In the last decade, India has made some improvements in tackling malnutrition. For instance, stunting has declined from 48% in 2005-06 to 38.4% in 2015-16. Similarly, underweight prevalence has reduced by 0.68 percentage points from NFHS-3. However, gaps remain. According to the National Family Health Survey-4, over one-third of all under-five children are stunted, every fifth child is wasted, and more than 50% children are anaemic. Further, half of women in the reproductive age-group are anaemic and only 10% of children between the ages of 6 and 23 months are receiving an adequate diet.

Another challenge is that there is a large disparity in nutritional outcomes between states as well as population groups. For instance, according to NFHS-4 data, the states which have the maximum population of undernourished people are Bihar and Madhya Pradesh. The problem of overweight people, on the other hand, is more acute in Andhra Pradesh, sikkim and Goa. Anaemia levels in women range from 45% in Karnataka to 63% in Haryana.

Early onset of malnutrition causes irreversible damage with reduced cognitive and physical growth and development, increased susceptibility to diseases, diminished capacity to learn, poor performance in school and a lifetime of lost earning potential. This, is order to fully realize the potential of our children, capitalize on our demographic dividend and catalyse economic growth, urgent measures are necessary as nutritional deficiencies in childhood have a compounding effect in adulthood, both in the short and long term.

Determinants of Malnutrition

There are several underlying determinants of malnutrition including lack of access to health services, safe drinking water, sanitation and household food security as well as unhealthy behavioural practices. As a result, both direct and indirect interventions in areas like agriculture, education, and drinking water, sanitation and gender equity, impact outcomes in nutrition. For instance, several studies have highlighted the link between inadequate sanitation, diarrhea and stunting in children. Similarly, a greater influence of women in household decisions plays a major role in the nutritional choices made by households. This means that implementing programs in a fragmented manner can contribute significantly to the persistence of malnutrition. A comprehensive and coordinated approach is therefore necessary for addressing the multiple and inter-related determinants of malnutrition across the life cycle of an individual.

Pillars of the Abhiyaan:

One of the most important pillars of the POSHAN Abhiyaan is programmatic convergence for enabling the development of a shared understanding of roles and responsibilities as well as mutual accountability mechanisms across sectors. For instance, agriculture plays a crucial role in enabling the availability of nutritious food. However, within the policy arena, agriculture and nutrition are largely treated as separate issues. Similarly, although women play a key role in providing good care within the household, including nutritious food, gender-related policies rarely emphasise these vital linkages. Further, linkages with programs in sanitation are critical because although the percentage of the population defecating in the open has reduced, the density of open defecation has increased, resulting in an enhanced exposure to disease causing pathogens, Such an approach would draw upon various programs in health, sanitation and gender, among other sectors.

Another key aspect of the Abhiyaan is focusing on the first 1,000 days of child’s life by providing health and nutrition services in an intensive manner. Studies indicate that 80% of the drain development occurs this stage. Home visits would be conducted by frontline health workers, thereby shifting the approach from centre-based to outreach-based. This will enable the entire family to be sensitized, instead of being restricted to mothers who visit Anganwadi Centres. Thus, in addition to ensuring the availability of age appropriate complementary foods, counseling families about the importance of feeding practices and the ability to take early corrective action, as required. Further, there will be an emphasis not just on food but a range of essential health care measures, including birth spacing, delaying age of marriage, exclusive breastfeeding for 6 month and immunization.

Incentives will also be provided to states and districts based on the improvements to the nutritional status of their respective populations in the form of both high absolute levels of achievement as well as positive changer in key indicators. Further, greater flexibility will be given to states so that they can focus on health and nutrition interventions that best address their needs. The geographic spread and diversity of India calls for customized interventions. The sub-group of Chief Ministers set up to review Centrally

Sponsored Schemes had universally recommended a flexible component in every scheme besides decentralized decision making by states on the pattern of the Rashtriya Krishi Vikas Yojana. Additionally, the success of the Atal Bal Mission in Madhya Pradesh which provided some untied funds at the district level from state resources to supplement grants under the integrated Child Development Services is a case in point.

Educating Communities:

Household choices with respect to food types and preparatory practices impact outcomes in nutrition to a great extent. A major challenge is that families are often unaware that the young infant is slipping into malnutrition until it becomes patently visible. An education community about nutritious food, effective and hygienic food preparation and storage as well as improved water and sanitation is important for enabling them to make informed choices. The success of the nutrition effort in other countries including Thailand, Peru, Brazil and Zimbabwe has been attributed at least partially to their ability to involve local communities. Greater community ownership can enhance awareness of nutrition-related issues, improve practices and expand outreach to the most vulnerable groups.

A recent World Bank report estimates that about two-third of the workforce in India earns on average 13% less than what they would have if they had not been stunted during childhood. Another World Bank Study calculates that malnutrition costs India’s GDP between 2 and 3 percentage points every year. With the launch of the POSHAN Abhiyaan, we have a historical opportunity to change these statistics and conquer malnutrition.

National Nutrition Month (Poshan Maah) witnesses overwhelming People’s participate

September was celebrate as the Rashtriya Poshan Maah across the country to address the malnutrition challenger and sensitize our countrymen regarding the importance of holistic nutrition. Poshan Maah aimed at making people aware of the importance of nutrition & giving individual access to government services to support supplement nutrition for their children & pregnant women /lactating mothers.

Ministry of Women & Child Development as the nodal agency, launched Rashtriya Poshan Maah or National Nutrition Month, across the length and breadth of the country on the 01st of Sep 2018. With wide range of activities focusing on antenatal care, anaemia, growth monitoring, girl’s education, diet, right age of marriage, hygiene and sanitation, eating healthy as themes were organized during the Poshan Maah. Entire range of themes were exhibited and showcased in form food melas, rellies, school level campaigns, anaemia tests camps, recipe demonstration, radio & TV talk shows, seminars all across country. As per latest reports, 23 lakhs activities across the country were recorded on Jan Andolan Dashboard wherein approximately 27 crore people were reached through these activities in this nationwide exercise, out of which one third were men. In order to keep the momentum of the awareness being generated country wide, the Ministry will be awarding Exemplary performers with Poshan Awards on the 10th of this October. He also added that National Institute on Nutrition report next year. This report, dealing with various parameters of nutrition will now be compiled annually to give more frequent feedback on status of nutrition in the country. The secretary also disclosed that the ICDS-CAS rollout is also moving at a good pace and more than 4 lakh Anganwadis will be covered by this IT tool by December this year.

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Courtesy: Kurukshetra