One in every three children in India is under-nourished. While the notorious levels of child malnutrition is a well-recognised fact in the Indian economy, the persistence of malnutrition among pregnant Indian women adds to the abysmal situation.
A significant proportion of Indian women are known to be underweight. However, the proportion of pregnant women who are underweight is significantly higher. In addition, about 55% of Indian women are anaemic. These figures does not speak well about our nutritional economy.
The Asian Enigma as an indicator
Given the relatively low age at which Indian women give birth and the linked risk of being under-nourished, the average pregnant woman in India is significantly worse off than even her Sub-Saharan counterpart. Diane Coffey estimates that 42.2% of Indian women are underweight when their pregnancy begins, as compared to 16.5% of African women. Deficits in maternal nutrition could help explain the ‘Asian enigma’—the puzzle of why Indian children are much smaller than what their relative wealth predicts.
Despite progress in the battle against poverty, India faces higher burden of malnutrition than Sub-Saharan Africa. One answer to the ‘Asian Enigma’ of high malnutrition could lie in the low social status of women in the region. This not only skews the distribution of food within the household against women, but also leads to a disproportionately higher work load for them, thereby adversely affecting childcare. It also compounds the problems caused by other unfavourable gender outcomes, such as limited participation of women in country economies, and their limited autonomy.
Taking a Gender Transformative Change approach
There have been several government interventions in this area, but they are not adequate given the deep roots of patriarchy in the Indian society. Correcting gender inequality is not merely a public policy challenge but also a civilizational one.
Gender is an important determinant of child nutrition as well. Discrimination between the boy and girl child during the breast feeding and complimentary feeding stages is widely prevalent. It is also a common sight at nutrition rehabilitation centres that while a girl child is admitted due to poor and debilitating conditions, sometimes almost near death, her male sibling has no nutritional or weight problems. Such cases are exemplary of a far more widespread social problem. In many cases, the birth of boys is celebrated while new-born girls are at best tolerated, and at worst, treated harshly.
The need of the hour is to address the root causes of gender discrimination and transform the societal norms and attitudes in favour of a more gender equitable environment. This need to be done in a sustainable manner through a Gender Transformative Change (GTC) approach. Interventions should ideally cater to women and girls. Engagement amongst all stakeholders and influencers in the community, including men and boys, women and girls, elderly family members, frontline workers (ASHA, AWW, ANM) and other influencers is very important. These groups need to be included in the endeavour to realise gender equality—to reflect and discuss gender discriminatory practices in nutrition consumption at the household level. Through such discussions, both women and men will be facilitated to challenge their own gender discriminating attitudes and practices around nutrition.
Continued engagement with the community on this issue would eventually lead to a change in the attitudes and behaviour of both women and men around gender and nutrition, leading to equitable distribution of food and improvement in other dietary practices. This change or rather transformed attitude, belief and practice around food intake and nutrition for women and girls will lead to a reduction in anaemia and promote gender equitable distribution of nutrition and food. Such gender transformative interventions have the potential to alter the root causes of malnutrition in India. However, such an approach requires time and persistent dedication, as there is a need to engage with a wider audience and help them reflect repeatedly on social and gender norms which have been followed without much questioning and challenge for generations. As a result, such norms take time to be addressed and change requires a longer time to manifest itself.
Rita Prasad is Technical Specialist for Health at CARE India.