Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

Nutrition-related data released by NFHS-5

• The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
• The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

Worrying findings

• 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 percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
• Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
• There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
• Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
• 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.
• Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

Economic growth vs health indicators

• There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
• This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
• The World Health Organization calls stunting “a marker of inequalities in human development”.
• Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
• Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
• The situation has become even worse due to the pandemic and lockdown-induced economic distress.
• Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
• All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

Social protection schemes and their impact on nutrition indicators

• Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
• However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
• Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
• There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

A piecemeal approach

• The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
• Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
• Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
• The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

Conclusion

• The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
• An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
• There have been many indications in our country that business as usual is not sustainable anymore.
• It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.

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