Context: Uttar Pradesh is a remarkable example of the importance of women’s empowerment in tackling malnutrition by supporting community-based micro enterprises led by self-help groups.
About Malnutrition:
According to the World Health Organisation:
- It refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
- The term malnutrition covers 2 broad groups of conditions:
- One is ‘undernutrition’: Includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
- The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes, and cancer).
- Conditions such as celiac disease and infections like h. pylori or worm infestations can disturb the digestive system, leading to nutrient deficiencies.
- Malnutrition caused by micronutrient deficiency has inter-generational impacts - anaemic mothers are known to give birth to anaemic babies.
- Severe acute malnutrition (SAM) is defined by a very low weight for height, severe visible wasting, or the presence of nutritional oedema.
Extent of malnutrition in India:
- According to UNICEF, India was at the 10th spot among countries with the highest number of underweight children, and at the 17th spot for the highest number of stunted children in the world
- According to National Family Health Survey 5, from 38.4% to 35.5% of children under age five years are stunted, 21.0% to 19.3% are wasted, 35.8% to 32.1% are underweight and 3% are overweight.
- 7.7 percent of children in the country are affected by SAM.
- Among adults, 23% of women and 20% of men are considered undernourished in India. On the other hand, 21% of women and 19% of men are overweight or obese.
Government initiative to tackle malnutrition:
- National Nutrition Strategy by Niti Aayog: To reduce all forms of malnutrition by 2030, with a focus on the most vulnerable and critical age groups. The Strategy also aims to assist in achieving the targets identified as part of the Sustainable Development Goals related to nutrition and health.
- Integrated Child Development Services (ICDS) Scheme: To improve the nutritional and health status of children in the age-group 0-6 years;
- Prime Minister’s Overarching Scheme for Holistic Nutrition Abhiyaan (POSHAN Abhiyaan 2.0): To strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition
- Mid-Day Meal Scheme: It provides that every child aged six to fourteen years, attending classes I to VIII, shall receive a free, hot cooked meal every day except on school holidays.
- Indira Gandhi Matritva Sahyog Yojna (IGMSY): To contribute to a better enabling environment by providing cash incentives for improved health and nutrition to pregnant and lactating mothers.
- National Food Security Act (NFSA): This act aims to provide subsidized food grains to a majority of the population, including children, to ensure access to adequate food.
Challenges in tackling malnourishment in India:
- Issues with ICDS: Lack of quality food supply and uniform distribution of food.
- Anganwadi workers' effectiveness in addressing malnutrition is hindered by low wages and inadequate training.
- Non- availability of instruments for child development: Height and weight measuring instruments in Anganwadi Centres (AWCs).
- More than 80% of Anganwadi centers in rural areas of the state lack proper sanitation facilities and access to clean drinking water, contributing to the prevalence of diseases that exacerbate malnutrition, such as diarrhoea and parasitic infections.
- Less than 50% of the total allocated funds for the Integrated Child Development Services (ICDS) were utilized in 2018-19, indicating underutilization of funds.
- Lack of credible data on a year-to-year basis: There was a 10-year gap between NFHS 3 and NFHS 4 surveys.
- Poverty and income inequality: Malnutrition arises from the vicious cycle that starts with poverty. Low-income families have less access to resources to attain healthy meals, leading to insufficient nutrients in their diets, which subsequently leads to malnutrition.
- Rice wheat-based policy: India’s food security policy gave excessive focus to rice and wheat for many decades.
- Poor feeding practices: Malnutrition among children can be attributed to poor feeding practices, which encompass various factors such as premature weaning, insufficient exclusive breastfeeding, and inadequate complementary feeding.
- Climate change impact: Erratic rainfall and increasing frequency of extreme events have impacted agricultural activities everywhere creating unfavourable conditions for food production.
- Corruption: Corruption in PDS is widely recognised. PDS a food distribution scheme is mired with inefficiencies and corrupt practices denying food to many. E.g: NAN scam of Chhattisgarh.
Suggestive measures to tackle malnutrition:
- Need to invest in the infrastructure of ICDS and the Anganwadi centres as well as improve their coverage.
- Promoting breastfeeding: Emphasizing exclusive breastfeeding for the first six months and sustained breastfeeding up to two years enhances the nutritional well-being of infants and young children.
- Enhancing dietary diversity: Encouraging a balanced and diverse diet incorporating fruits, vegetables, whole grains, legumes, nuts, and animal-source foods helps address nutrient deficiencies. For example: Haryana is providing financial incentives of ₹7,000 per acre to farmers for shifting from paddy to pulses, oilseeds, and cotton.
- Need to implement Buddy Mothers Model, the mother of a healthy baby guides the mother of a malnourished child at an Angandwadi centre every week in the all over India so that children can enjoy their right to stay healthy.
- Social audit of Mid-day meal scheme: The mid-day meal scheme should undergo a social audit in every district by the states and union territories.
- Establishing an Agriculture-Nutrition Corridor: Can be pivotal in addressing India's nutritional challenges, particularly in its undernourished villages. This initiative aims to develop mechanisms to ensure the nutritional security of villages.
- Cash transfers: Especially in regions experiencing acute distress, where household purchasing power is very depressed. It can also be used to incentivise behavioural change in terms of seeking greater institutional support.
Take home ration model
- Collaboration between United Nations World Food Programme (WFP)and the Department of Women and Child Development aims to boost the nutritional value and utilization of supplementary nutrition in Uttar Pradesh's ICDS scheme. Focus on enriching take home ration products to promote diversity and increase consumption.
- Women’s empowerment in tackling malnutrition by supporting community-based micro enterprises led by self-help groups. These enterprises produce fortified and nutritious foods for pregnant/breastfeeding mothers and children, provided as take home ration through the Integrated Child Development Services (ICDS) programme.
- Engaging women from the community to run the take home ration production units. They have been provided with machinery and raw materials such as wheat at subsidised rates to produce and distribute take home ration, this unique gender-transformative approach provides livelihood opportunities to local women, empowering them economically.
- The model involves the production of different variants for ICDS beneficiaries. This is done by a 20-member women group that uses automated equipment with a capacity of five metric tonnes per day.
- Once the rations are delivered to Anganwadi centres by the women’s groups, the women are reimbursed according to ICDS cost norms.
- National Accreditation Board for Testing and Calibration Laboratories-accredited laboratories test the products before dispatch to Anganwadi centres to certify the requisite calorie and protein values and ensure food safety.