MALNUTRITION - HEALTH
News: Fixing India’s malnutrition problem
What's in the news?
● The Global Hunger Index (GHI) 2022 has brought more unwelcome news for India, as far as its global ranking on a vital indicator of human development is concerned.
Global Hunger Index 2022:
● The
GHI is an important indicator of nutrition, particularly among children, as it
looks at stunting, wasting and mortality among children, and at calorific
deficiency across the population.
● India’s National Family Health Survey (NFHS-5) from 2019-21 reported that in children below the age of five years, 35.5% were stunted, 19.3% showed wasting, and 32.1% were underweight.
Malnutrition problem in India:
● Malnutrition
has been India’s scourge for several years now. Political battles over
malnutrition are not going to help; nor is continuing to think in silos.
● It is clear that malnutrition persists due to depressed economic conditions in large parts of the country, the poor state of agriculture in India, persistent levels of unsafe sanitation practices, etc.
What is malnutrition?
● In
malnutrition, the body becomes deficient
in vitamins, minerals, and other nutrients required to maintain healthy tissues
and organs.
● It
occurs in people who are either undernourished or over nourished.
● Multiple
dimensions of malnutrition in India includes:
○ Undernutrition,
which includes wasting (low
weight-for-height), stunting (low
height-for-age) and underweight (low
weight-for-age)
○ Together,
the stunted and wasted children are considered to be underweight, indicating a
lack of proper nutritional intake and inadequate care post-childbirth.
○ Micronutrient-related
malnutrition, which includes micronutrient
deficiencies (a lack of important vitamins and minerals) or micronutrient
excess; and
○ Overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and some cancers).
Causes of malnutrition in India:
1. Agriculture output:
● The
agriculture output from small and marginal holdings are either stagnant or declining due to reasons
such as reduced soil fertility, fragmented lands or fluctuating market price of
farm produce.
2. Low income:
● Relative
income of one section of people has been on the decline.
● This
has adverse effects on their capacity to
buy adequate food, especially when food prices have been on the rise.
● The
kind of work a section of people have been doing are less remunerative or there
is less opportunity to get remunerative work.
3. Public Distribution System:
● The
public distribution system of the state is not functioning well or is not
accessible to everyone.
4. Rural unemployment:
● The
emaciated rural livelihoods sector and lack of income opportunities other than
the farm sector have contributed heavily to the growing joblessness in rural
areas.
● The
PLFS 2017-18 revealed that rural unemployment stood at a concerning 6.1
percent, which was the highest since 1972-73.
5. Lack of diversified food:
● With
the increase in diversity in food intake, the malnutrition
(stunted/underweight) status declines.
● Only
12% of children are likely to be stunted and underweight in areas where
diversity in food intake is high, while around 50% children are stunted if they
consume less than three food items.
6. Infection driven malnutrition:
● Infections
like malaria and measles may precipitate
acute malnutrition and aggravate the existing nutritional deficit. It is
also worsened by lack of accessibility and affordability to health services.
● Also, a child may consume fewer calories during an infection because of reduced appetite which leads to malnutrition.
Government measures:
1. Poshan Abhiyan:
● It
was approved in 2017.
● It
is a multi-ministerial convergence
mission with the vision to ensure the attainment of malnutrition free India by
2022.
● The
Ministry of Women and Child Development (MWCD) is implementing POSHAN Abhiyaan.
2. Anemia Mukt Bharat Abhiyan:
● The mission was launched in 2018 with the aim of accelerating anemia decline by one to three percentage points annually.
3. National Food Security Act (NFSA), 2013:
● Assuring
food and nutrition security for the most vulnerable is the aim of this law,
which makes access to food a legal entitlement.
4. Pradhan Mantri Matru Vandana Yojana:
● The
centrally sponsored scheme was launched in 2017.
● Rs.
6,000 is transferred directly to the bank accounts of pregnant women and
lactating mothers for availing better facilities for their delivery to compensate for wage loss and is
eligible for the first child of the family.
● Implementation
of the scheme is closely monitored by the central and state governments through
the Pradhan Mantri Matru Vandana Yojana-Common Application Software
(PMKVY-CAS).
5. National Nutrition Strategy:
● The Strategy aims to
reduce all forms of malnutrition by 2030, with a focus on the most vulnerable
and critical age groups.
● The
Strategy also aims to assist in achieving the targets identified as part of the
Sustainable Development Goals related to nutrition and health.
6. Mid-Day Meal Scheme:
● The
Mid-day Meal Scheme is a school meal programme in India designed to better the
nutritional standing of school-age children.
