The war against child malnutrition can be won only with the help of data.
As a Parliamentarian, I believe that reliable data is my biggest asset. If I can quantitatively track the effectiveness of our interventions and use data to course-correct, I strongly believe that I would be able to serve my duty as an elected representative of the people. Hence, the release of the National Family Health Survey - round 5 (NFHS-5) that cover about 6.1 lakh sample households, providing estimates for 707 districts has particularly caught my attention.
According to the results of the survey, India has encouragingly noticed a substantial improvement in maternal and child health indicators over NFHS-4 (2015-16). This is not only a step forward in India’s progress in achieving the SDG goals, but is also an indicator of a healthier future generation. Further, an increase in the use of contraceptives and a decline in the fertility rate has also been noted. The survey also found considerable improvement in vaccination coverage among children age 12-23 months across all states/UTs. Women’s empowerment indicators (including women with bank account) also portray considerable progress. India has made tremendous strides in Total Fertility Rate (TFR), which has come down to 2.1 or below (replacement level) in all states and UTs, except Bihar (3), Meghalaya (2.9) and Manipur (2.2) and we have even noticed an increase in antenatal care across the country. These heartening results show a promising upward trend and a better future ahead.
While the efforts of the government have translated wonderfully for multiple key indicators, child nutrition outcomes showcase a mixed picture. The NFHS-5 data showcases multiple interstate variations, with some states showing improvements and some states lagging behind. For instance, all states have witnessed a decline in IMR and U5MR (we have been successful in saving the lives of children). But alarmingly, eighteen of the 22 states and Union Territories (UTs) have recorded a rise in the percentage of children under five years of age who are stunted, wasted and underweight compared with 2015-16. Rates of stunting have risen in rich states such as Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh, all of which had lowered their rates of stunting in the previous decade. Sixteen states and UTs out of the 22 surveyed recorded a rise in the percentage of children under five years who are severely wasted and underweight in comparison to NFHS-4, the data showed.
While these statistics seem alarming, there are multiple lessons from Indian states that have managed to reduce stunting over the period of 2006-2016 which offer insight into how success can be achieved. States like Chhattisgarh, Gujarat, Tamil Nadu and Odisha are examples of states that have added to national efforts with varying nature and timing of focussed interventions help scale efforts towards child nutrition. They focussed on health and nutrition interventions, maternal behaviour and reporting, efforts to strengthen implementation systems and scaled major national efforts such as ICDS, NRHM, etc. The force behind these interventions was not only a vision and commitment to address the issue but also, capable, stable bureaucrats who were given the space, time and resources to work towards effective administration. This perhaps is our biggest takeaway from the success stories of these states - we need to efficiently identify and support provisions that address not only child nutrition specifically, but also, empower administrators and people on the ground to support the effective implementation and scaling up of these programs.
As I stressed at the beginning of this piece, India can win this war only with the help of data. Unless we take action to carefully monitor certain key indicators and indexes, collect reliable and updated data and ensure faster analysis, we would not be able to effectively ensure the collective benefit of our young ones. As India rises from the pandemic it has been facing, we must realise that the challenges in front of us are even tougher than those we have previously overcome. The year behind us has impacted every aspect of our lives, and more so for those who are already underprivileged.
It is time we relook at our budgetary allocations alongside introducing a standard mandate and machinery across all the states and UTs. Our focus should be on proper planning and implementation of schemes and policies, with key targeted efforts to support activities that increase the efficiencies of existing programs. In addition, these efforts must be supported by a time-proven method of public awareness - large scale campaigns that are interactive and informative, catching the imaginations of citizens across the country.
Further, India can benefit by looking at increasing budgetary allocation for Poshan and ICDS. This allocation would focus on providing nutritious food in the mid-day meal scheme and ICDS, targeting women-specific schemes to combat anaemia and low/high BMI as well as increase awareness about balanced diets. It is important to remember that a child’s nutrition is dependent on their family, therefore, we must also specifically work to ensure access for all to health services, food security interventions, relevant cash transfers (such as PMMVY), income support programs such as NREGA, sanitation programs such as the Swacch Bharat, along with programs addressing women’s pre-pregnancy nutrition, education and wellbeing. Let us ensure we are truly able to deliver what we promise, and strengthen action towards it in every possible way to make lives better for each and every child in the country.
(Dr Gavit is an MP and National Spokesperson, BJP. She has been very vocal about the issues related to children in and outside the parliament. She penned down this article to highlight the issue pertaining to child stunting and wasting and advocate necessary mitigating steps.)