In news:

• The covid-19 pandemic has disrupted optimal care for children, especially those who are malnourished, said a UNICEF report - Community based programme for children below 5 years of age with severe acute malnutrition in India - Progress so far and lessons learned 2020.

 

 

Malnutrition crisis in India: 

• According to the Global Nutrition Report, 2020, malnutrition is the predominant risk factor for death in children younger than five years in every state in 2017, accounting for 68.2% of the total under-5 deaths.
• As much as 35.7% children under 5 years of age are underweight, 38.4% are stunted, and 21% are wasted, according to the National Family Health Survey-4 in 2015-16, conducted by the ministry of health and family welfare.
• As per the Comprehensive National Nutrition Survey (2016-18), conducted by UNICEF and the Ministry of Health & Family Welfare (MoHFW), 1 in every 20 children in India under 5 years of age suffers from SAM.

 

What are the 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.
   
  • This is because, for long the agriculture sector in India focused on increasing food production, particularly staples (wheat and rice).
  • This led to lower production and consumption of indigenous traditional crops/grains, fruits and other vegetables, impacting food and nutrition security in the process.
  • This intensive monoculture agricultural practices can perpetuate the food and nutrition security problem by degrading the quality of land, water and the food derived through them.
• Changing food patterns: Food consumption patterns have changed substantially in India over the past few decades, which has resulted in the disappearance of many nutritious local foods, for example, millets.
• 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.

 

Salient findings of the UNICEF report:

• Lack of guidelines: States were using their funds to roll out such programmes in select areas even as they were awaiting guidelines from the ministry of women and child development on community-based management of children with severe acute malnutrition (SAM).
• Barriers in the state-level Community Management of Acute Malnutrition (CMAM) Programme: Planned community  activities are rarely implemented due to a lack of convergence between government departments, with proposed actors engaged in other activities.
• Data exclusion: List of children developed by Anganwadi workers are often used to identify children who need to be screened, yet they are often not complete. 
  • As a result, children living in more remote and hard-to-reach areas of the block can be excluded from routine screening.
• Inaccurate data: Screening equipment is often faulty and unusable.
  • Weight and height measurements by Anganwadi workers and auxiliary nurse midwives are of poor quality, leading to inaccurate classification of children’s nutrition status,
• Vacancies: Many areas with fewer frontline worker vacancies have been chosen to ensure high quality service delivery. However, to scale up, vacancies will become a challenge.

 

 

 

Government schemes:

As of 2014, schemes addressing one or other aspect of nutrition are as followed.

• 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.

 

National Nutritional policy 1993

• The National Nutrition Policy (NNP) was adopted under the aegis of the Ministry of Women and Child Development.
• The strategy of NNP was a multi-sectoral strategy for eradicating malnutrition and achieving optimum nutrition for all.

 

National Nutrition Mission

• The government launched National Nutrition Mission(renamed as Poshan Abhiyaan) in March 2018
• It aims to reduce undernutrition, anemia (among young children, women and adolescent girls) and low birth weight by 2%, 3% and 2% per annum respectively.
• It also aims to reduce stunting (a measure of malnutrition that is defined as the height that is significantly below the norm for age) by 2% a year, bringing down the proportion of stunted children in the population to 25% by 2022.
• The policy aims to map various schemes that address malnutrition and set up a robust convergence mechanism, and an information and communications technology-based real-time monitoring system, besides incentivising states and Union territories to meet the targets.
• National Nutrition Mission is backed by a National Nutrition Strategy prepared by the NITI Aayog with the goal of attaining “Kuposhan Mukt Bharat" or malnutrition-free India, by 2022.
• However, achieving this target will require doubling the current annual rate of reduction in stunting.

 

 

POSHAN abhiyan: 

• The Prime Minister’s Overarching Scheme for Holistic Nutrition or POSHAN Abhiyaan or National Nutrition Mission, is Government of India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers. 

• It is a strategy for addressing malnutrition majorly focusing on the under-nutrition by adopting a life cycle approach. 
• It is launched by the Ministry of Women and Child Development
• Its aim is to make India malnutrition-free by 2022.
• It aims to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.

 

Way ahead:

• Establishing a dedicated day for nutrition education, screening and growth monitoring in every village (VHSND)
• Improved supplementary nutrition program for children and pregnant women
• Establishment of Nutrition Rehabilitation in district and sub-district level
• Nutrition Missions at the national and regional levels
• Improved coverage of de-worming
• Improved monitoring and reporting
• Community-based management programme: There is an urgent need to bring SAM management under essential health and nutrition services and to ensure continuity of services for the management of child wasting.

1. One key mandate for Poshan Abhiyaan isto positively integrate and influence maternal child nutrition and well-being.
2. For all this awareness and sensitization of local masses are extremely critical.

 

Recommendations:

• Recommendations to solve mal-nutrition by Food and Nutrition Security Analysis, India, 2019:
• Recommendations are grouped by the three pillars of food security: availability, access and utilisation.

 

Availability:

• • Farmers should be encouraged and incentivised for agricultural diversification.
  • Innovative and low-cost farming technologies, increase in the irrigation coverage and enhancing knowledge of farmers in areas such as appropriate use of land and water should be encouraged to improve the sustainability of food productivity.
  • The government should improve policy support for improving agricultural produce of traditional crops in the country.

 

Accessibility:

• The targeting efficiency of all food safety nets should be improved, especially that of the Targeted Public Distribution System (TPDS), to ensure that the poorest are included.
• In addition, fortification of government-approved commodities within the social safety net programmes can improve nutritional outcomes.
• Child feeding practices should be improved in the country, especially at the critical ages when solid foods are introduced to the diet.
• Fortification, diversification and supplementation may be used as simultaneous strategies to address micro and macronutrient deficiencies.

 

Utilisation:

• Storage capacity should be improved to prevent post-harvest losses.
• There is a need for more robust measures that can take cognizance of all aspects of SDG 2.
• All the major welfare programmes need to be gender sensitive.
• The inherited dehumanising poverty explains the persistence of malnutrition on a large scale.
• Children born in impecunious circumstances suffer the most from malnutrition. It is all the more reason for governments to intervene to provide adequate nutrition to all.
• Funds for food to all yield great returns and help in unlocking the full potential of citizens besides strengthening the workforce.

 

Conclusion:

• Coherent policy action, right from sectors such as health, nutrition, environment, urban and rural development, to education and finance, needs to be implemented at all levels with participatory approach.  The POSHAN Abhiyan is a step in the right direction. Children should be given access to nutritious food to prevent malnutrition.