The WHO in its nutrition factsheet states that “Maternal and child under-nutrition is a largely preventable cause of more than 3.5 million deaths annually, accounting for 35 percent of the disease burden among children under 5, and 11 percent of the total global disease burden.” And some of these statistics in India can be linked to the intergenerational nutrition gap that is prevalent in the country today.
The discourse on how to improve the nutrition of our people, especially mothers, is not new. Neither is it bereft of the attention of international and national stakeholders who are working towards addressing the issue. However, a large gap still persists. Studies have revealed that these gaps further get aggravated due to poverty, lack of livelihood opportunities, unorganized work sectors as well as the complex social norms that women have to follow. All these lead to a lack of knowledge on nutrition and eating patterns among women which leads to adverse health outcomes.
According to NFHS-4 data, about 22.9 per cent of women in the 15-49 years age bracket in India are underweight, with a Body Mass Index (BMI) of less than 18.5 kg/m2. The need of the hour is therefore to address this serious concern. Evidence shows that malnourished mothers tend to have underweight children. The newborns might also have improper mental growth and certain birth defects.
Intergenerational nutrition gap: A deep dive
As stated above, the causes of malnutrition are many. However, in the case of adolescent girls and young mothers, a prominent reason for this is the incidence of early marriage coupled with the fact that these young girls are not bestowed with the best of health to begin with. About 26.8 per cent of women in India aged between 20-24 years got married before 18 years of age, as per NFHS-4.
This was echoed by the Niti Aayog which in its national nutrition strategy stated that in chronically undernourished women, pregnancy and lactation have an adverse effect on maternal nutritional status. Low pre-pregnancy weight and low pregnancy weight gain are associated with low birth weight and all its attendant adverse consequences.
A UNICEF report states that over 80 percent of adolescents also suffer from ‘hidden hunger, i.e. the deficiency of one or more micronutrients such as iron, folate, zinc, vitamin A, vitamin B12, and vitamin D. The intergenerational cycle of under-nutrition, manifested as low birth weight, is compounded by gender discrimination and social exclusion. The report states that focusing on adolescent girls before they become mothers, is critical to breaking India’s intergenerational cycle of malnutrition.
How do we solve this?
Undernutrition is both a consequence as well as a cause of perpetuating poverty and eroding human capital through irreversible and intergenerational effects on cognitive and physical development. The nutrition status of children in the most vulnerable age group is also a sensitive proxy indicator of human development and of the effectiveness of national socio-economic development strategies. The Global Nutrition Report 2015 estimates that for investment in nutrition, there is a benefit-cost ratio of 16:1 for 40 low and middle-income countries.
Like all problems that impact our ecosystem, we strive to resolve together with the nutritional health outcomes with a clear goal and objective in mind – A healthy generation of mothers and children.
The Government has accorded high priority to the issue of malnutrition and is making serious efforts to address the issue. Several schemes with direct as well as indirect interventions are being implemented across the country. Schemes like Anganwadi Services, scheme for Adolescent Girls and Pradhan Mantri Matru Vandana Yojna (PMMVY) under the Umbrella of Integrated Child Development Services (ICDS) Scheme are direct targeted interventions being implemented to address the problem of malnutrition among women and children in the country.
Other interventions include targeted large-scale programmes like Anemia Mukt Bharat and Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan, which includes beneficiaries across the board. Anemia Mukt Bharat, a flagship programme of the Ministry of Health and Family Welfare (MoHFW), under the POSHAN Abhiyaan, is a strategy focussed on reducing the burden of maternal anemia. It aims to reduce the prevalence of anemia by three percentage points per year among children, adolescents, and women of reproductive age by 2022.
The Budget 2021 also offers some solace in this direction. The budgetary push is an attempt to strengthen India’s nutritional delivery and outcome with special focus on 112 aspirational districts with the launch of Mission POSHAN 2.0.
Increasing holistic awareness on nutrition and its outcomes and improvement on purchasing parity and financial independence among young girls and women is where we can support, complement and make the efforts undertaken by government, sustainable. Organizations like Smile Foundation that work with self-help groups, mothers’ groups, health centers and even capacity building of frontline workers on various subjects can bring about a positive change. Smile Foundation, through its project ‘Sampoorna’ in Banaskantha district of Gujarat, has created a model and laboratory of learning. The project has managed a small but impactful positive improvement in the intervention area of 10 villages in Block Amirgarh.
At the initiation of the project, the baseline study revealed that 78 percent of adolescent girls were anemic (varying from mild to severe), with 50 percent girls being moderately anemic and about 13 percent being severely anemic. The survey also revealed that only 17.6 percent were attending school, with most respondents (49 percent) dropping out of school after Class 6 or 8, due to non-availability of further classes in the vicinity, to support in domestic chores, etc.
The pilot program launched thereafter, was able to impact the nutrition status of 1,000 adolescent girls from 10 villages in the district. We were able to achieve increased consumption of IFA, de-worming, and multi-vitamin tablets, substantially increase Hemoglobin levels in adolescent girls and create positive outcomes in their Body Mass Index (BMI). Efforts were also made to inculcate healthy eating habits by discussing several homemade recipes, how to grow kitchen gardens, and serving nutritious snacks during awareness generation sessions and activities. As a result of these steps, the incidence of severe to moderate anemia too fell from nearly 78 percent to around 34 percent.
Apart from this, livelihood training was imparted with support from various government schemes under skill-building so that the girls gain economic independence and hence have decision-making authority for themselves.
It has been assessed that there has been a change in the knowledge level and also the behavior and practices of the girls. However, making the efforts sustainable is a challenge because of demography and socio-economic reasons.
Thus the model proposed for such similar interventions in the future is inculcating healthy eating behavior and healthy menstrual hygiene practices in girls. At the same time, one has to intervene for ensuring their economic empowerment which will help them in adopting and ensuring these healthy habits and practices.
As a community, we need to ideate, innovate and solve together for long-term sustainable change. And the first step for doing so is deciding to do so as we did.
(The author is co-founder and executive trustee of Smile Foundation, an NGO)
