India’s Nutrition Challenge

GS 2Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources, Issues relating to Poverty and Hunger.

Source : The Indian Express dated 11/06/2021

https://indianexpress.com/article/opinion/columns/how-india-can-tackle-its-formidable-nutrition-challenge-7353391/

Context

One of the silent and invisible crises the Covid 19 pandemic is amplifying is that of malnutrition, as incomes, food consumption and essential services all come under pressure.
As India intensifies efforts to rebound from the impact of the pandemic, there is added urgency for an evidence-based, integrated, outcome-focused approach to address India’s nutrition challenge. 

What is malnutrition?

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions.

  1. One is ‘undernutrition’— which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
  2. The other is overweight, obesity and diet-related non communicable diseases (such as heart disease, stroke, diabetes and cancer).
    • According to the World Food Programme and World Bank, malnutrition affects cognitive ability, workdays and health, impacting as much as 16% of GDP of the world.
Triple burden of malnutrition
  1. Undernutrition
    • Stunting: Children are defined as stunted if their height-for-age is below the WHO Child Growth Standards median. It is a clear sign that children in a country are not developing well – is both a symptom of past deprivation and a predictor of future poverty.
    • Wasting: Low weight-for-height indicates in most cases with acute starvation and/or severe disease. Contrary to common belief, most wasted children around the world live in Asia and not in emergency settings.
  2. Hidden hunger is a lack of vitamins and minerals which harms children and women. Iron deficiency reduces children’s ability to learn and iron deficiency anaemia increases women’s risk of death during or shortly after childbirth.
  3. Child overweight can lead to early onset of type-2 diabetes, stigmatization and depression, and is a strong predictor of adult obesity, with serious health and economic consequences.
Malnutrition in India
  • The Global Nutrition Report 2020 highlighted following trends in India
  • Global Nutrition Targets: India will miss targets for all four nutritional indicators i.e. target on stunting, anaemia, overweight & exclusive breastfeeding.
  • Stunted and wasted: In India 37.9% of children under 5 years are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively.
    • Inequalities are evident for stunting, with stunting prevalence being 10.1% higher in rural vs urban areas.
  • Underweight: Between 2000 and 2016, rates of underweight (low weight for age) have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls.
    • However, this is still high compared to the average of 35.6% for boys and 31.8% for girls in Asia.
  • Overweight: As of 2015, the national prevalence of under-five overweight is 2.4%, which has increased slightly from 1.9% in 2006.
  • Adult nutrition: India’s adult population faces a malnutrition burden.
    • 51.4% of women of reproductive age have anaemia
    • 9.1% of adult men have diabetes, compared to 8.3% of women.
    • 5.1% of women and 2.7% of men have obesity.
Global Hunger Index

India ranked 94 among 107 countries in the Global Hunger Index 2020 and is in the ‘serious’ hunger category with a score of 27.2. India’s rank was 102 out of 117 countries last year.
Out of the total 107 countries, only 13 countries fare worse than India including countries like Rwanda (97), Nigeria (98), Afghanistan (99), Liberia (102), Mozambique (103), Chad (107) among others.

Challenges

Paradox related to production and Accessibility: In India, food grain yields have risen 33% over the last two decades, however, consumer’s access to rice, wheat and other cereals has not increased at the same rate, due to population growth, inequality, food.

Urbanization: In cities, many poor children live in ‘food deserts’, facing an absence of healthy food options, or in ‘food swamps’, confronted with an abundance of high-calorie, low-nutrient, processed foods.

Poverty: Poor families tend to select low-quality food that costs less. Because of poverty and exclusion, the most disadvantaged children face the greatest risk of all forms of malnutrition.

