In 2008, when distinguished international economists including many Nobel laureates were asked by the Copenhagen Center to build consensus on the most important development agenda in which policymakers and philanthropists should invest, ‘battling malnutrition’ emerged as the top priority. It took time for this to sink in our country. For generations, malnutrition and undernutrition remained an all-pervasive but largely invisible issue in India and it didn’t receive the attention it deserved.
In fact, it was not until 2016 that a large-scale nationwide survey was conducted to understand the nuances of the nutrition status of the population. Over half of our children under five years were found to be either stunted (too short for their age) or wasted (too thin for their age) or both, reckoned this Comprehensive National Nutrition Survey, released in 2019. The results were alarming for what it meant for the future of our children, but they were broadly in sync with other independent estimates on malnutrition’s prevalence. Malnutrition adversely affects the physical and mental growth of the child and is the single most important risk for acquiring other diseases. Research also shows malnourished children are less likely to go to school and more likely to drop out. This meant half of our children were silently falling behind, and no development can be truly meaningful without ensuring that our children and mothers are better fed and healthy. Addressing this was at the heart of Poshan Abhiyan launched by Prime Minister Narendra Modi in 2018.
Poshan Abhiyan, which vowed to make India free of malnutrition by 2022, repositioned nutrition as central to development and emphasised its multi-factorial and multi-sectoral nature. First, the movement built in its approach that, on top of direct interventions, nutrition can be improved in many ways, including better sanitation that addresses intestinal diseases and allows people to absorb more nutrients; increasing dietary diversity; vaccinating children against diseases; counselling more women to breastfeed babies for longer, which in turn improves immunity. Second, by involving many ministries and departments outside the nodal ones, along with bringing on board other stakeholders including communities, Poshan Abhiyan helped to build a comprehensive nutrition response, never seen before in this country’s history.
Given that the damage malnutrition does in the first 1,000 days of life is irreversible, it beamed intense focus on nutrition-related intervention to improve maternal and child health in that window since conception. The nutrition mission also measured and monitored indicators real-time during the programme using technology, so that timely course corrections could be made in different contexts. However, what really stood out as a stellar achievement of Poshan Abhiyan was the way the senior political leadership committed itself to eradicating malnutrition and galvanised it into a people’s movement—with the celebration of Poshan Maah in September and Poshan Pakhwara in March, along with several other activities.
However, the momentum set by this entire nutrition movement was disturbed once Covid lockdowns led to the shutting of schools, Anganwadi centres, Nutritional Rehabilitation Centres; further, frontline workers had to be engaged in Covid-related work that took precedence over their daily duties, which entailed identifying, referring and monitoring children suffering from severe acute malnutrition and moderate acute malnutrition among other nutrition-strengthening activities. States tried to cope to the best of their abilities by replacing hot-cooked meals with dry ration or cash transfers. But understandably, they couldn’t match the intensity of Poshan Abhiyan with Covid surveillance taking over as priority.
Moreover, indirect forces triggered by the pandemic such as disruption in food systems, dried-up income sources, job losses and consequent financial hardships also mean that access to nutrient-rich food might have reduced among economically vulnerable people. Though reliable data to support the possibility of a heightened nutrition crisis during the pandemic is not yet available, anecdotal evidence and previous global experiences of the impact of economic shocks and epidemics on nutrition status show that we must double our efforts to ensure that we do not lose the recent gains made in the nutrition space.
Covid-related shocks could lead to an additional 9 million children under the age of five suffering from wasting, of which two-thirds will be in South Asia, predicted research in Nature in August. So it is important to not only renew but multiply our efforts towards Poshan 2.0 with full vigour while practising physical distancing, mask wearing and hand hygiene.
Under Poshan 2.0, several related schemes have been merged to tap the synergies, malnutrition hotspots are being identified and 112 aspiring districts will receive extra attention. Under the current Poshan Maah, the drive to identify children suffering from severe acute malnutrition has been intensified and Anganwadi workers have been asked to refer those having medical complications to health institutions and NRCs. For those facing severe acute malnutrition without medical complications, community management protocols should be strengthened, so that they do not go on to develop medical complications in times of the pandemic. Fresh waves of Covid cannot be ruled out in the near future, and we must adapt our nutrition interventions to the possibility of such repeated shocks.
Rising above political differences, it is important to document and learn from states like Gujarat, Madhya Pradesh and Rajasthan, which have scaled up Community-based Management of Malnutrition practices in recent times, so that best practices can be adopted and incorporated. Other activities, such as making new mothers breastfeed for longer, managing childhood diarrhoea, distributing deworming tablets and iron and folic acid diligently while convincing target groups to take these diligently will go a long way in improving the nutrition status of children and new mothers.
About 68% of the deaths of children under the age of five in India can be attributed to child and maternal malnutrition, said Lancet in 2019. This basically means that tackling malnutrition as a whole, instead of addressing one disease at a time, will keep our children much safer and make their futures brighter. A safe and bright future for our children will translate into a safe and bright future for the country. And that’s the message we want every fellow citizen to internalise—Sahi Poshan, Desh Roshan.
Dr Kirit Solanki
BJP LS MP, Chairman of the Committee on SC/ST Welfare, & ex-Professor of Surgery