Malnutrition most often refers to under-nutrition resulting from inadequate consumption, poor absorption or excessive loss of nutrients, but the term can also encompass over-nutrition, resulting from excessive intake of specific nutrients. An individual will experience malnutrition if the appropriate amount of, or quality of nutrients comprising a healthy diet are not consumed for an extended period of time.
The level of malnutrition is of great concern in India with over 40% of children being classified as undernourished. Undernutrition is highly prevalent among rural children in India. Acute malnutrition is one of the major public health problems in the country and one of the contributing causes for high rates of mortality and morbidities among children and mothers. It is an underlying cause of about 50% deaths in children. The prevalence of underweight children in India (47%) is among the highest in the world. (Source: NFHS III 2005-06)
The National Nutrition Strategy launched in 2017 envisages a ‘Kuposhan Mukt Bharat’ linked to Swachh Bharat and Swasth Bharat focusing on improving healthcare and nutrition of the most vulnerable and critical age groups including mothers and children through direct and nutrition sensitive interventions. Here are few Government interventions to address Malnutrition in India.
POSHAN Abhiyan
POSHAN Abhiyan (National Nutrition Mission) is a flagship programme of the ministry of women and child development (MWCD), Government of India, which ensures convergence with various programmes i.e., Anganwadi Services, Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for adolescent girls (SAG) of MWCD Janani Suraksha Yojana (JSY), National Health Mission (NHM), Swachh-Bharat Mission, Public distribution System (PDS), Department food & Public Distribution, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) and Ministry of Drinking Water and Sanitation.
The Integrated child development services (ICDS) and National Health Mission (NHM) are the most largest platforms that address maternal nutrition. The National Health Mission(NHM) positions itself to alleviate supply side challenges by addressing infrastructural and service delivery issues. JSY has been a flagship intervention of conditional cash transfer to incentivise facility-based deliveries. The NHM program includes early registration of pregnancy, providing micronutrient supplementation, birth planning, institutional birth, post-delivery visit and reporting, family planning and counselling and behaviour change communication activities.
Integrated Child Development Services (ICDS) Programme
Launched on 2nd October, 1975, the Integrated Child Development Services (ICDS) Scheme is one of the world’s largest and unique programmes for early childhood care and development. It is the foremost symbol of country’s commitment to its children and nursing mothers, as a response to the challenge of providing pre-school non-formal education on the one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other.
The beneficiaries under the Scheme are children (<6 years), pregnant/nursing mothers and women in reproductive ages (15-44 years) as well as adolescent girls for improving their nutrition/health status. The interventions of ICDS programme are as follows
- Pre-School Non-Formal Education
- Nutrition & Health Education
- Immunization
- Health Check-Up
- Referral Services
Under Umbrella ICDS, following schemes has been covered under Ministry of Women and Child development.
- Anganwadi Services Scheme
- Pradhan Mantri Matru Vandana Yojana
- National Creche Scheme
- POSHAN Abhiyaan
- Scheme for Adolescent Girls
- Child Protection Scheme
Mothers Absolute Affection (MAA)
It is a nationwide programme launched in August 2016 an attempt to bring undiluted focus on promotion of breastfeeding. Breastfeeding is the most natural, cost effective and an enormous resource that every child has access to. This programme will greatly help to reduce the under-five mortality of children. Early initiation of breastfeeding within one hour of birth and thereafter exclusive breastfeeding for the first six months is essential for the wellness of the child.
National Iodine Deficiency Disorders Control Programme (NIDDCP)
Iodine is an essential micronutrient required daily at 100-150 micrograms for normal human growth and development. Realizing the magnitude of the problem, the Government of India launched a 100 percent centrally assisted National Goitre Control Programme (NGCP) in 1962. In August, 1992 the NGCP was renamed as National Iodine Deficiency Disorders Control Programme (NIDDCP) with a view of wide spectrum of Iodine Deficiency Disorders like mental and physical retardation, deaf mutism, cretinism, stillbirths, abortions squint & various types of goiter, etc.
Over the years the Total Goiter Rate (TGR) in the entire country is reduced significantly. Production of iodized salt in the country reached 65.00 lakh MT which is adequate to meet the requirement of population. The consumption of adequately iodized salt at household level has been increased from 51.1% (as per NFHS III report 2005-06) to 71.1% (as per CES report, 2009).
National Nutritional Anaemia Prophylaxis Programme (NNAPP)
Anaemia especially affect women in the reproductive age group and young children. In a recent survey of NFHS-4 states that 53% of women of reproductive age group suffering from anaemia in India. Anaemia affects over 3/4th of the school children due to low intake of iron and folic acid. Nutritional anaemia, due to iron and folic acid deficiency, is directly or indirectly responsible for about 20 percent of maternal deaths. The NNAPP was started in 1970 as a centrally sponsored scheme.
Children 6-10 years old will be provided 30 mg elemental iron and 250 mcg folic acid per child per day for 100 days in a year. Adolescents, 11-18 years will be supplemented at the same doses and duration as adults. The adolescent girls will be given priority.
Anaemia is also a major contributor of high incidence of premature births, low birth weight and perinatal mortality. At Present, 22 million adult and 30 million child beneficiaries are being covered under the programme.
National iron+ Initiative
In 2016-17, to bring synergy in the existing iron supplement programs and schemes, ministry of health and family welfare developed the National iron+ Initiative that embraced all the programs across all population categories for addressing anaemia. The initiative is an attempt to oversee interventions addressing iron deficiency anaemia systematically across all life stages.
