Every four years, at the Olympics, India faces the same question—why does its medal tally pale in comparison to the strength of its population? Some economists have tried to dig answers in distant but likely corners of history—child malnutrition. For decades, governments have been attempting to tackle hunger and malnutrition by making malnutrition a priority in the health agenda. However, due to the complex nature of malnutrition, many children in India are still suffering. This historical challenge seemed ready for a reset in March 2018, when Prime Minister Narendra Modi launched the Poshan Abhiyan.
The flagship programme charted out the path to reduce maternal and child malnutrition. Still, it also clearly stated that doing so will need a holistic approach—involving the convergence of the agriculture sector, water, sanitation, gender and health issues and other components. This paradigm shift of intersectoral convergence to address malnutrition promised to be a game-changer in improving nutrition-related indicators for women and children.
Add to this, the vision and commitment of the top leadership of the country in transforming Poshan Abhiyan into a Jan Andolan with the celebration of Poshan Maah meant that for the first time in history, an issue as complex as malnutrition was within the grasp of the general population, whose well-being was at stake. However, when the nutrition movement had been re-invigorated, targets reset, and programmes in different states were being set in motion, Covid-19 struck. Since then, the pandemic directly disrupted many components of the Poshan Abhiyan, as states struggled to cope with the damage the virus was inflicting.
Among the direct setback to nutrition interventions, closure of schools, mid-day meals, Anganwadi centres, Nutrition Rehabilitation Centres (NRCs) meant that channels to prevent and treat malnutrition stood choked in parts of the country. As schools shut, so did mid-day meal programmes, which remained the main source of nutrition for millions of children in India. Early in the pandemic, the Centre asked the states to address the need-gap through cash transfer or dry ration. But in the case of some states that opted for cash hand-outs, the sum was too small and came too irregularly in beneficiaries’ bank accounts to fully compensate for daily wholesome meals. In states where dry ration was distributed, it seems to have worked more effectively than cash transfers, but even that couldn’t have fully compensated the child’s needs when entire families were struggling for food.
With the Anganwadi centres staying shut for most of last year, Anganwadi workers getting diverted to Covid-related duties, the identification and referral of children suffering severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) and other services under the Integrated Child Development Scheme (ICDS) suffered. The NRCs which treat the most severely malnourished children as in-patients were closed during lockdowns, and even at places where they were open, parents avoided approaching them for fear of getting infected. This means severely malnourished children mostly live in their homes without any medical care and most likely without adequate supplementary nutrition. Data from the district of Nandurbar in Maharashtra shows that out of 15,256 children surveyed in 2021, 1.48% or 220 children and 11.9% or 1765 children suffered from SAM and MAM, respectively. Further, a staggering 27.17% and 7.98% of the total surveyed children were moderately and severely underweight. Considering social distancing norms are here to stay, we must find robust alternative ways to manage children suffering from SAM and MAM in their communities by strengthening community management guidelines. In this prolonged period of crisis, we also do not know how many moderately underweight children have slipped to suffer SAM, and how many more children, who may not have suffered malnutrition in normal times, are now suffering MAM because of indirect consequences of Covid-19.
The protracted pandemic period— hitting in waves, destroying lives and livelihoods— is also when vulnerable sections of the population already living in nutrition insecure contexts are at risk of getting pushed deeper into the poverty-malnutrition trap. Amid job losses, reduced income, depleted savings, families may switch to less expensive sources of calories and poorer quality diets, which can increase the risks of undernutrition, particularly micronutrient deficiencies.
It’s hard to measure the combined effects of Covid-19 accurately triggered disruptions to economic, food and health systems on maternal and child undernutrition, but it is important to model different possible scenarios in future and prepare nutrition interventions for those. We must also find ways to increase financing for nutrition interventions and expand the safety net to cover more vulnerable populations. We must actively search, screen, identify and treat children suffering moderate and severe malnutrition in their communities, as service delivery must adapt to Covid-19 enforced realities.
The announcement of Poshan 2.0 in this year’s budget speech shows that nutrition remains a priority where the national leadership is invested. However, its targeted implementation by states, coming together of stakeholders to understand and adapt to Covid 19 -induced additional nutritional crisis will determine whether we can give our children the right start in life. Malnutrition is transmitted across generations, and its full resolution at the population level is also an intergenerational process. Only if we can address child malnutrition today can we expect our youth to reach their full potential tomorrow in all walks of life, including bringing home those missing medals in Olympics.
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