Context

Even after seven decades of Independence, India is afflicted by public health issues such as child malnutrition (35.5% stunted, 67.1% anemic) attributing to 68.2% of under-five child mortality.

• Therefore, Government is giving a push to National Nutrition Mission (NNM) or POSHAN Abhiyan, an overarching scheme for Holistic Nutrition.

Background

• Back in the 1970s, India had launched the National Nutritional Anemia ProphylaxisProgramme (NNAPP) to fight the deficiency.
• POSHAN (Prime Minister's Holistic Nutrition Scheme) Abhiyaan was launched in 2018 toimprove the effects of healthy eating on children, pregnant women, women, andbreastfeeding mothers.
  • POSHAN Abhiyaan aims to make India a world without malnutrition by 2022.Abhiyaan aims to reduce stumbling in children from 38.4 percent to 25 percent by2022.
• In 2019, it rolled out the AnemiaMukt Bharat campaign.
• Despite several schemes and programmes, the problem still exists in a large segment of thepopulation.
  • India continues to host the highest number of malnourished children in the world.
  • Over 33 lakh children in India are malnourished and more than half of them fall inthe severely malnourished category with Maharashtra, Bihar, and Gujarat toppingthe list according to Ministry of Women and Child Development.

Analysis

Mapping child nutrition in India

• Data from the National Family Health Survey (NFHS)-5 2019-21, as compared to NFHS-4 2015-16,reveals a substantial improvement in a period of four to five years in several proxy indicators ofwomen's empowerment, such as:
  • There is a substantial increase in antenatal service attendance (58.6 to 70.0%)
  • Women having their own saving bank accounts (63.0 to78.6%)
  • Women owning mobile phones that they themselves use (45.9 % to 54.0%)
  • Women married before 18 years of age (26.8 % to 23.3 %)
  • Women with 10 or more years of schooling (35.7% to 41.0%)
  • Access to clean fuel for cooking (43.8 % to 68.6%).

But the country has not progressed well in terms of direct nutrition interventions, Preconception nutrition, maternal nutrition, and appropriate infant and child feeding remain to be effectively addressed.

• India has 20% to 30% undernutrition even in the first six months of life when exclusivebreastfeeding is the only nourishment required.
• Despite a policy on infant and young child feeding, and a ban on sale of commercial milk forinfant feeding, there has only been a marginal improvement in the practice of exclusive breastfeeding (EBF)
• NFHS-5 also confirms a gap in another nutrition intervention - complementary feedingpractices i.e., complementing semi-solid feeding with continuation of breast milk from sixmonths onwards.
• Poor complementary feeding is often due to a lack of awareness to start feeding at six to eight months, what and how to feed appropriately family food items, how frequently, and inwhat quantity.
• The fact that 20% of children in higher socio- economic groups are also stunted indicatespoor knowledge in food selection and feeding practices and a child's ability to swallowmashed feed.
• Poor nutrition not only adversely impacts health and survival but also leads to diminishedlearning capacity, and poor school performance. And in adulthood, it means reducedearnings and increased risks of chronic diseases such as diabetes, hypertension, and obesity.

According to the Global Nutrition Report 2020, India is among the 88 countries that are likely to lose the standards of healthy eating in the world by 2025.

What factors are responsible for nutrition deficiency?

The most common nutritional deficiencies are due to inadequate consumption of proteins, vitamin D, iron, vitamin B12 and folate.

• Interlinked issues: The issues of poor food safety, food insecurity, and unsustainable foodsystems are closely interlinked and responsible for undernutrition.
• Early marriage: Significant incidence of early marriage and childbearing have been found asamongst the important causes of nutrition issues facing the country today.
• Use of agrochemicals: Agrochemicals comes at aperilous cost. Chemical contamination changes thebiochemical composition of food, and can lead to arange of diseases.
• Climate change: Climate change also affects foodsafety, with both abiotic and biotic agriculturalcontributing factors.
  • Abiotic factors such as air pollution, nutrition deficiencies, and extreme changes intemperature impact soil quality and the health and productivity of crops.
  • Biotic ones-e.g., insects, pests, and soil-are equally affected.
• Other major reasons include:
  • disruptions in food supply chains
  • loss of income and livelihoods
  • widening inequalities across gender, class, caste, and disparities
  • fluctuations in food prices

Impact of Malnutrition:

• Deprived brain growth: The effects of malnourishment in a small child are not merelyphysical. A developing brain that is deprived of nutrients does not reach its full mentalpotential.
• Structural damages: Under nutrition can affect cognitive development by causing directstructural damage to the brain and by impairing infant motor development.

