India’s greatest treasure is its people. Of all the children in the world, every fifth one lives in India. India is also home to every third malnourished child in the world. The cycle of malnourishment for a child starts at conception and continues to impede the child once they are born and as they grow. In 2018, Prime Minister Narendra Modi’s government launched the National Nutrition Mission (NNM), also known as ‘POSHAN Abhiyaan’, under the National Nutrition Strategy as a remedial measure. NNM, the world’s largest nutrition program, aims to reduce stunting, underweight, and low birth weight, each by 2% per year; and anemia among children, adolescents, and women each by 3% per year until 2022. However, despite such focused efforts, malnourishment continues to be an issue, mainly because of poor access and affordability to nutritional food and limited access to proper maternal and child-health services.
To combat this persistent issue,ChildFund India recognized that there was a need to create an ecosystem which addressed multi-sectorial needs – bringing together the ICDS (Integrated Child Development Services), Health centers, WASH, Panchayati Raj Institution and State Food Commissions. While many may argue that implementing a multi-sectorial program limits large-scale implementation, finding the right balance between community involvement, partner support and institutional implementation has become our greatest strength in realizing the success of our programs and interventions across 15 states. It has helped us approach the issue of malnutrition in young kids on various spectrums. Our program, MACHAN (Mother and Child Health and Nutrition) is a holistic program which addresses the lack of nutrition, while synergizing with important pillars that contribute towards reducing malnutrition, mother and child health, new-born care, and adolescent nutrition.
Communities matter
In 2019-20, more than 500 mothers became community leaders as ‘mentor’ mothers and created a support system for more than 60,000 mothers in 201 villages across14 states. In places that are hard to access, like Jagaldalpur in the strife-torn Bastar district of Chhattisgarh, they went door-to-door, tirelessly creating scientific awareness on nutrition, hygiene and malnutrition in young kids, linked young children and new mothers to various government programs and schemes and taught mothers the need for self-care and rest, a thought that is elusive to women in rural India.
Behavior-change interventions
Behavior-change interventions ensured that the change, which was brought in today, became a part of the legacy tomorrow. Change-makers are often community members and health workers themselves, as families are more welcome to change via a familiar face. Our behavior-change interventions include WASH practices, child-upbringing for cognitive and physical growth, encouraging routine health check-ups, consulting healthcare professional, among other things.
Local Knowledge
Our behavior-change interventions work towards disseminating new scientific knowledge but we do not attempt to reinvent the wheel where knowledge already exists. Therefore, we draw a lot from local, collective knowledge in matters of nutrition, local foods, child-care methods and train our staff as well as communities in these because these solutions are effective, low-cost and easily available and sustainable for long, even in marginalized areas, contributing to nutrition and food security. Our sessions that focus on local solutions have reached 185 villages and 87 urban slums across 15 states.
Food security and nutrition security
Food and nutrition security mean continuous access to nutritional food to aide in child development. While ChildFund India supplies locally-made ‘nutrimix’ – a nutritious mix of pulses, flours and grains for pregnant women and malnourished children – we know that to create a sustainable solution, the community needs to be involved. In rural areas, although economic stability is hard to come by sometimes, the open space outside their huts and homes are a source of security. In 2019-20, more than 1,700 households and communities have planted nutrition gardens with the help our mentor mothers, partners, and trainers. These gardens also proved to be extremely valuable during COVID-19 pandemic, when families were suddenly out of work.
Expert support
While enabling the community to take charge of the health and nutrition of their children in the long run, our trainers and staff also address the immediate needs on the ground – ensuring that young children, expectant and new mothers benefit from government-run facilities and schemes. We work to support the children by focusing on the first 1,000 days of their life and till they are 5 years old through regular supply of nutrition. In the last year, more than 90% SAM (Severe Acute Malnutrition) and MAM (Moderate Acute Malnutrition) children out of 6,500 were referred to Nutrition rehabilitation centers and 70% SAM and MAM children have since then recovered to healthy parameters.
Economic Stability
Economic stability is imperative for continuous access to healthcare, education, and resources, thereby becoming a key component to ensuring nutritional support to children and adults alike. In marginalized households in rural India, often fathers migrate to urban centers seeking employment opportunities, leaving mothers behind to take care of children and elders. When families migrate together, women and children often are victims of exploitation and educational opportunities for children drastically reduces as they are pushed into labor. Therefore, our trainers focus on bringing economic stability for mothers so that children experience stability, continue education, and are prevented from entering the labor market. These women are taught kitchen gardening, income generation through allied agricultural activities (thereby increasing financial savings) and provided knowledge of food and nutrition.
Post COVID world
Since March 2020, COVID -19 has aggravated many of the existing socio-economic problems. The most affected groups continue to be women and children, especially the migrant workers. The pandemic is also likely to increase mortality indirectly due to malnutrition and preventable diseases. As per an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, an additional 1600 children could die every day due to malnutrition and other preventable diseases.
As the industry slowly sputters to life again, it will be a while before migrant workers, especially in the unorganized sector, have viable economic opportunities, the lack of which will adversely affect their children’s nutrition, education and psychological wellness.
We are working with migrant families and encouraging them to take up agriculture. We are also providing seeds, organic manure, and technical support. We are enabling women to set up nutrition gardens and take up poultry farming, to create an alternative, sustainable source of income and to ensure that the children enjoy nutritional and food security in the long run. We constantly are improving our intervention – sometimes by thinking outside the box, and sometimes simply borrowing local wisdom.
(The author is a Health Specialist, ChildFund India)
