Updated: March 31, 2021 6:32:09 pm
Written by Sunish Jauhari
Thirty-six year-old Theithim, who lives in the village of Chongchin in Churachandpur district of Manipur, works hard to ensure that she can feed her seven children one nutritious meal. On most days, all she can afford to feed them is rice and some vegetables from the forest.
For mothers like Theithim, often daily-wage labourers, caring for their children and earning an income can be a tough balance to maintain. Many of them experience far greater vulnerability because they live in hard-to-reach areas, often lacking essential health services.
For migrant populations, access to nutrition and healthcare is further compromised by the seasonal nature of their occupation. Children are repeatedly exposed to challenging environments affecting their nutrition and health at a critical growing age. Parents in this population lack awareness about nutritional needs, or even routine immunisation, causing an increased risk of severe malnutrition among their children.
The COVID-19 pandemic has only further exacerbated this problem. Tens of thousands of households have lost their incomes, causing food insecurity. Essential health services have been disrupted, and economic activity has dwindled. With the continued crisis, the cases of malnutrition are only likely to increase.
India has taken nearly 30 years to bring down the problem of stunting (low height for age) by a third. Today, one in every three children under the age of five in India is stunted. One in every five children is “wasted” (low weight for height). The recently released NFHS-5 (2019-20), though, shows some progress. The incidence of neonatal, infant and under-five mortality has decreased over time, and the coverage of immunisation, water and sanitation facilities, institutional births and exclusive breastfeeding has increased. However, stunting, wasting, and anaemia in children has only worsened.
The problem of malnutrition is a complex one. For example, there is a lot that needs to happen in social behaviour to improve infant nutrition. Only 57 per cent of mothers put their babies to the breast within the first hour of birth, says the CNNS 2019 Report. This is even though 78.7 per cent of deliveries happen in health facilities. Further, only 50 per cent of infants are introduced to complementary foods at six months. The status of complementary feeding practices remains poor, with only 6 per cent of these infants receiving a minimum acceptable diet. The sheer diversity of such a vulnerable population makes it seemingly impossible for some of these practices to reach them.
Mission Poshan 2.0 launched recently by the Government of India aims to develop practices that will accelerate health, wellness and immunity of children and pregnant women. Even though there has been an increase in budgets, low-spending at the state level needs to be addressed to ensure that interventions reach the beneficiaries at the last-mile.
In this scenario, the role of community-based organisations (CBOs or NGOs) becomes vital. They can help bridge gaps in health and nutrition programming by working in collaboration with local governments. Equipping these hyperlocal organisations with the knowledge on mother, infant, and young child nutrition and training them on integrating evidence-based nutrition interventions into their work could directly add to our collective capacity.
CBOs could also help to unlock some attractive markets for Self Help Groups and small enterprises. For example, Kandhamal Zilla Sabuja Vaidya Sangathan, an NGO that works in Daringbadi, Odisha, supports SHGs and the local community with millet (ragi) processing and how it can be incorporated into daily diets.
When the problem is multifaceted, it needs collective and collaborative action. Besides community organisations and governments, businesses and livelihoods in food and nutrition markets could bring much-needed behaviour-change in communities. Low-cost, nutritious ready-to-eat snacks and awareness around nutrient-dense local foods can help mothers constrained for resources. Businesses are brilliant shapers of demand, often for unhealthy foods. But when businesses are encouraged to bend the market towards health and create messaging around the importance of nutritional outcomes, customers can demand appropriate care and information from healthcare providers.
Private healthcare providers can engage with their government counterparts to expand health and nutrition services. These healthcare providers can be linked to frontline health workers who can identify early signs of malnutrition and refer those patients to them. Government schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) can be leveraged for nutrition rehabilitation services and treatment of childhood illnesses, thus reducing out of pocket expenditure.
COVID-19 has been a rude reminder that such pandemics can set us back many years on sustainable development. It has also reminded us that while a virus does not differentiate in infecting, it impacts differently. Those on the margins and fighting with existing vulnerabilities are often the most affected, and a sound system must ensure that the response is equitable. Organisations like ours have been working in this direction for the last decade with NGO partners and state governments in hard-to-reach areas to reach underserved populations with evidence-based nutrition interventions. When NGOs, governments, and small enterprises work together, we will be able to reach 27.6 million children 6-59 months and 13.8 million pregnant women, with interventions like vitamin A, deworming and multiple micronutrient supplementations. These simple, lifesaving interventions can have long-term impacts on mothers and children’s health across the country and can help us break the intergenerational cycle of malnutrition.
Jauhari is the president of Vitamin Angels in India