By Antaryami Dash
India is home to about 30 per cent of the world’s stunted children and nearly 50 per cent of severely wasted children under the age of five. Malnutrition remains the predominant risk factor for child deaths, accounting for 68 per cent of total under-five deaths and 17 per cent of the total disability-adjusted life years. Nutrition is not a peripheral concern. It is central to our existence. Increased food and nutrition insecurity severely weakens our immune systems and contributes to poor growth, intellectual impairment, and lowers human capital and development prospects.
COVID-19 has posed serious threats to children and their health and nutritional rights. According to recent estimates, even in the best possible scenario and accounting for changes in the provision of essential health and nutrition services due to COVID-19, India could have around additional 60,000 child deaths (around 3,00,000 in the worst-case scenario) in the next six months. Based on evidence from the field, there is a need to explore possible solutions and putting forward key policy and programme proposals for the integrated management of acute malnutrition and mitigating the impact of COVID-19.
Inadequate dietary intake and disease are directly responsible for undernutrition, but multiple indirect determinants exacerbate these causes. These include food insecurity, inadequate childcare practices, low maternal education, poor access to health services, lack of access to clean water and sanitation, and poor hygiene practices.
The lockdown disrupted access to essential services, including mid-day meals, which are not only a nutritional measure to supplement some portion of a child’s calorie needs but is also a tool to access education. Through a concurrent rapid needs assessment in its programme areas, carried out in June 2020 across 14 states and 2 union territories, and covering 7235 respondents, Save the Children found that around 40 per cent of eligible children have not received mid-day meal during the lockdown.
There is a steady and silent revolution taking place in the field of nutrition, with an ever-increasing political will on the issue. This should be sustained throughout the year and in the coming years. Since the pandemic has pushed back our efforts on ending malnutrition by a few years, here are some immediate steps that need to be taken to address the issues.
First, core indicators across the lifecycle should be prioritised and reviewed at all levels (national, state, district, and block). Second, for easy and sustained access to nutritious food, we need to bring the spotlight back on locally-available, low-cost nutritious food. We also need to maximise maternal, infant and young child nutrition actions.
Third, we need to strengthen take-home ration and mid-day meal service delivery strategies to ensure the continuation of services and coverage of the most vulnerable communities, especially in urban areas. Fourth, child-sensitive social protection schemes, like PMMVY, need to be implemented in a way so that they reach the last child.
Fifth, strict measures are needed to ensure that the PDS is accessible to all, especially the vulnerable population. Sixth, efforts to ascertain allocation and distribution of additional food supply to the most vulnerable population and to ensure food security under the Pradhan Mantri Garib Kalyan Anna Yojna (PMGKAY) for next five months, need to be undertaken urgently. Finally, the use of newer technologies in service delivery, data management, evidence generation and real-time monitoring will help this process.
Given the range of drivers of nutrition — spanning multiple sectors of agriculture, social protection, health, WASH, and education — tackling undernutrition demands a multi-sectorial response. Political, cultural, social, and economic factors also play a role. Nutrition interventions are not sufficient to tackle the problem of undernutrition: Even at 90 per cent coverage, the core set of proven nutrition-specific interventions would only decrease stunting by 20 per cent. Reducing under-nutrition requires effective implementation of both nutrition-specific and complementary nutrition-sensitive interventions, addressing the underlying and basic causes of undernutrition.
The writer is head of nutrition at Save the Children.