  • Climate shocks, loss of biodiversity, and damage to water, air and soil are worsening the nutritional prospects of millions of children and young people, especially among the poor.
  • Inter and Intra State Variations in Malnutrition
    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
Economic growth vs health indicators
  • The World Health Organization calls stunting “a marker of inequalities in human development”.
  • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
  • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequalitygreater informalisation of the labour force, and reducing employment elasticities of growth.
  • Absence of Agriculture-Nutrition Link: An important approach to address nutrition is through agriculture. This link is important because about three-fifths of rural households are agricultural in India (National Sample Survey Office, 70th round) and malnutrition rates, particularly in rural areas are high (National Family Health Survey-4).
Government initiatives
  1. National Nutrition Strategy
    • It is a 10-point nutrition action plan that includes governance reforms and envisages a framework wherein the four proximate determinants of nutrition – uptake of health services, food, drinking water & sanitation and income & livelihoods – work together to accelerate decline of under nutrition in India.
    • Key Feature of Strategy are:
      • It focuses to reduce all forms of malnutrition by 2030, with a focus on the most vulnerable and critical age groups.
      • A decentralised approach will be promoted with greater flexibility and decision making at the state, district and local levels.  The Strategy proposes to launch interventions with a focus on improving healthcare and nutrition among children and improve maternal care.
    •  Governance reforms envisaged in the Strategy include:
    • Convergence of state and district implementation plans for ICDS, NHM and Swachh Bharat
    • Focus on the most vulnerable communities in districts with the highest levels of child malnutrition.
    • Service delivery models based on evidence of impact.
  2.  National Nutrition Mission (NNM)
    1. Ending all forms of malnutrition by 2030 is also the target of Sustainable Development Goal (SDG-2) of Zero Hunger.
    2. Towards this end, NNM aims to reduce stunting, underweight and low birth weight each by 2 per cent per annum.
    3. It aims to reduce anaemia among children, adolescent girls and women, each by 3 per cent per annum by 2022.

Way forward

  1. Mothers’ education
    • Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and the sanitation facility.
    • Despite India’s considerable improvement in female literacy, only 13.7 per cent of women have received higher education (NFHS, 2015-16).
    • Therefore, programmes that promote women’s higher education such as liberal scholarships for women need to be accorded a much higher priority
  2. Sanitation and access to safe drinking water
    • The second key determinant of child under-nutrition is the wealth index, which subsumes access to sanitation facilities and safe drinking water.
    • WASH initiatives, that is, safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes.
      • In five years of the Swachh Bharat Abhiyan, as per government records, rural sanitation coverage has gone from 38.7 per cent in 2014 to 100 per cent in 2019, while the sanitation coverage in urban cites has gone up to 99 per cent by September 2020.
      • This remarkable achievement of the Swachh Bharat Abhiyan, subject to third-party evaluations, is expected to have a multiplier effect on nutritional outcomes.
  3. Leveraging agricultural policies
    • We should leverage agricultural policies and programmes to be more “nutrition-sensitive” and reinforcing diet diversification towards a nutrient-rich diet.
      • Bio-fortification is very cost-effective in improving the diet of households and the nutritional status of children.
      • The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops.
  4. Promotion of exclusive breastfeeding, complementary foods, diversified diet
    • The promotion of exclusive breastfeeding and the introduction of complementary foods and a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.
  5. Access to prenatal and postnatal care
    • Access and utilisation of prenatal and postnatal health care services also play a significant role in curbing undernutrition among children.
    • Anganwadi workers and community participation can bring significant improvements in child-caring practices.
Recent initiatives
  • POSHAN 2.0 guidelines announced in January 2021.
    • The focus is on the 1,000 days between a mother’s pregnancy and her child’s second birthday, prioritising women and girls, and addressing their nutritional deficiencies through fortification and provision of take-home rations. 
    • The guidelines place accountability for the first time at the district level with nutrition indicators included in the KPIs (key performance indicators) of district magistrates/district collectors. 
  • POSHAN tracker –The tracker replaces the CAS system as the digital backbone of Poshan 2.0. It aims to provide a holistic view of distribution and access of nutrition services by anganwadi centres and AWWs to eligible groups — pregnant women, lactating mothers, children and adolescents.
    • Its centralised data architecture enables interfaces with digital technology systems of other ministries, to help ensure that households which fall in the critical 1,000-day period receive benefits and services across different social protection programmes. 
    • In response to the tragedy of children orphaned by Covid-19, the tracker now carries a module to enable AWWs to identify and provide support to these children.
  • “Poshan Vatikas” or nutrition gardens – allowing families to access locally-produced nutritive foods while increasing their livelihoods and productivity.
Conclusion

If India’s overwhelming goal is to become a $5 trillion economy within a few years, there is no reason to pay attention to children. But if it is development in the full sense of the term, then child development is paramount.

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