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Mainstream, VOL LIX No 32, New Delhi, July 24, 2021

Addressing the Nutrition Crisis in India in the time of Covid 19 Pandemic | Chathukulam & Joseph

Friday 23 July 2021

by Jos Chathukulam and Manasi Joseph *

Abstract

This article briefly examines the status of nutrition in India before the onset of the Covid 19 pandemic and after the outbreak. It also suggests how Mahatma Gandhi’s simple and local diet along with self -sufficiency could have helped India in addressing the malnutrition crisis India have been suffering for decades.

Nutrition Status in Pre Covid India

India has been grappling with all forms of malnutrition for decades. The latest National Family Health Survey (NFHS 5) [1] for the year 2019 -2020 reported a high prevalence of malnutrition among children under five years of age. In the case of stunting (low height for age), wasting (low weight for height) and underweight (low weight for age) — all three key indicators related to nutritional status have worsenedin the country, as per the NFHS 5. Anaemia is widespread and is prevalent among all age groups. According to NFHS 4, over 53 per cent of pregnant women and over 58 per cent of children under five were found anaemic. The latest NFHS 5 also shows that there has been an increase in the prevalence of anaemia among young children, adolescents, pregnant women, non-pregnant women and even men. As many as 68.40 per cent children and 66.40 per cent women surveyed suffer from anaemia. The first phase results of the NFHS 5 are based on the data collected in the pre-pandemic era and that the second phase might reveal a far worse reality as it will take into account the damage done by the pandemic as well.

The 2016 — 2018 Comprehensive National Nutrition Survey (CNNS), the largest micronutrient survey and the first ever nationally representative nutrition survey of children and adolescents in India also showed that 34.70 per cent of children under five are stunted, 17.30 per cent wasted and 33.40 per cent underweight. The 2019 State of Worlds Children Report by United Nations Children’s Fund (UNICEF) stated that 69 per cent of deaths among children under five years of age can be attributed to malnutrition in India.

India is home to half of the wasted children globally (Global Hunger Index Report, 2020).Child wasting is an indicator of acute undernutrition. According to WHO and UNICEF, India has the highest number of Severely Acute Malnutrition (SAM) children in the world with 9.3 million children below the age of five severely wasted, particularly worrying because children with SAM are nine times more likely to die than their well-nourished peers and tens of thousands of young Indian children suffering from SAM go untreated every year.

In the case of inadequate infant and young child feeding practices. The NFHS 5 survey indicates a decline in early initiation of breastfeeding in 12 states/union territories. Meanwhile, the period between 2005-06 to 2015-16 saw some improvement in the nutrition indicators in the country with the overall prevalence of stunting reducing from 48 per cent (NFHS-3) to 38.4 per cent (NFHS-4). It was mainly due to increase in real wages and expansion in a slew of social security schemes. However, post 2016, the economic slowdown and stagnation in wages of the poor have reduced the access of common people to consume good quality nutritious food at an affordable cost and the Covid 19 pandemic has further worsened it.

Nutrition Status in the Time of Covid 19 in India

The first and second waves of Covid 19 had a negative impact on the child and adult nutrition in the country. Children as well as economically disadvantaged are deprived of nutritious food. Food security has been threatened especially in the case of the poorest of the poor due to the pandemic induced lockdown. India have already various programmes aimed at ensuring food security including Mid Day Meal Schemes at schools, Anganwadi Centres (AWCs) under Integrated Child Development Services (ICDS), POSHAN Abhiyan and schemes like Pradhan Mantri Matru Vandana Yojana (PMMVY) and these schemes have helped in addressing the nutrition crisis to a little extent. But following the pandemic induced lockdown, the deliveries of such services and programmes have taken a backseat. Following the lockdown schools were shut and as a result hundreds of children were deprived of mid -day meals at school. When schools were functioning, a child will get a fistful of rice with some vegetables, eggs, and lentils on her plate as a standard meal. But following the pandemic this remains inaccessible. Similarly, 1.3 million AWCs across India also remained closed following the lockdown. AWCs are entrusted with the delivery of preschool education but also health and nutrition services of vulnerable children and their mother under ICDS. India launched ICDS in the mid 1970s with the goal of improving the nutrition, health, and development of children from birth to age six, and to monitor and educate pregnant and lactating mothers, adolescent girls, and women between 15 and 44. ICDS services are offered through AWCs.

