India alone accounts for 46.6 million stunted children, 97 million are anaemic and undernourished.
The ongoing covid-19 pandemic will have far reaching consequences, with the most impacted being the health of children and adolescents. And quite unsurprisingly this is mostly tied to nutrition while other aspects such as violence and abuse where children continue to live in close proximity to their abusers in lockdown also play an undeniably major role.
What makes this alarming is the staggering numbers and the vulnerability of children and adolescents to undernutrition, especially in India. India, home to the largest adolescent population has 46.6 million stunted children - a third of world's . 1 in every 3 children in India, are malnourished. 97 million are anaemic and undernourished. Nearly half of all under-5 child mortality in India is attributable to undernutrition while chronic malnutrition is irreversible if not addressed within the first 2 years of life.
The nature of the covid-19 pandemic and our response to it has resulted in a series of small food shocks for children and adolescents. “There are several reasons behind these small food shocks”, says Piyasree Mukherjee, Director - Programs, Swasti while listing out key ones.
1. Healthcare workers and anganwadi workers who are the frontlines of the Integrated Child Development Services (ICDS), a flagship program of the Govt. of India for all-round development of children have been diverted to respond to covid-19. This has not only resulted in disrupted nutrition services but also loss of data that drives evidence based programing.
2. The lockdown has led to schools being closed and mid-day meals therefore stand suspended. As per the government data, in the year 2018-19, MDM scheme served about 9.17 crore children in 11.35 lakh schools across the country. This year, 9.17 crore children who need the Mid Day Meals the most have gone without it. This in a country where hunger is rampant and real and where the mid-day meal is often the only meal the child has access to is exceptionally alarming.
3. Additionally, the lockdown caused severe resource crisis for families, especially the vulnerable population, who lost out on any possible diet diversity in their daily meals. Loss of wages led to loss of nutrients on their plates, with only food choices available in the form of foodgrains through PDS and relief packages.
A study published in the Global Health Science journal on July 16, 2020 attempted to estimate children who may fall to the threshold of the malnourished category due to small food shocks. By its estimations, five million children in India are at risk of falling in the wasting category of malnourishment, while an additional two million children are at risk of being pushed into the severe wasting category, the study pointed out.
Globally, nutrition has been undermined across the world with low income and middle income countries being most affected. Children and adolescents are greatly dependent on adults and societal systems to protect and meet their needs.
“It is our moral responsibility to step up now more than ever before. If India implements its committed social protection schemes and invests in strengthening local governance systems, it can be an exemplar to the world”, remarks Dr.Angela Chaudhuri, lead of Health Practice, Catalyst Group and also a member of the Board, The Partnership for Maternal, Newborn and Child Health hosted by the World Health Organization. In response to the question on how this can be achieved, she adds “The access to nutritious, safe, and affordable diets for the most poor and marginalized families needs to be safeguarded and promoted as part of the covid-19 response. Tele-care can fill the gap in counseling, information, education and communication services. Families can take over services for early detection and deployment of treatment protocols for child wasting. Mid Day Meals need to find its way to community kitchens run by community groups or SHGs as long as schools are closed, especially for vulnerable children and social protection services need to be expanded to safeguard access to nutritious food.”
“Community led interventions are a proven and effective measure. For example, community-led sanitation programs have been evidenced as ensuring healthy household environments and reducing undernutrition.”, ShamaKarkal, CEO, Swastiand also Chair of the Asia Pacific Alliance for Sexual and Reproductive Health and Rights, chimes in. “The aspects that are at the brink of collapse due to the pandemic are the very protectors of well-being for the most vulnerable. And women, children and adolescents are going to be most affected with decades of progress possibly coming undone. And these aspects span critical areas such as financial inclusion and social protection, health care services, access to clean water and sanitation and food systems. Each of these are determinants of nutrition. With self sustained community led interventions and initiatives, these aspects can be addressed locally and with leveraged resources - an approach that is sustainable and contextual and therefore, most effective.”
(The author is an Associate Director of Swasti - The Health Catalyst, a global public health not-for-profit headquartered in Bangalore, India)