Note to Students:

• The key emphasis of this article is on malnutrition. We have also added a section in this analysis that covers the important government schemes aimed at alleviating malnutrition in India.

Background:

A Look at some of the Government Schemes: 

Government has taken various measures to check malnutrition in the people living Below Poverty Line (BPL) and the tribals which are as follows:

1. Promotion of appropriate infant and young child feeding practices that include early initiation of breastfeeding and exclusive breastfeeding till 6 months of age through ASHA worker and health care provider at health facilities. Under “MAA” programme of MoHFW, impetus on capacity building of the health workers on lactation management at both community and facility levels and 360 degree IEC campaign to create awareness regarding breastfeeding is being carried out.
2. Treatment of sick children with severe acute malnutrition at special units called the Nutrition Rehabilitation Centres (NRCs), set up at public health facilities.
3. Vitamin A supplementation for children aged 6 months to 5 years and iron and folic acid supplementation is being carried out for children, adolescents, pregnant and lactating women through life cycle approach under “National Iron Plus Initiative”programme. Also, promotion of intake of iodised salt is being carried out under National Iodine Deficiency Disorders Control Programme.
4. Village Health and Nutrition Days and Mother and Child Protection Card are the joint initiative of the Ministries of Health & Family welfare and the Ministry of Woman and Child for addressing the nutrition concerns in children, pregnant women and lactating mothers. Monthly Village Health and Nutrition Days (VHND) are monthly days held at village level in Anganwadi centre to increase the awareness and bring about desired changes in the dietary practices including the promotion of breastfeeding.
5. Under the RashtriyaBalSwasthyaKaryakram (RBSK) and Rashtriya Kishore SwasthyaKaryakram (RKSK), systematic efforts are undertaken to detect nutrition deficiency among children and adolescents respectively.

6. Supplementary Nutrition in form of hot-cooked meals and take-home ration provided to children aged 6 months to 6 years under Integrated Child Development Services (ICDS) Scheme, Growth monitoring of children aged 0-5 years on a monthly basis at Anganwadi Centres.

7. Mid-day meal is provided for all students enrolled in Government and Government aided schools.

• It is important to note that the Government is implementing several schemes and programs like:

1. Anganwadi Services,
2. Scheme for Adolescent Girls and
3. Pradhan Mantri Matru Vandana Yojna under the Umbrella Integrated Child Development Services Scheme as direct targeted interventions to address the problem of malnutrition in the country.

• All these schemes address one or other aspects related to nutrition and have the potential to improve nutritional outcomes in the country.
• Malnutrition is not a direct cause of death but contributes to mortality and morbidity by reducing resistance to infections.
• There are a number of causes of death of children such as prematurity, low birth weight, pneumonia, diarrhoeal diseases, non-communicable diseases, birth asphyxia & birth trauma, injuries, congenital anomalies, acute bacterial sepsis and severe infections, etc.

Perspective on National Nutrition Mission (NNM): 

• Apart from the existing schemes aimed at reduction in the levels of malnutrition among women and child, recently, the Government has set up the National Nutrition Mission (NNM) for improving the nutritional indicators of children and pregnant women and lactating mothers.

What does the National Nutrition Mission (NNM) aim to do?

• The Mission aims to prevent and reduce prevalence of stunting among children (0-6 years) in the country by 6%, under-nutrition (underweight) prevalence among children (0-6 years) by 6%, prevalence of anaemia among children (6-59 m) by 9%, prevalence of anaemia among women (15-49 years) by 9% and reduction in prevalence of low birth weight by 6%.
• The Goals set under the mission will be achieved by ensuring convergence with various programmes; incentivizing States/ UTs; IT enabled Real Time Monitoring (ICT-RTM) by using Smart Phones and Tablets; Evaluation; Community mobilisation awareness advocacy; IEC, Online Course on Nutrition for Children, Nutrition message from folk songs and songs on WASH, and strengthening human resource, etc.

