Combatting Malnutrition: India’s Silent Emergency

By Neelmani Singh, Sanjeev Kumar & Anand Kumar

Malnourishment has long been silent emergency in India. Evidence suggests that there are several factors, working independently or combined, that are responsible for poor nutritional status among the women in India. These include lack of access to adequate and nutritious food, inadequate hygiene, infections such as diarrhoea and helminths, and gender and class disparities. Due to which, it is seen throughout the life cycle and is most acute during childhood, adolescent age, pregnancy, and lactation.

Pregnant and lactating women are among the most vulnerable groups. Evidence suggests that maternal nutrition during antenatal significantly affects foetal growth and pregnancy outcome. Additionally, there is significant association between chronic undernutrition and pregnancy outcome for both for the mother and the offspring. Therefore, these groups of women require an adequate supply of micronutrients prior to conception to ensure optimal nutrient transmission to the foetus. In India, 20% of babies born annually are as low birth weight (LBW).

Efforts of India’s Union and State Governments to improve the nutritional status of women of reproductive age have yielded a significant reduction in women’s undernutrition, but problems associated with excess weight and obesity continue to rise in this demographic section. The 2015-16 National Family Health Survey study showed that the double burden of malnutrition (Undernutrition and Obesity) among mother-child pairs in India is 6%.

In 2013, the Government of India adopted a ‘continuum of care’ approach along with a strategy for Reproductive, Maternal, New-born, Child, and Adolescent Health (RMNCH+A). This included an Iron and Folic Acid supplement being distributed to during Antenatal Care check-ups, as this has been found to be a highly effective intervention in the fight against malnutrition,

In 2019, the Government of India developed a strategy to eliminate Anaemia (Anaemia Mukt Bharat) under the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan, to accelerate the anaemia reduction rate (less than 1% between 2005-2015). This strategy has enabled the health system to resolve numerous issues in supply-side barriers.

National Livelihood is a non-health program with a community-level women’s Self Help Group (SHG) network. Such groups are self-governed and empowered to plan and execute activities according to local context. In Bihar, the Jeevika group’s members are from local communities. Jeevika provides women with practical support to help them generate income, and encourages its members to take part in social protection schemes. Working with groups like Jeevika in established rituals like weaning ceremonies (Annaprasans) and in the distribution of Nayi pahal kits (Family Planning Kit meant for the newlywed couples) could be a route into promoting healthy nutrition.

Local governance bodies significantly influence health & its determinants, including nutrition services in communities. Local governance bodies and SHGs are essential links between the rightsholders and the duty bearers who can improve the coverage, continuity, quality, and intensity (C2IQ) of community health & nutrition programs. Such institutions can raise community awareness on rights and responsibilities and entitlement to nutrition-related services within communities. They can also provide accurate information about nutritional interventions.

Both union and state governments recognise the role thatlocal governance bodies and SHGs play in improving community-based nutritional services for women. Resilient intersectoral coordination between the existing primary care avenues and these change agents could be highly effective in generating demand for community based nutritional interventions. Additionally, Village Health Sanitation & Nutrition Committees (VHSNC) can help ensure health and nutrition plans meet local needs. Village Health Sanitation and Nutrition Days (VHSNDs) are held monthly in villages, involving Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), Anganwadi Workers (AWWs), SHG leaders, Parent Teacher Association (PTAs) and village representatives cooperate in delivering activities based aroundfor health, sanitation and nutrition needs. These activities encourage women to seek ANC care, adhere to IFA supplementation and address knowledge & food taboos on the importance of diet diversity. Anecdotal evidence suggests that pregnant women are more likely to adhere to IFA courses when husbands attend, so efforts are being made to encourage their participation.

Conclusion:

Local bodies and SHGs have great potential to impact women’s nutritional practices within communities. Hence, these institutions could serve as significant catalysts in creating demand for community-based nutritional services. However, despite acknowledging their potential, establishing and implementing a resilient intersectoral coordination mechanism between local bodies, SHG and primary care apparatus remains a challenge.

About the Authors:

Neelmani Singh is a public health professional with more than 10 years’ experience as Nutrition professional.