Micronutrients The World Health Organization (WHO) defines 'Micronutrients' as compounds required in very smaller amounts,<100 mg/d. Micronutrients include vitamins and minerals. They are vital for the production of hormones, enzymes and other substances that manage growth and development. Diseases caused by deficiencies of Iron (anaemia) Iodine:iodine deficiency (IDD) disorders such as goitre and hypothyroidism Vitamin A: vitamin A deficiency(VAD) disorders such as blindness, measles and diarrheal diseases.

• • This in turn affects the child's ability to learn atschool, leading to a lifetime of poverty andlack of opportunity.
  • These disadvantaged children are likely to dopoorly in school and subsequently have lowincomes, high fertility, and provide poor carefor their children, thus contributing to theintergenerational transmission of poverty.

• Impact on vulnerable section: Food insecurity andfood safety issues disproportionately affect women.
• Increased gender inequalities: Gender inequalities arefurther exacerbated as food systems workers and unpaid care workers, women experienced additionalburdens.

International Institutions and Protocols

• The FO is the primary international organisation responsible for monitoring differentdimensions of the food chain, from farm to fork.
• It partners with the World Health Organization (WHO) to enforce mandates for enhancingfood safety and improving the health of populations across the globe.
• While WHO deals predominantly with the public health sector, the FAO is concerned withfood safety issues along the food value chain.

Example One example of collaboration between the two is the FAO/WHO Codex Alimentarius Commission. It is responsible for implementing the Joint Food Standards Programme and the CodexAlimentarius or "Food Code", a collection of standards, guidelines, and codes related tofood safety practices.

Challenges

• Poverty, unemployment, lack of education
• Lack of infrastructure to integrate nutrition into health care.
• Lack of awareness pertaining to importance of nutrition.
• Lack of monitoring and evaluation of programs to address systemic.

The Granular Solution

• Investment: There is a greater need now to increase investment in women and children'shealth and nutrition to ensure their sustainable development and improved quality of life.
• Reaching to individuals: There is need to fight malnutrition through a micro-level approachwith needs-based additions in order to reach and influence each individual.
• Focusing on right technique of breastfeeding: Promoting the technique of appropriateholding, latching and manually emptying the breast are crucial for the optimal transfer ofbreast milk to a baby.
• Awareness regarding special care: Creating awareness at the right time with the right toolsand techniques regarding special care in the first 1,000 days deserves very high priority.
• Focus on effective implementation: There is a pressing need to revisit the systemspearheading POSHAN 2.0 and overhaul it to remove any flaws in its implementation.
  • There is need for systematically reviewing the status, and develop and test a newsystem that would combine the human resource of ICDS and health from village to the district and State levels.
• Real-time monitoring: Real-time monitoringof the Public Distribution System (PDS) wouldgo a long way in ensuring food at the familylevel.
• More awareness: Moreover, mass media orTV shows could organize discourses on care inthe first 1,000 days to reach mothers outsidethe public health system.

Important nutrients along with their sources: Proteins: Chicken, milk, eggs, pulses Vitamin D: Exposure to sunlight, egg yolk,fortified foods, fish Vitamin B12: Shellfish, salmon, liver, trout Folate: Citrus fruits, peas, tomato juice Vitamin A: Grapefruit, cantaloupe, pumpkins Iron: Organ meat, shellfish, red meat, kidneybeans lodine: Egg dairy, fish, seaweed

Way Forward: 

It is time to think out of the box, and overcome systemic flaws and our dependence on theantiquated system of the 1970s that is slowing down the processes.The pandemic has shown us that the only way forward is to work together and not in isolation.There is a need for the same recognition of the nutrition crisis that faces everyone, in every country.The need to prioritize and invest in nutrition has never been greater. Poor diets and malnutritionshould be addressed holistically and sustainably to create a healthy future for all.