The Global Nutrition Report 2017 released earlier this month revealed that virtually every nation in the world is grappling with a nutrition-related challenge. As far as India is concerned, the report shows that the country is facing ‘significant burdens’ in three areas – childhood stunting, anaemia in women and overweight adult women.
While the scenario is fairly grim, it is important to note the progress that has been made. Stunting among children under 5 years declined from 48 percent to 38.4 percent between 2005-06 and 2015-16. During the same period, the percentage of underweight children reduced from 42.5 percent to 35.7 percent. The absolute levels of stunted and underweight children, however, remain high.
One in two women in the 15-49 age group is anaemic, with considerable inter-state disparities. For instance, anaemia levels in women ranged from 45 percent in Karnataka to 63 percent in Haryana in 2015-16.
Further, women who are overweight or obese increased from 12.6% in 2005-06 to 20.7% in 2015-16, while men went from 9.3% in 2005-06 to 18.6% in 2015-16. Women also tend to be more obesity-prone in urban areas, with the report citing increasing "gadgetisation" as one of the reasons – tasks that would allow women who stay at home to stay physically active are now becoming digitised. Another factor could be that under-nutrition in childhood and adolescence can often lead to being overweight and obese in adulthood. Many more girls tend to be undernourished than boys, which has adverse consequences.
Are these unsolvable problems? Absolutely not. However, achieving a malnutrition-free India will require intensive efforts in six key areas:
1. Enable Convergence
The proposed National Nutrition Mission should be launched on a priority basis with representation from the relevant government ministries and departments. This is crucial because malnutrition by its very nature has multiple determinants including health, gender equity, drinking water and sanitation. In Tanzania, for instance, a High-Level Committee on Nutrition, chaired by the Prime Minister, was constituted with representation from key ministries, development partners and the private sector.
Geographic convergence is also key. Over the years, districts with a high burden of malnutrition have been identified for different programmes, independently. In order to use resources more efficiently and achieve better outcomes, it is important that these programmes are implemented concurrently in districts that are lagging behind.
2. Invest in Data Systems
By making district-level estimates available for the entire country, the National Family Health Survey-4 is undoubtedly helping to address some of the bottlenecks in the country’s health and nutrition data. The expected periodicity of three years, going forward, is also a welcome development.
The need of the hour is to develop a web-enabled Nutrition Information System that can be used for monitoring progress on various indicators as well as holding personnel at every level of the implementation chain accountable for delivery. In order for such a system to be effective, it must also incorporate data from health and sanitation.
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3. Strengthen Government Nutrition Programmes
The Targeted Public Distribution System (TPDS) has a wide reach and can be leveraged for tackling micronutrient deficiencies like anaemia in the population. Rajasthan and Gujarat, for instance, have distributed fortified commodities through the TPDS ration shops.
Another approach that can be tested, initially in a few districts, is the use of cash transfers instead of providing cereals for increasing dietary diversity. This is important because a diet focused on cereals coupled with a higher genetic predisposition can worsen India’s already significant heart disease and diabetes burden.
Efforts should also be made to increase the levels of awareness among citizens about their entitlement and corresponding prices at Fair Price Shops. For instance, an SMS could be sent at the beginning of every month with this information and display boards could be set up in shops.
Similarly, the Integrated Child Development Services programme should include a component of nutrition counselling not only for the mother but for the entire family through home visits.
4. Replicate Good Practices
Several states in India have adopted innovative models for implementing nutrition programmes. In West Bengal’s Keno Parbo Na (positive deviance) model, mothers participated in nutrition counselling sessions over a twelve-day period. Children were weighed repeatedly till they attained an acceptable level of nutrition.
Mothers were encouraged to adopt cooking and feeding practices that would help to maximise the nutrient value of locally available ingredients instead of requiring them to follow government sermons or circulars. Regular weighing helped to keep the motivation levels of mothers high as they could see the progress made by their children. It is important that such practices are evaluated and replicated, if found to be successful.
5. Address Overweight and Obesity
While currently the affluent sections of society are affected disproportionately, the problem of overweight and obesity will progressively impact all population groups including poorer households.
Thus, while efforts need to be made for enhancing the calorific content of food for the undernourished, it is important that foods that provide balanced nutrients are promoted, instead of simple sugars or fats.
Physical activity should also be promoted in every age group. In China, for instance, local governments have increased the opportunities for exercising by building parks, large squares as well as green spaces. By recognising that the habits inculcated during childhood and adolescence have a higher likelihood of being sustained throughout life, the Chinese Ministry of Education has also launched a campaign to reduce the academic burden of students allowing them more time to focus on physical fitness.
6. Focusing on Community Empowerment
Malnutrition is often invisible to families till such time that it starts manifesting through obvious signs and symptoms. It is therefore crucial that large-scale awareness drives are conducted for involving mothers and young children, in particular.
Weighing of children should also be done in front of communities to make them equal partners in the fight against malnutrition. The success of the nutrition effort in countries like Thailand, Peru, Brazil and Zimbabwe has been attributed at least partially to their ability to involve local communities.
(Disclaimer: The views and analysis expressed in the article are personally those of the author. They do not reflect the views of NITI Aayog. NITI Aayog does not guarantee the accuracy of data included in the publication nor does it accept any responsibility for the consequences of its use.)
(Urvashi Prasad is a Public Policy Specialist with NITI Aayog. She can be reached at @urvashi01. The views expressed in the article are the author’s alone. The Quint neither endorses nor is responsible for the same.)
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