We spoke to Kalpana Beesabathuni, Global Lead for Technology and Entrepreneurship at Sight and Life Foundation, which calls itself a “humanitarian nutrition think tank”. Kalpana has been working towards ensuring food and nutrition security, especially in low-income economies.
Why is it important for countries such as India to ensure the integration of nutrition in pandemic response/prevention strategies?
Kalpana Beesabathuni: Not just for India, but for any country, good nutrition is fundamental to improving immunity. The immune system is the body’s defense against disease and infection and it has long been established that several factors influence the function of the immune system including stress, sleep and nutrition (Song et al, 2019; Patel et al 2012 and Gombart et al 2020). The WHO guidance on diet, especially during the current pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back” (WHO, 2020).
How has COVID-19 set us back with respect to our nutrition targets and outcomes? Do you think the relief measures like increased rations under the public distribution system, additional take home rations and doorstep delivery of services is enough to ensure COVID-19 doesn’t set India behind with respect to its nutrition goals?
Kalpana Beesabathuni: This set of relief measures is extremely important for the most vulnerable who have suffered immensely in this pandemic. While bellies are filled with starchy staples, essential nutrients are not. During the lockdown, we have tried to match nutritious food stocks in excess with suppliers with the demand from grassroots organisations who were caring for the migrant workforce and their families and the rural poor. But it’s only a drop in the ocean.
‘Nutrition in the Perfect Storm’
This quote is taken from an article entitled ‘Nutrition in the Perfect Storm’ that we published in Sight and Life Magazine in 2008, raising concerns about widespread micronutrient deficiencies during the food price crisis and the detrimental consequences of this development for nutritional status, health and wellbeing. During crises such as drought, flooding and locust plagues, poor families suffer reduced dietary diversity and forgo the consumption of relatively expensive micronutrient-rich foods such as eggs, meat, fruit and vegetables in order to fill their bellies with empty calories from starchy staples and energy-dense processed foods.
The recommendations provided in our 2008 paper are still relevant for the current crisis: “… support micronutrient supplementation, fortification and food-based strategies to address micronutrient malnutrition among vulnerable population groups…” to mitigate the development of “a potential ‘lost generation’ of unhealthy children, and irreversible economic loss.”
Although women and young children are not the face of this pandemic, they are among the hardest-hit among vulnerable groups. According to a study in The Lancet, nearly 3 lakh children could die in India alone due to lack of access to nutrition during the pandemic. Do the interventions under the Poshan Abhiyan programme need to be realigned to offset COVID-19’s impact on the first 1,000 days affecting women and their newborns’ health status?
Kalpana Beesabathuni: In a crisis, however bleak, there is always a sliver of opportunity. The disruption of food systems by Covid-19 and its impact on the availability of nutritious food in large parts of the country has brought to light the importance of the Take-Home Rations (THR) programme and its potential to deliver fortified food to the last mile in the country. India’s Supplementary Nutrition Programme receives Rs 15,000 crore in funding from the central government, making it one of the largest such initiatives in the world, reaching 8.5 crore children less than 6 years old and 2 crore pregnant and lactating women. It has three components: hot cooked meals and a morning snack in the Anganwadi Centers and Take-Home Rations for home use. The THR programme is unique in its reach and scale; it is also well resourced reaching hundreds of millions of beneficiaries (young children, pregnant and lactating women). The current crisis presents a window of opportunity for THR to fully realise its promise and transform India’s nutrition security scenario.
How important is food fortification in India, particularly in the case of women and girls?
Kalpana Beesabathuni: Women of reproductive age especially, including adolescent girls, pregnant and breastfeeding women, are more vulnerable to micronutrient deficiency, as they have an increased requirement for micronutrients such as iron, vitamin A, D, B12, folic acid, calcium, iodine and zinc. In cases of severe iron deficiency that leads to anemia, women are at increased risk of dying during childbirth. Children with micronutrient deficiencies experience poor cognitive development and reduced learning capacity. The deaths of women and the loss of cognitive development in children have a profound and lasting impact on human capital.
As per the Comprehensive National Nutrition Survey, 2016 – 2018, anemia prevalence in female adolescents aged 10-19 years is two times higher than male adolescents; Vitamin D deficiency is an emerging public health issue especially among urban children and adolescents; Vitamin B12 deficiency — correlated to low consumption of eggs/fish/meat — ranged from 14% to 31% in 1-19 years of age and was highest among adolescents. Fortification can be considered as one viable solution to address many of these micronutrient deficiencies.
Do women and girl children in India require special food fortification that is at present missing in their diets in the country?
Kalpana Beesabathuni: Plant-based supplementary foods or staple food fortification are insufficient to meet micronutrient requirements. Further, actual intake is frequently less than recommended, particularly for children under 12 months of age with smaller stomach capacity. Hence THR program was designed to address some of the nutrient gaps. Because of these challenges, while ICDS guidelines recommend 50% RDA inclusion for nine micronutrients (iron, calcium, folic acid, zinc and vitamins A, B1, B2, B3 and C), most beneficiaries, in reality, consume substantially less. Multiple improvements across the THR systems will be required to fully address these challenges.