Editorial Analysis:

• Experts opine that in this election season, it is important to keep promises made not just to voters, but also those made to improve the lives of children, the future of the nation.
• Despite programme commitments since 1975, such as creating Integrated Child Development Services and national coverage of the mid-day meal scheme, India continues to grapple with a high rate of under-nutrition.

Stunting: A Major Challenge Area

• Improving nutrition and managing stunting continue to be big challenges, and they can be addressed only with an inter-sectoral strategy.
• Stunting has lifelong consequences on human capital, poverty and equity.
• It leads to less potential in education and fewer professional opportunities.
• According to the National Family Health Survey (NFHS)-4, India has unacceptably high levels of stunting, despite marginal improvement over the years.
• In 2015-16, 38.4% of children below five years were stunted and 35.8% were underweight. India ranks 158 out of 195 countries on the human capital index.
• It is important to note that a lack of investment in health and education leads to slower economic growth.
• The World Bank says, “A 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in economic productivity”.
• Stunting also has lasting effects on future generations.
• Since 53.1% of women were anaemic in 2015-16, this will have lasting effects on their future pregnancies and children. The situation further worsens when infants are fed inadequate diets.

Some of the Ambitious goals that have been set:

• The aim of the National Nutrition Strategy of 2017 is to achieve a malnutrition-free India by 2022.
• The plan is to reduce stunting prevalence in children (0-3 years) by about three percentage points per year by 2022 from NFHS-4 levels, and achieve a one-third reduction in anaemia in children, adolescents and women of reproductive age.
• This is an ambitious goal, especially given that the decadal decline in stunting from 48% in 2006 to 38.4% in 2016 is only one percentage point a year.
• This promise calls for serious alignment among line ministries, convergence of nutrition programmes, and stringent monitoring of the progress made in achieving these goals.
• The data available on stunting tell us where to concentrate future programmes.
• Stunting prevalence tends to increase with age and peaks at 18-23 months.
• Timely nutritional interventions of breastfeeding, age-appropriate complementary feeding, full immunisation, and Vitamin A supplementation have been proven effective in improving outcomes in children.
• However, data show that only 41.6% children are breastfed within one hour of birth, 54.9% are exclusively breastfed for six months, 42.7% are provided timely complementary foods, and only 9.6% children below two years receive an adequate diet. India must improve in these areas.
• Vitamin A deficiency can increase infections like measles and diarrhoeal diseases.
• About 40% of children don’t get full immunisation and Vitamin A supplementation. They must be provided these for disease prevention.

Variations across States and districts

• According to NFHS-4 data, India has more stunted children in rural areas as compared to urban areas, possibly due to the low socio-economic status of households in those areas.
• Almost double the prevalence of stunting is found in children born to mothers with no schooling as compared to mothers with 12 or more years of schooling.
• Stunting shows a steady decline with increase in household income.
• The inter-generational cycle of malnutrition is to be tackled with effective interventions for both mother (pre- and post-pregnancy) and child, to address the high burden of stunting.
• In terms of geographical regions, Bihar (48%), Uttar Pradesh (46%) and Jharkhand (45%) have very high rates of stunting, while States with the lowest rates include Kerala, and Goa (20%).
• While nutrition has improved across all States, inter-State variabilities remain extremely high. The most significant decline has been noted in Chhattisgarh (a 15 percentage point drop in the last decade). Thus, the government can take lessons from Chhattisgarh. The least progress has been made in Tamil Nadu.
• A study by the International Food Policy Research Institute shows that stunting prevalence varies across districts (12.4-65.1%), and almost 40% districts have stunting levels above 40%. U.P. tops the list, with six out of 10 districts having the highest rates of stunting.

Concluding Remarks:

• Looking at this data, it is imperative to push for convergence of health and nutrition programmes right from pregnancy until the child reaches five years of age.
• This is doable.
• India must adopt a multi-pronged approach in bringing about socio-behavioural change.
• What is really needed is effective monitoring and implementation of programmes to address malnutrition.