Addressing Maternal and Child Malnutrition in India: Expert views on strengthening the National Nutrition Mission
Author: Shailesh Vaite, Sector Leader - Health, Wellness and Nutrition, Taru Leading Edge
24th May 2018
India carries one of the highest global burdens of the maternal and child malnutrition. More than one-third of the world's malnourished children live in India. In India, 38.4 percent of children under the age of five are stunted, while more than half of the children between 6-59 months and women between 15- 49 years of age are. In this context, the National Nutrition Mission (NNM), launched by the government of India is a welcome development. The NNM aspires to make India malnutrition free by 2022.
To put this issue and the NNM in perspective, a technical discussion was organised as part of the Third BoP Global Network Summit held in New Delhi between 18th to 20th April 2018. The panel members discussed the present discourse on the maternal and child malnutrition in India and the possible ways in which it can be addressed by various stakeholders including the civil society and private sector.
Addressing Malnutrition under the National Nutrition Mission
Setting the context for the discussion, Mr Prakash Kumar, Global Advisor, Policy and Public Services, Taru Leading Edge, observed that this is a crucial time for the nutrition sector in the country, especially due to the recently launched NNM by the Government of India.
Compared to other countries, India’s progress in addressing malnutrition has been slow. One of the reasons can be due to the lack of household level awareness of nutrition. The knowledge gap is even greater among mothers. The mothers are also less empowered to make the right nutritional choices for their families. A mass awareness campaign under the Swachh Bharat Mission is required to address this gap in knowledge.
In the past, addressing nutrition issues were subject to multiple ministries in the Government of India. This led to lack of synchronisation. There is hope that this issue will be adequately addressed under NNM.
Situational Analysis of Maternal and Child Malnutrition in India
Dr Bitra George, India Country Director, FHI 360, presented some comparative figures from National Family Health Survey (NFHS) rounds 3 and 4. The showed that, though there has been some reduction in the percentage of stunted (38.4) and underweight (35.7) children, they remain alarming. There is an increase in the children with wasting. The situation in some states of India can be considered as a public health emergency. However, there is hope as government initiatives like Anaemia Mukta Bharat (Anaemia Free India), Mother’s Absolute Affection (MAA) focusing on early and exclusive breastfeeding and the NNM may help improve the situation.
Additionally, organisations like FHI 360 have undertaken nationwide to address malnutrition in India. George also highlighted a need for interventions around complimentary feeding. In his opinion, there is deep mistrust between the public and private sectors for collaborating on addressing malnutrition. This needs to change.
Roger Thurow, Senior Fellow, Global Food and Agriculture, The Chicago Council on Global Affairs began his session by terming malnutrition as ‘a life sentence of underperformance and inequality’. A community with malnutrition remains poor because they have a bad start in life. The cycle continues from one generation to another. A lot of resources are being used to build physical infrastructure but unless we don’t address malnutrition, we would be neglecting the ‘brain infrastructure’ which will have a deep impact on the GDPs of countries. The first 1000 days of an individual’s life are crucial in terms of nutrition, having a long-term effect not only on the individual, family and community but also the nation and the whole of humanity. Up to now, the focus of many programmes on malnutrition has been on ‘feeding’ which needs to shift to ‘nourishing’.
Dr. Alok Ranjan, Country Lead, Nutrition, Bill and Melinda Gates Foundation highlighted that 10 percent of world’s stunted children come from UP and Bihar collectively. It is not only that the children categorised as stunted, who are at a disadvantage but there are a large number of children who are just above that categorisation and are equally at disadvantage in terms of nutrition; they constitute almost half of the total children’s population in India. First 1000 days of their lives is the only window of opportunity available for us to reach out to them. The most prominent reason for under five mortalities in India is due to malnutrition.
A Way Forward
Furthermore, Dr Ranjan noted that parents seldom take their children to doctors with an intention of finding a solution for their child’s malnutrition. Hence every opportunity of contact with the child should be used by the doctors/health systems to assess the nutrition status of the child. The private sector can play an important role in dealing with malnutrition. This can include private hospitals and practitioners who cater to almost half of the total pregnant women. The Indian food fortification industry representatives should also be involved in execution and strategy planning of nutrition programmes in the country.
The standardisation and digitalisation of monitoring systems proposed under the NNM to detect malnutrition can contribute substantially. Besides, the use of energy-dense food and food fortification would play a significant role in addressing malnutrition in India. However, this can only be achieved if all stakeholders like the government, civil society organisations and the private sector join hands in a convergent manner.
A lot of pilot projects on malnutrition have been undertaken successfully but many of these are not adequately scaled up. A multi-pronged and multi-sectoral approach to address malnutrition is required. Moreover, technical assistance at national and state level on behaviour change communication (BCC), capacity building and monitoring of front-line workers, and lastly ensuring the quality of services can go a long way in eradicating malnutrition in India.
There are multiple solutions to addressing malnutrition. These include educating girls, addressing concerns about water, sanitation & hygiene and family planning. At the same time, a strong political will, evidence-based policy making, adequate funding and human resource allocation for addressing malnutrition are essential. A clear demarcation of responsibilities of each department would go a long way in making the National Nutrition Mission a success.