Wednesday, July 11, 2018
Malnutrition: More than just lack of food
A joint study by Assocham and Ernst & Young showed that almost 50% of the worlds under nourished children reside in India.(1) Malnourishment has been called India’s silent emergency and the need to look into this issue has never been this urgent. The cause of alarm is the high rate of infant deaths. Pankaja Munde, Minister, Women and Child Development Department admitted that a total number of 2,161 infant deaths have been recorded in 16 districts of Maharashtra in 2017. Adding to this, in the span of only 5 months, September 2017 – January 2018, a total number of 995 infants between 0 – 6 months have died (2). The numbers are alarming.
Malnutrition at such a high level implies heavy economic costs for India, as it affects a child’s productivity, cognition, reduces participation in school and further ability to contribute to the economy (3). India is one of the fastest growing economies of the world, yet has the highest number of under nourished children. The basic right to a healthy life and to simply live is a fundamental one. The fact that this is snatched away from children and infants due to various structural and social barriers is unacceptable and requires immediate redressal. Although the battle to tackle this issue has been an uphill one with little visible progress, it has been uneven and the structural reasons causing malnourishment remain unaddressed.
A common misconception held by most people about child malnutrition is: food insecurity is the only cause for malnutrition (4), often placing the onus upon the mother or the child for not ‘eating well’. However, the reasons resulting in such high levels of malnutrition are varied and go beyond just the consumption of food. But unfortunately, most interventions are based on providing food rather than addressing other determinants.
The data from the National Family Health Survey (2015 – 16) showed three key factors of difference in districts with high and low levels of child malnutrition. These are: the status of women, diets fed to children and access to toilets (5). Lack of education, health awareness, sanitation and infrastructure form the basis of child under nourishment. It is also important to recognize that malnourishment is very much a gendered issue (6) stemming from the patriarchal set-up of society. The NFHS survey also revealed that malnutrition is higher in girls especially from rural areas and the scheduled castes and tribes are more susceptible to malnutrition.
Malnourishment affects women more than men due to specific nutrition requirements of women during adolescence, pregnancy and lactation. The nutrition deprivation in women perpetuates a cycle of deprivation in children. Under nourished girls grow up to become under nourished women who then give birth to undernourished children. The onus often lies with the woman to provide nutrition for the child, however she is not equipped to do so due to skewed power relations within the family, food distribution practices, lack of economic means and health awareness.
Integrated Child Development Services program, is the government’s flagship program to tackle child malnutrition. It has sustained for over 30 years and has been successful in many ways. However, it has been unsuccessful in reversing the adverse effects of child malnutrition due to the emphasis it lays on food supplementation and distribution.
There are gaping holes in in the implementation of the ICDS policies. There are no consistent mechanisms of identifying children with malnutrition which results in denial of special care and support to Moderately/Severely malnourished children. There is a lack of and poor distribution of appropriate and adequate supplementary nutrition. Often, adequate medical support is not provided at the right time. Moreover, cultural differences of different communities and groups are not taken into consideration by the health officials. It is important to also note the rampant under reporting of malnutrition, due to the misdirected monitoring system which puts the blame completely on the Anganwadi worker for the number of Malnutrition cases, thus absolving the family, community and the medical service providers and institutions of their role in addressing issues related to malnutrition (7).Interventions on creating awareness around good caring behaviors for infants and children require community and familial engagement and require the training of grass root workers in order to maximize impact. Investments should be redirected towards younger children (between 0 – 3 years), the mother’s feeding and caring behaviors, improving household sanitation and strengthening access to health care. Economic growth cannot alone address these problems. Malnutrition is a social phenomenon which must be addressed by changing mind sets, scaling up of health, nutrition, education and infrastructural interventions.