security for the most vulnerable through its associated schemes and programmes, making access to food a legal right.
• Mid-day Meal (MDM) scheme aims to improve nutritional levels among school children which also has a direct and positive impact on enrolment, retention and attendance in schools.
• Integrated Child Development Services (ICDS), with its network of 1.4 million Anganwadi Centres, reaching almost 100 million beneficiaries who include pregnant and nursing mothers and children up to 6 years;
• Public Distribution System (PDS) that reaches over 800 million people under the National Food Security Act.
• Additionally, NITI Aayog has worked on a National Nutrition Strategy (NNS), isolated the 100 most backward districts for stunting and prioritised those for interventions.
• The National Nutrition Strategy (NNS) has set very ambitious targets for 2022 and the Poshan Abhiyaan has also specified three-year targets to reduce stunting, under-nutrition and low birth weight by 2% each year, and to reduce anaemia by 3% each year.
• IYCF (Infant and Young child feeding), Food and Nutrition, Immunization, Institutional Delivery, WASH (Water, Sanitation and Hygiene), De-worming, ORS-Zinc, Food Fortification, Dietary Diversification, Adolescent Nutrition, Maternal Health and Nutrition, ECCE (Early Childhood care and Education), Convergence, ICT-RTM (Information and Communication. Technology enabled Real Time Monitoring), Capacity Building.

According to National Family Health Survey (NFHS)-4 conducted in 2015-16, 21 per cent of children in India under-5 suffered from Moderate Acute Malnourishment (MAM) and 7.5 per cent suffered from Severe Acute Malnourishment (SAM).

• Reduce the burgeoning burden of acute malnutrition and ensure early identification and treatment of SAM children to stop them from further slipping into the vicious cycle of malnutrition.
• Enrol such children in Nutrition Rehabilitation Centres.
• The second step is, treatment of SAM children without any complications at community level through Village Child Development Centre (VCDC) by using different centrally and locally produced therapeutic food.
• These energy-dense formulations are often at the core of nourishing the children since they are fortified with critical macro- and micro-nutrients. It ensures that the target population gains weight within a short span of six to eight weeks.
• Follow up of such children is needed to prevent relapse of malnutrition and ensure adequate food supply to the target population.
• ASHA workers must be given adequate remuneration to be able to carry out this responsibility with more rigour.

Nutrition is not a peripheral concern rather a central to our existence; a pro-equity agenda that mainstreams nutrition into food systems and health systems, supported by strong financing and accountability is the greatest need. Only five years are left to meet the 2025 global nutrition targets, while the time is running out, the focus should be on an action that provides the maximum impact.