Context

More than seven decades after independence, India still suffers from the public health issues such as child malnutrition attributing to 68.2% of under-five child mortality.

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.
• 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).
• The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).

Marginal improvement on Stunting and Wasting

• The National Family Health Survey (NFHS-5) has shown marginal improvement in different nutrition indicators, indicating that the pace of progress is slow.
• This is despite declining rates of poverty, increased self-sufficiency in food production, and the implementation of a range of government programmes.
• Children in several States are more undernourished now than they were five years ago.
• Increased stunting in some states: Stunting is defined as low height-for-age.
• While there was some reduction in stunting rates (35.5% from 38.4% in NFHS-4) 13 States or Union Territories have seen an increase in stunted children since NFHS-4.
• This includes Gujarat, Maharashtra, West Bengal and Kerala.
• Wasting remains stagnant: Wasting is defined as low weight-for-height.
• Malnutrition trends across NFHS surveys show that wasting, the most visible and life-threatening form of malnutrition, has either risen or has remained stagnant over the years.

National Nutrition Mission (NNM): Focus on essential nutrition interventions

• Government appears determined to set it right — with an aggressive push to the National Nutrition Mission (NNM), rebranding it the Prime Minister’s Overarching Scheme for Holistic Nutrition, or POSHAN.
• Window of opportunity: The Ministry of Women and Child (MWCD) continues to be the nodal Ministry implementing the NNM with a vision to align different ministries to work in tandem on the “window of opportunity” of the first 1,000 days in life (270 days of pregnancy and 730 days; 0-24 months).
• POSHAN Abhiyaan (now referred as POSHAN 2.0) rightly places a special emphasis on selected high impact essential nutrition interventions, combined with nutrition-sensitive interventions, which indirectly impact mother, infant and young child nutrition, such as improving coverage of maternal-child health services, enhancing women empowerment, availability, and access to improved water, sanitation, and hygiene and enhancing homestead food production for a diversified diet.

Key findings of NHFS-5 data

• Data from the National Family Health Survey (NFHS)-5 2019-21, as compared to NFHS-4 2015-16, reveals a substantial improvement in a period of four to five years in several proxy indicators of women’s empowerment.
• No progress on nutritional intervention: Alarmingly, during this period, the country has not progressed well in terms of direct nutrition interventions.
• Preconception nutrition, maternal nutrition, and appropriate infant and child feeding remain to be effectively addressed.
• India has 20% to 30% undernutrition even in the first six months of life when exclusive breastfeeding is the only nourishment required.
• Neither maternal nutrition care interventions nor infant and young child feeding practices have shown the desired improvement.

Suggestions

• Child undernutrition in the first three months remains high. Creating awareness on EBF, promoting the technique of appropriate holding, latching and manually emptying the breast are crucial for the optimal transfer of breast milk to a baby.
• Complementary feeding: NFHS-5 also confirms a gap in another nutrition intervention — complementary feeding practices, i.e., complementing semi-solid feeding with continuation of breast milk from six months onwards.
• The fact that 20% of children in higher socio- economic groups are also stunted indicates poor knowledge in food selection and feeding practices and a child’s ability to swallow mashed feed.
• Creating awareness: So, creating awareness at the right time with the right tools and techniques regarding special care in the first 1,000 days deserves very high priority.
• Revisit nodal system for nutrition program: There is a need to revisit the nodal system for nutrition programme existing since 1975, the Integrated Child Development Scheme (ICDS) under the Ministry of Women and Child and examine whether it is the right system for reaching mother-child in the first 1000 days of life.
• Alternative way to distribute ICDS supplies: There is also a need to explore whether there is an alternative way to distribute the ICDS supplied supplementary nutrition as Take- Home Ration packets through the Public Distribution (PDS) and free the anganwadi workers of the ICDS to undertake timely counselling on appropriate maternal and child feeding practices.

Conclusion

It is time to think out of the box, and overcome systemic flaws and our dependence on the antiquated system of the 1970s that is slowing down the processes.

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