Anaemia Mukt Bharat
Recently launched Anaemia Mukt Bharat campaign is planned to strengthen evidence based strategies with targeting-setting, strengthening procurement and supply chain management, intensive behaviour change communication and robust monitoring and review. Materials developed under the Anaemia Mukt Bharat strategy such as communication resources material, survey data, targets, state and district-wise denominators, and state and district-wise quarterly progress reports are available on Anaemia Mukt Bharat portal.
According to the National Family Health Survey-4, 23 percent of women are undernourished and have BMI<18.5. Women continue to be at risk of low BMI throughout their adult life and their childbearing years.
Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) – ‘SABLA’
This scheme aims at empowering Adolescent Girls (11-18 years) through nutrition, health care and life skills education. It has two major components viz. Nutrition and Non Nutrition.
Under the Nutrition component, the out of school Adolescent Girls (AGs) in the age group of 11-14 years attending Anganwadi Centres and all the girls in the age group of 14-18 years are provided Supplementary Nutrition containing 600 calories, 18-20 grams of protein and micronutrients, per day for 300 days in a year.
‘Kishori Shakti Yojana’ (KSY)
For the first time in India, a special intervention was devised for adolescent girls using the ICDS infrastructure The Adolescent Girls (AG) Scheme under ICDS primarily aimed at breaking the intergenerational life-cycle of nutritional and gender disadvantage and providing a supportive environment for self-development.
The broad objectives of the Scheme are to improve the nutritional, health and development status of adolescent girls, promote awareness of health, hygiene, nutrition and family care, link them to opportunities for learning life skills, going back to school, help them gain a better understanding of their social environment and take initiatives to become productive members of society.
Weekly Iron and Folic Acid Supplementation (WIFS) Programme
The Ministry of Health and Family Welfare has rolled out the Weekly Iron and Folic Acid Supplementation (WIFS) Programme in 2012-13 to meet the challenge of high prevalence and incidence of Iron Deficiency Anaemia amongst adolescent girls and boys. The long term goal is to break the intergenerational cycle of anaemia, the short term benefits is of a nutritionally improved human capital.
WIFS programme included- weekly supervised administration of Iron and Folic Acid supplements to in-school adolescent girls and boys and out-of-school adolescent girls, screening of target groups for moderate/severe anaemia and referral, biannual deworming and provision of information and counselling.
Tamil Nadu Mid-Day Meal Scheme /Nutritious Meal Programme (NMP)
Tamil Nadu was a frontrunner in the implementation of the scheme. A welfare State has the responsibility of ensuring an atmosphere in which children can grow with good health and good education. Poverty and hunger should not deprive a child from getting educated.
When children have to sit in class with empty stomachs, they cannot focus on learning. This scheme addresses the twin objective of improving nutritional status as well as enables the children to come to schools and remain there in school throughout the day. Further, it has had other social benefits, such as inculcating the practice of all children irrespective of social backgrounds eating together, involvement of the local community in monitoring the meals and thus increased parental encouragement in schools and in some cases allowed local produce to be used in the meals also.
It was launched in Primary Schools for classes I-V during 1st July 1982 and to Pre-school Children of 2-5 years in Rural areas. Subsequently, the scheme was extended to Nutritious Meal Centres in urban areas from 15-9-1982 and further extended to school students in the age group of 10 to 15 from September 1984. TN is the only state that provides eggs on all 5 working days (Monday to Friday).
Nutri Farms Scheme
A pilot scheme on Nutri Farms has been launched in 2013-14 with an outlay of Rs.200 crores to promote cultivation of bio-fortified food crops enriched with critical micro nutrients like iron-rich bajra, protein rich maize and zinc-rich wheat etc. to improve the nutrition status of the most vulnerable sections of the population of the country and it will add nutritional dimension to farming sector.
This programme has been implemented in 100 high malnutrition burden districts of 9 Northern and Eastern states. Under the scheme, micro-nutrient rich cultivars of cereal and vegetable crops namely, rice, pearl millet, maize, finger millet, wheat, sweet potato are promoted through cluster demonstrations and efforts were made for the procurement of the produce from such demonstrations and their supply/distribution among children for improving the nutrition level in the identified districts.
280 Cluster demonstration units (one unit – 10 hectares) of identified nutri-rich crops in each district will be organised through identified beneficiary groups by State Department of Agriculture. Assistance of Rs.5000 per ha for the crops [Cereal crops – Rice, Maize, Pearl millet, Finger Millet, Wheat and Horticulture crops – Sweet Potato and Moringa (drumstick) comes under this scheme will be provided to the farmers in the terms of critical inputs for organization of demonstrations of nutri-rich varieties of the identified crops.
National Food Security Mission (NFSM)
Under National Food Security Mission(NFSM), targeted additional production of 25 million tonnes of food grains comprising of 10 million tonnes rice, 8 million tonnes of wheat, 4 million tonnes of pulses and 3 million tonnes of coarse cereals by the end of XII Plan.
There are other promising features under the Act, such as free daily meals for children and maternity benefits, including cash for pregnant women, which can combat rampant undernutrition (calorie deficiency) and malnutrition (protein deficiency) across the country. These steps may perhaps complement the existing nutritional programmes such as mid-day meals and Integrated Child Development Services.
Now, availability of food grains, especially in the case of rice and wheat exceeds consumption requirement of food grains in the country. But, the level of malnutrition is not declining to desired extent and still there is deficiency of’ Iron, Zinc, Vitamin-A. The promotion of cultivation of micro-nutrients rich cultivars of these crops and development of their effective supply chain could help in reduction of malnutrition.
This was originally published in IMoT Agri Forum
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