In every AWC there are anganwadi workers and they are assisted by an anganwadi helper; an auxiliary nurse midwife who provides health services to pregnant and lactating women and assist in delivery; and an Accredited Social Health Activists (ASHAs). The anganwadi workers provide take home ration to children, pregnant women, lactating mothers, and adolescent girls. In the aftermath of Covid 19 and lockdown, the anganwadi workers, ASHAs and frontline health staff are overburdened with Covid 19 duties and they have little or no time to monitor the nutrition status of the children and women in their community. Thus the reliable sources for nutritious food for women and children have been closed for a while. Meanwhile, following the first nation wide lockdown in India in March 2020, the government launched Pradhan Mantri Garib Kalyan Anna Yojana Scheme. Under this scheme, beneficiaries of public distribution system (PDS) were entitled to an additional 5 kg of food grain. But that did not solve the hunger and nutrition problem on a large scale as millions of people are excluded from PDS. For instance, based on the population projection for 2020 — over 1,371 million people- the number of people covered under National Food Security Act should have been around 919 million. But only 804 million people were identified under Pradhan Mantri Garib Kalyan Anna Yojana Scheme for additional food grain allocation from July 2020 to November 2020. That is nearly 115 million people who could have been eligible were excluded both from the National Food Security Act and the scheme. Though government allowed those with no ration cards to avail the benefits from PDS shops, it did not go smoothly in many parts of the country as even those holding ration cards had a hard time in availing their due. This in a way made food grains inaccessible to those in need. Lack of nutritious meals will worsen the malnutrition among children and marginalized sections of the society. It will have long term impacts on their health and well being and is already undoing the small progress made over decades in India reducing malnutrition. According to the Child Well Being Report 2020 by World Vision India [2], the Covid 19 pandemic and lockdown has put 115 million children at the risk of malnutrition.

Due to decline in household incomes and loss of jobs, parents in rural as well as urban areas are unable to feed their children and themselves. Thus the bleak social and economic conditions in the aftermath of Covid-19 have pushed the nutrition to a back seat. Despite the worrying developments, the 2020 — 2021 Union Budget decreased allocations to the Women and Child Development Ministry by as much as 18 per cent. The allocations for Poshan Abhiyan have been slashed by a sharp 27 per cent, from Rs. 3,700 crores to Rs. 2,700 crores. (Union Budget 2020 -2021, Government of India).

As per the Global Nutrition Report 2020 [3], India will miss targets for four nutritional indicators which include stunting among children under 5, anaemia among women of reproductive age, childhood overweight and exclusive breastfeeding. The report also highlighted India as a country with the highest rates of domestic inequalities in malnutrition (Chathukulam et al. 2020)

“Inequity is a cause of malnutrition — both under-nutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle,” says the report. (Global Nutrition Report 2020, p.10).

Though early research and studies suggested that elderly people, especially with comorbidities are more at the risk of getting infected by Covid-19, the recent studies prove thar children are not immune from contracting Covid—19. Health experts have warned that the third wave of Covid-19 pandemic can prove fatal to children. This is a wake up call for India as children suffering from malnutrition and other diseases have weak immune system and thus, they are at high risk of contracting the novel coronavirus case and in worst cases it can even lead to death. Consumption of healthy food is a sine qua non for maintaining a good and healthy immune system for children and adults. Those overweight and obese are also prone to Covid 19. The status of nutrition in the post Covid India can turn into a nightmare if we as a society fail to come up with a strategy to fight malnutrition and to build a comprehensive and inclusive food policy. Rather than blaming government and policy makers, it’s high time if we open our eyes to make a collective effort to provide accessible and nutritional food to those around us.

