Context

The country’s response to its burden of malnutrition and growing anaemia has to be practical and innovative.

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).

What are the root causes of malnutrition in India?

The following three deficits are the root cause of malnutrition in India.

1) Dietary deficit

• There is a large dietary deficit among at least 40 per cent of our population of all age groups, shown in— the National Nutrition Monitoring Bureau’s Third Repeat Survey (2012), NFHS 4, 2015-16, the NNMB Technical Report Number 27, 2017.
• Our current interventions are not being able to bridge this protein-calorie-micronutrient deficit.
• The NHHS-4 and NFHS-5 surveys reveal an acute dietary deficit among infants below two years, and considerable stunting and wasting of infants below six months.
• Unless this maternal/infant dietary deficit is addressed, we will not see rapid improvement in our nutritional indicators.

2) Information deficit at household level

• We do not have a national IEC (information, education and communication) programme that reaches targeted households to bring about the required behavioural change regarding some basic but critical facts.
• For example, IEC tells about the importance of balanced diets in low-income household budgets, proper maternal, child and adolescent nutrition and healthcare.

3) Inequitable market conditions

• The largest deficit, which is a major cause of dietary deficiency and India’s chronic malnutrition, pertains to inequitable market conditions.
• Such market conditions deny affordable and energy-fortified food to children, adolescents and adults in lower-income families.
• The market has stacks of expensive fortified energy food and beverages for higher income groups, but nothing affordable for low-income groups.

The vicious cycle of malnutrition

• Link with mother: A child’s nutritional status is directly linked to their mother.
• Poor nutrition among pregnant women affects the nutritional status of the child and has a greater chance to affect future generations.
• Impact on studies: Undernourished children are at risk of under-performing in studies and have limited job prospects.
• Impact on development of the country: This vicious cycle restrains the development of the country, whose workforce, affected mentally and physically, has reduced work capacity.

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.

Prevalence of anaemia in India

• What is it? Anaemia is defined as the condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
• Consequences: Anaemia has major consequences in terms of human health and development.
• It reduces the work capacity of individuals, in turn impacting the economy and overall national growth.
• Developing countries lose up to 4.05% in GDP per annum due to iron deficiency anaemia; India loses up to 1.18% of GDP annually.
• The NFHS-5 survey indicates that more than 57% of women (15-49 years) and over 67% children (six-59 months) suffer from anaemia.

Way forward

1] Increase investment:

• There is a greater need now to increase investment in women and children’s health and nutrition to ensure their sustainable development and improved quality of life.
• Saksham Anganwadi and the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) 2.0 programme have seen only a marginal increase in budgetary allocation this year (₹20,263 crore from ₹20,105 crore in 2021-22).
• Additionally, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilised.

2] Adopt outcome oriented approach on the nutrition programme

• India must adopt an outcome-oriented approach on nutrition programmes.
• It is crucial that parliamentarians begin monitoring needs and interventions in their constituencies and raise awareness on the issues, impact, and solutions to address the challenges at the local level.
• Direct engagement: There has to be direct engagement with nutritionally vulnerable groups and ensuring last-mile delivery of key nutrition services and interventions.
• This will ensure greater awareness and proper planning and implementation of programmes.
• This can then be replicated at the district and national levels.

3] Increase awareness and mother’s education

• With basic education and general awareness, every individual is informed, takes initiatives at the personal level and can become an agent of change.
•  Various studies highlight a strong link between mothers’ education and improved access and compliance with nutrition interventions among children.

4] Monitoring

• There should be a process to monitor and evaluate programmes and address systemic and on the ground challenges.
• A new or existing committee or the relevant standing committees meet and deliberate over effective policy decisions, monitor the implementation of schemes, and review nutritional status across States.

Conclusion

We must ensure our young population has a competitive advantage; nutrition and health are foundational to that outcome.

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