● It covers all school students studying in Classes 1 to 8 of government schools, government-aided schools, special training centers, including madrasas supported under Samagra Shiksha Abhiyan.
Problems in the malnutrition schemes:
Many
Governments centrally sponsored schemes are being implemented to address
malnutrition. But gaps remain in how they are funded and implemented, in what
one might call the plumbing of these schemes.
1. Underfunding:
● For
instance, the Government of India implements the Saksham Anganwadi and Prime
Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) 2.0 scheme (which
now includes the Integrated Child Development Services (ICDS) scheme), which seeks
to work with adolescent girls, pregnant women, nursing mothers and children
below three.
● However,
the budget for this scheme for FY2022-23 was ₹20,263 crore, which is less than
1% more than the actual spend in FY 2020-21 , an increase of less than 1% over
two years.
2. Administrative issues:
● The
budget brief also mentions that over 50% Child Development Project Officer
(CDPO) posts were vacant in Jharkhand, Assam, Uttar Pradesh, and Rajasthan,
pointing to severe manpower constraints
in successfully implementing the scheme of such importance.
● PM
POSHAN (or MDM) is widely recognised as a revolutionary scheme that improved
access to education for children nationwide, it is often embroiled in
controversies around what should be included in the mid-day meals that are
provided at schools.
● Social audits that are meant to allow for community oversight of the quality of services provided in schools are not carried out routinely.
How Direct cash transfer is changing the scheme's
outcome?
● Cash
transfers seem to be a favored solution for several social sector interventions
which includes the health and nutrition sectors.
● Example:
Use of JAM trinity (Jan Dhan bank accounts, Aadhaar, Mobile).
1. Targeting the right beneficiaries -
i.e pregnant women and families with children under the age of five is
possible.
2. Expanding choice at the household level - they
make decisions on what to put on their plates.
3. Cash transfers - It can also be used to incentivise behavioral change in terms of seeking greater institutional support.
Issues with the cash transfers:
● Evidence
shows cash transfers improve household food security, but not necessarily translate into improved child nutrition outcomes.
● The
effect of cash transfers is limited, where food
prices are volatile and inflation depletes the value of cash.
● Son preference:
It can influence household-level decisions when responding to the nutrition
needs of sons and daughters.
● Study of the Mamata scheme in Odisha: It targets pregnant and lactating women. It showed that there were persistent socio-economic discrepancies in the receipt of cash transfers.
WAY FORWARD:
1. Ensure diversified food:
● Food
rations through PDS and special supplements for the target group of pregnant
and lactating mothers, and infants and young children, are essential.
2. Tackling underfunding problem:
● Persistently
under-funded and poorly implemented public programmes (such as the erstwhile
ICDS and MDM schemes) must take a large share of the blame for India’s
malnutrition problem.
3. Cooperation with local people:
● But
getting these schemes right requires greater involvement of local government
and local community groups in the design and delivery of tailored nutrition
interventions.
● A comprehensive programme targeting adolescent girls is required if the intergenerational nature of malnutrition is to be tackled.
4. POSHAN Utsav:
● A
month-long POSHAN Utsav may be good optics to increase the awareness about malnutrition
in India.
5. Nutritional Awareness:
● Promoting
nutritional awareness at the ground level is necessary by educating the public
on the importance and nutritional quality of locally available low-cost foods.
● The
best recipes for preparing proper weaning foods and supplementary foods from
low-cost, locally available ingredients can also be shared with women of the
family via self-help groups.
6. Early Detection of Malnutrition:
● A
well recorded growth health chart of newborn babies and pregnant womens can
detect malnutrition very early.
● The
mid-day meal scheme must also be subjected to a social audit in every district
by the states and union territories.
● Use
of information technology to improve program monitoring is also a worthwhile
consideration.
7. Getting schemes right:
● It requires greater involvement of local government and local community groups in the design and delivery of tailored nutrition interventions.
Go back to the basics:
National Family Health Survey-5:
● Negligible
gains in nutritional outcomes among under-five children.
● There
has been tardy progress in reducing undernutrition, wasting and stunting.
● 35.5%
of under-five children are stunted.
● 19.3%
are wasted.
● Childhood
anemia has worsened from NFHS-4.
● Anemia
among adolescent girls and women aged 15-49 has also worsened.
● More
than 57% of women (15-49 years) and over 67% children (six-59 months) suffer
from anemia.
● Assam,
is among the low-performing States, with a huge burden of anemic cases - 66.4%
of women (15-49 years) and 68.4% children (6-59 months) are affected.