The data on malnutrition, stunting, and wasting in children across states in India emerging from the first phase of the National Family Health Survey 5 (2019-2020) is Dickensian in scope and sentiment. The spectre of hunger and starvation, worsened by the ongoing pandemic and the subsequent loss of livelihoods, is spawning Oliver Twists, who subsist on thin gruels, with little nutrition thrown in.
Almost 90% of the human brain said to develop by age five, studies point to the key role of nutrition in early years for optimal brain development. Essentially, neuroscientists term the first five years of a child’s life as a critical period for brain development and learning. Changes in the brain’s structure during this period due to malnutrition can result in irreversible consequences.
Wasting and stunting
Malnutrition in children is often associated with wasting and stunting. While wasting signifies low weight for height, stunting signals low height for age. Wasting is attributed to acute food shortage and/or disease. Similarly, stunting is caused by long-term insufficient intake of nutrients. The effects of stunting, such as delayed motor development and impaired cognitive functions, are largely irreversible.
Stunting and wasting are marked by reduced muscle mass and fat mass. Though these are different forms of malnutrition, they often coexist in the same vulnerable population, and unfortunately, in the same children.
Though the first phase of the survey covered only 17 states and 5 union territories (UTs), the statistics on the nutritional state of children is alarming. Compared to the earlier survey (NFHS 4) in 2015-2016, the proportion of children who are severely wasted has gone up in 14 states and 3 UTs. These include rich states, such as Maharashtra (up by 1.5%) and Gujarat (up by 1.1%) and poor states such as Bihar (up by 1.8%) and Assam (up by 2.9%), among others.
Though some states have ducked the national trend as far as severe wasting of children is concerned, they are in the red with regard to the data on stunting of children. Thus, while Goa has recorded a rise in stunted children by 5.7%; Kerala has registered a rise by 3.7%, compared to the numbers in the last survey.
The findings of the current survey reinforce the concerns of nutritionists and social workers that under the pandemic, India is reversing the gains made under POSHAN Abhiyaan, the government’s flagship national nutritional mission, launched in 2018.
Karnataka fares well
The only state which has beaten the downward national trend is Karnataka. While the state has reined in the proportion of children who are wasted by 6.6%, the percentage of children severely wasted has declined by 2.1%, compared to NFHS 4. The graph of stunted children has also declined by 0.8%.
Several on-ground policy measures have helped the state swim against the general tide. The state pioneered the World Bank-supported Multisectoral Nutrition Pilot Project in backward taluks to reduce undernutrition and micro-nutrient deficiency. This project is now being transitioned to the production and marketing of low-cost fortified energy food Shakti Vita, made from locally produced ragi, corn, soya, wheat, green gram, and ground nut across the state.
The state also appointed nutritional volunteers in each village to create awareness about the care and nutrition of newborns, the importance of maintaining a healthy body mass index (BMI), and consumption of local fruits and vegetables.
The government has also partnered with the Center for Study of Science, Technology and Policy (CSTEP), a research-based think tank, to develop a state-of-the-art digital platform, SNEHA, which provides a comprehensive solution—from detection to cure—for malnutrition management.
Undoubtedly, the repercussions of the pandemic have been grave for the vulnerable sections of the society. With schools staying shut, millions of children were robbed of their only nutritional meal in the day—the mid-day meal (MDM) scheme in government schools, which provides free lunches to 120,000,000 children in the country. Though the government made provisions for extra food ration, including pulses, under the Pradhan Mantri Gramodaya Yojana, implementation of the scheme was mired in controversies due to discrepancies in the distribution network. Further, the closure of Anganwadis that ensure supplementary nutrition to children under six, besides pregnant and lactating mothers in the country, has aggravated the situ
Predictably, the recently released 2020 Global Hunger Index (GHI) ranks India 94 in its list of 107 countries for which data was collected. The GHI estimate gives the country a score of 27.2, tagging India in a level of hunger that is “serious”.
Solving India’s complex malnourishment challenge and achieving the second UN Sustainable Development Goal of Zero Hunger will involve concerted pro-active measures, such as instilling nutritional awareness at the village level, targetting the supply and distribution of supplementary nutrition among vulnerable sections, constant monitoring of the nutritional status of severe malnutrition cases, and ensuring a balanced diet for pregnant and lactating mothers through dietary supplements.
Our children are our future. We need to fortify the foundation on which our future will be built.
(The writer works with the Center for Study of Science, Technology and Policy, a research-based think tank)