By Priyanka Venkat
The problem of widespread malnutrition among women and children cannot be overstated, especially for a country with a high human dividend like India. According to the National Family Health Survey-3, 36% of the women in India suffer from chronic undernourishment and 55% from anaemia. A woman who is undernourished is likely to give birth to a child who is malnourished. Hence, if her nutritional needs are not addressed, a vicious cycle is created. This could drastically impact productivity and growth, as we rely considerably on our ever-growing labour force.
In order to consolidate its efforts towards tackling the malnutrition challenge, the government has approved the initiation of a National Nutrition Mission (NNM). With a budget set at Rs. 9046 crores, over a period of three years, the mission is expected to benefit 10 crore people. Through the programme, the government seeks to reduce stunting, malnutrition and low birthweight by 2% each year, over the three year period.
An attempt to bring about convergence
The government aims to make the fight against malnutrition, a more organised and effective one. The creating of a nutrition mission will help achieve this, through the convergence of existing schemes onto one big platform. This is important as the actions taken by the various ministries in this regard are interrelated and coordination is required to make them effective.
For instance, Mission Indradhanush, which focuses on the total immunisation of children and women, operates under the Ministry of Health. Whereas the Pradhan Mantri Matruvandana Yojana, which focuses its efforts on helping pregnant and lactating women, functions under the Ministry of Women and Child Development. Inter-related ministries such as these, need to work in conjunction to achieve shared goals. Hence, the mission will provide a structure that facilitates coordination between the many departments.
An organised approach towards tackling malnutrition
The government plans to use a district-wise approach for rolling out the mission. It will be launched in January and the districts will be covered under the mission in phases over the three-year period. 315 districts will be covered in this financial year, 235 districts in 2018-19 and the remaining in 2019-20. Additionally, the mission will set up an apex body. This body will set nutrition-related targets and monitor the efforts taken to achieve those targets across the ministries.
Stunting rates stand at 38.4% according to the National Family Health Survey-4. The mission will work towards bringing it down to 25% by 2022. It will also strive towards bringing down anaemia in adolescent girls, women and young children by 3% each year.
The government plans to use information technology while implementing the mission. Supervisors will be provided with smart tablets and smartphones will be given to Anganwadi workers. This will help make monitoring easier and bring about transparency.
Further, the mission will be linked to Aadhar to prevent the pilferage of benefits. In a pilot research carried out on child nutrition programmes in Assam, it was seen that out of the total number of children enrolled at the Anganwadi, three lakh of those enrollments were fake. To ensure that this doesnt happen again, the government has made it mandatory for beneficiaries to have an Aadhar card to avail benefits. There are concerns, however, over whether children under the age of three will fall under this rule as well. A rule such as this would restrict the entry of children under the age of five years to the group of beneficiaries, as biometric data cannot be recorded for them.
In response, Ms Maneka Gandhi, the minister of Women and Child Development said, There has to be some sort of identification. This is a good question I think we have to work it out so that it does not create more paperwork but at the same time avoid an Assam-like situation.
Improving outcomes by addressing root issues
Effectively tackling malnutrition also mandates evaluating the social context in which the problem occurs. Gender forms a very big part of the discussion, as the status of women in society translates into nutritional discrimination at home as well. Studies have found that women and girl children are allocated less food and nutrients at home. as compared to the male members. They are also given less importance when it comes to healthcare. Malnutrition affects women more than men because they have specific nutrition-related needs during pregnancy, lactation and even adolescence.
There needs to be an adequate focus on incentivising families to actively take care of the nutritional needs of their women and children. One way to do this are nutrition-based conditional cash transfers (CCTs) made to mothers. The mothers will get the cash only if certain nutrition-based conditions like height and weight targets for children are met. Nutrition counselling sessions can be organised to educate mothers in a bid to improve awareness. Attendance of pregnant women at nutrition counselling sessions is paramount and should be made mandatory for claiming cash incentives. Topics covered in the sessions should include, but not be limited to, guidance regarding nutrition, family planning, behavioural changes that can be made to improve health (such as hygiene), immunisation and best breastfeeding practices. The attendance of men at these sessions could also be a condition to receive the transfer.
By making the transfer to the mother, the financial autonomy of the woman is improved, improving her decision-making power. The importance of such transfers can be seen in the impact that the Janani Suraksha Yojana had. It involved providing cash incentives to pregnant women in order to motivate them to go for institutional deliveries and avail antenatal care at clinics. As a result of the scheme, a drastic rise in institutional deliveries was seen from 39% in 2005-05 to 79% in 2015-16.
Other areas for improvement
However, it is important to remember that a conditional cash transfer in itself isnt sufficient to bring about the required change. The motive behind such a transfer is to bring the beneficiaries to the access points such as Anganwadis. It is also the responsibility of the government to ensure high quality in the services offered by these centres. In addition to building access and ensuring an adequate number of primary health care centres, Anganwadi workers and volunteers should be properly trained and held accountable for certain metrics. These could include the number of home visits conducted by them, the frequency of counselling sessions that have been conducted for mothers and their efforts towards building community awareness and participation.
Another important focus area should be implementing food fortification on a larger scale. Improving diversity in diets by the addition of micronutrients is a highly sustainable solution to malnutrition. The addition of staples like wheat flour and corn can help reduce the risk of nutritional deficiencies.
There also exists a need for establishing accountability at every stage of implementation, to ensure that nutrition targets are met. The path ahead is a difficult one, and tackling malnutrition is likely to be an uphill battle. Regardless, the setting up of the National Nutrition Mission can hasten efforts towards solving the issue. This, coupled with well thought out implementation and an understanding of the context of nutritional challenges, can give us a real shot at addressing the multi-faceted problem of malnutrition.
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