Nurturing India

Context: Prime Minister of India has launched a campaign, “POSHAN Maah 2020” to create awareness about the POSHAN Abhiyan through community mobilisation. 

Nutritional Goals and Initiatives

• Sustainable Development Goal (SDG-2) of Zero Hunger aims to end all forms of malnutrition by 2030.
• National Nutrition Mission (NNM)/POSHAN Abhiyan, aims to reduce stunting, underweight and low birth weight each by 2% per annum by 2022
• Whereas anaemia among children, adolescent girls and women, each by 3% per annum by 2022. 

Issue of Malnutrition/Undernutrition in India: Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.

• Undernourishment: High percentage of undernourished people in India, i.e. 28% in 2017-19 (189.2 million out of 673 million)-  Food and Agriculture Organisation’s (FAO) “The state of Food Security and Nutrition in the World” report.
• Stunting and Wasting: High percentage of the world’s stunted children ( 28 %, i.e. 40.3 million) and wasted children (43%, i.e. 20.1 million) under five years of age.
• Out of the total Indian population, around 14% were undernourished during 2017-19. 
• Proportion of underweight and stunted children was as high as 35.8% and 38.4% respectively as per NFHS, 2015-16.
• In several districts of Bihar, Jharkhand, UP, Madhya Pradesh proportion of underweight children was more than 40%.

Determinants of Malnutrition

• Mothers’ education, particularly higher education, has the strongest inverse association with under-nutrition. 

• Women’s education has a multiplier effect on household food security, child’s feeding practice and the sanitation facility. 

• Challenges: 

• Only 13.7% of women have received higher education (NFHS, 2015-16). 
• Factors for higher girls dropout rates: lack of basic infrastructure in schools and distance between the school and home.

• Wealth index and WASH initiatives (sanitation and drinking water) are critical for improving child nutritional outcomes. 
• Swachh Bharat Abhiyan (SBA) subject to third-party evaluations is expected to have a multiplier effect on nutritional outcomes. 
• Achievements: In five years of the Abhiyan, rural sanitation coverage has gone from 38.7% in 2014 to 100% in 2019, while the sanitation coverage in urban cites has gone up to 99% by September 2020.
• Nutrition-sensitive agricultural policies and programmes and nutrient-rich diet diversification could reduce cases of malnutrition.
• Bio-fortification could be very cost-effective in improving the diet of households and the nutritional status of children. 
• Exclusive breastfeeding, complementary foods and a diversified diet is essential for meeting the nutritional needs of infants 
• It will also ensure appropriate growth and cognitive development of children. 
• Access and utilisation of prenatal and postnatal health care services also play a significant role in curbing undernutrition among children. 

Way Forward

• Promote and priorities women’s higher education through liberal scholarship schemes and provision of separate sanitation facilities for girls in schools. 
• Initiatives like the distribution of bicycles to girls could help in reducing the girls' dropout rate.
• Behavioural change (through SBA) towards personal hygiene still needs to be promoted at the grassroots level.
• Improve dietary preferences: through diet diversification.
• The Harvest-Plus programme of Consultative Group on International Agricultural Research (CGIAR) can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops.
• Comprehensive awareness programmes: to secure Aanganwadi workers and community participation to bring improvements in child-caring practices and antenatal care for mother and children

Conclusion: Address the multi-dimensional determinants of malnutrition for ensuring holistic nourishment of children and a malnutrition free India by 2030.