In India, around 22% of its over a billion population still lives below poverty line. Proving minimal nutritional needs to such number is a challenge in itself. In 2013 Parliament enacted historic National Food Security Act which aims to provide subsidized food grains to approximately two thirds of India's 1.2 billion people. Significant strides has been made in strengthening public distribution system. However, new Global Nutrition Report 2017 place India at the bottom of the table. Recently, sensing the urgency and based on NITI Ayog's National Nutrition Strategy, the Cabinet approved National Nutrition Mission. Let us look into India's nutritional challenge in more depth.
Issues : malnutrition manifest in stunting (low weight for age), wasting (low weight for height), micro-nutrient deficiencies and over-weight.
In Sept 2016, NHRC issued notice to Maharashtra govt over reports of 600 children dying due to malnutrition in Palghar district.
Status :
- ~ 1/3 rd of children are undernourished
- UNICEF - India 10th spot among countries with highest no of underweight children. 17th - stunted children
- Global Nutrition Report 2017 -
- more than half (51%) of all women of reproductive age have anaemia, whereas more than one in five (22%) of adult women are overweight.
- 38% of children under-5 are affected by stunting(Mission 25 by 2022) & 21% of under-5s are defined as 'wasted' or 'severely wasted'
- calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.
Nutritional Diseases :
- Kwashiorkor & Marasmus - protein deficiency
- Anemia - Iron deficiency - 51% of Indian women aged 15-49 anaemic
- Goitre - Iodine deficiency
- Pellagra - niacin deficiency etc.
Causes :
- Poverty - extreme hunger; NITI Aayog in a report on the rule played by rations in food security found families BPL consumed more cereals and less milk compared to affluent.
- Lack of access to health and child care services (Poor service delivery)
- Lack of awareness & Illiteracy - hidden hunger; low breastfeeding
- Unbalanced diet - rice-based diets of south & east India make these ppl more vulnerable to micro-nutrient deficiencies
- Poor Water, Sanitation & Hygiene(WASH) reduces uptake of nutrition (diarrhea, worms)
- Inter-generational cycle of under-nutrition
- Gender discrimination
- Child marriage
Need of investment in Nutrition :
- poor nutrition is poor economics - a/t WB India loses 2-3% of GDP annually due to lower productivity
- poor nutrition will fracture the dreams and aspirations of India to become a global player in manufacturing and other industries. Success of several of Government's initiative like Make In India, Smart City etc rest on healthy workforce.
- poor nutrition is poor humanity - DPSP Article 47 of the Constitution mentions the “duty of the state to raise the level of nutrition..."
- Improving nutrition will be a catalyst for achieving goals throughout the SDGs
- Fighting poverty : a well-nourished child is one third more likely to escape poverty,
- India pays income penalty of 10% due to workforce that was stunted during their childhood.
- Global Nutrition Report 2015 - investment in nutrition has benefit : cost = 16:1 for low & middle income countries
- Eco Survey 2015-16 noted that it is important to focus on “mother and child,” involving maternal health and early life interventions .
Existing schemes/policies :
- NFSA -
- ICDS, - caters to the needs of pregnant and nursing mothers and children under the age of 6
- MDM
- PDS
- National Deworming Programme
- National Nutrition Policy
- National Policy for Children,2013 - identifies key priority areas:
- survival, health and nutrition;
- education and development;
- protection and participation, for focused attention
Steps to enhance outcomes :
NITI Ayog - National Nutrition Strategy
- Focus on governance reforms - strengthening local governance in policy designing and implementation
- Convergence of govt schemes & convergence of state/district implementation prog
- focus on 200 low performing states
- give prominence to demand & community mobilization - key determinant to address India's nutritional needs
- coordination among front line workers -ASHA, ANM, ...
- decentralized approach promoting greater flexibility and decision making at the state, district and local levels.
- Technological intervention through private sector participation in R&D - Fortification
- providing DBT where service delivery is poor (e.g. Poshak Yojna, BH)
- coarse cereals(millet) - bajra, ragi, along with legumes, leafy vegetables & coconut - could reduce India's micro-nutrient deficiencies & reduce GHG emissions.
Recent Steps taken :
- National Nutrition Mission (click here for Features, Targets, Strategy)
- 2018 - National Year of Millet (nutritional superiority)
- Budget 2018-19 : TB Patient to get Rs. 500 per month during treatment
Some points to ponder ?
- Per capita food production in India has increased by 26% (2004-05 to 2013-14), while it has doubled in the last 50 year. Why is then India ranked low in Global Hunger Index ?
- “The Global Nutrition Report highlights that the double burden of undernutrition and obesity needs to be tackled as part of India’s national nutrition strategy". What explains the existence of such paradox ?
Why the Risk of Obesity is Greater for the Poor ?
- Poor families have limited food budgets and choices
- Families choose high-fat foods dense with energy – foods such as sugars, cereals, potatoes and processed meat products – because these foods are more affordable and last longer than fresh vegetables and fruits and lean meats and fish.
- Economic insecurity – such as trouble paying bills or rent – leads to stress, and people often cope by eating high-fat, sugary foods.
- Poor families often live in disadvantaged neighborhoods where healthy foods are hard to find. Instead of large supermarkets, poor neighborhoods have a disproportionate number of fast food chains and small food stores providing cheap, high-fat foods.
- Options for regular physical activity can also be restricted for poor people:
- Due to inflexible work schedules, lack of transportation, or unmet needs for child care, poor parents, especially single mothers, may find it hard to support extra activities for their children. Leaving kids in front of the TV is often all stressed poor parents can manage
- In many poor neighborhoods, parks, playgrounds, trails, and free public gyms are often not available or safe
- mothers who smoked during pregnancy(inefficient chulhas), poor breastfeeding