The Relevance of Gandhian Diet in the Time of Covid 19 

Mahatma Gandhi has always been an advocate of simple and local foods. Gandhi always advised to consume locally grown vegetables, fruits, nuts, cereals, and grains. He always preferred low fat foods that are less sugary, less oily, and less salty. There is nothing wrong if someone calls Gandhi as the first nutritionist and dietician in India. The Gandhian Diet purely focused on “the cheapest nutritious diet for the poor”. Healthy foods suggested by Gandhi decades ago can act as a solution for the various lifestyle diseases plaguing the population of India. The simple diet adopted by Gandhi can be used to address the nutrition crisis in the wake of Covid—19 (Chathukulam et al, 2020). Gandhi disregarded polished food, refined sugar, fried foods, and high trans-fat vanaspati ghee and favoured goat milk, soyabean, raw tomatoes, green leaves, and other locally fresh produces.To stay healthy and increase our immunity we have to consume fresh vegetables, pulses, and fruits. In this juncture, Gandhiji’s simple and affordable dietary practices can help us to stay healthy. Fruits like oranges, lemons were preferred by Gandhi and in the wake of Covid-19, drinking lemon juice was considered as a way to boost immunity. Fresh fruits. greens and vegetables are filled with nutrients and are helpful in maintaining good health and immunity. Gandhi was in favour of consuming raw uncooked food whenever possible. In India, the poor often struggle to gain access to sufficient food of any kind. Gandhi hoped that raw food would solve this problem. But in the recent times, even raw food remains inaccessible to poor and accessible to affluent due to rampant urbanization and commercialization. Those simple fruits, vegetables preferred by Gandhi are no longer affordable to the poorest of the poor in India now. So the solution to this is ‘self-sufficiency’ at local level as advocated by Gandhi and in the recent times it can be amended as to ‘self sufficiency at household level’. To incorporate Gandhi’s diet into our daily lives, we have to attain self sufficiency in food production. Anyone can grow locally fresh vegetables and fruits right from the backyards of their houses or even small kitchen spaces. Agriculture sectors serves as the backbone of our country as it contributes 17 per cent of the GDP and a lot of people in the country are into agriculture and allied activities to make the ends meet. However, the pandemic induced lockdown has cripple agriculture sector. It has led to shortage of food items, the prices for essential items has gone up and this can lead to poor food security and poor consumption of food which will have a negative impact on health and nutrition of the young and the old. The Covid 19 pandemic has taught us the importance of food security and self sufficiency and we have simple and affordable solutions top accomplish this in the Gandhian way. Looking through the lens of Gandhi even today can act as a solution to the major and minor problems India face today but we often fails to do so thinking those visionary lens are too outdated for our eyes and minds.

Authors: Jos Chathukulam (joschathukulam[at]gmail.com) is former Professor, Sri Ramakrishna Hegde Chair on Decentralization & Development, Institute for Social and Economic Change, (ISEC), Bengaluru. He is currently the Director, Centre for Rural Management (CRM), Kottayam, Kerala, 686 016. & Manasi Joseph (manasijoseph[at]gmail.com) is Research Associate, Centre for Rural Management (CRM), Kottayam, Kerala, 686 016.)

References

1. Chatukulam, Jos; Joseph, Manasi; & V Rekha. 2020. Navigating the Report of the Comprehensive National Nutrition Survey (CNNS) from a Gandhian Perspective, Gandhi Marg Quarterly, Vol. 42. Issue No: (1& 2) pp: 25-82.

2. Union Budget 2020 -2021, Government of India.

3. Global Hunger Index Report, 2020.

4. Global Nutrition Report 2020, p.10.

5. National Family Health Survey (NFHS 5), 2019 -2020. International Institute for Population Sciences, Mumbai, India.


[1Dr. Harsh Vardhan, former Union Minister of Health and Family Welfare, Government of India, released the Factsheets of key indicators on population, reproductive and child health, family welfare, nutrition and others for 22 States/UTs of the first Phase of the 2019-20 National Family Health Survey (NFHS-5) on Universal Health Coverage Day on 12th December, 2020.The NFHS factsheets that are available pertain to 17 states and five Union Territories — put together they roughly account for half of India’s population.

[2A non -governmental organization that work towards helping underprivileged children

[3India along with 88 other countries are likely to miss the global nutrition targets by 2025. In 2012, the World Health Assembly identified six nutrition targets for maternal, infant, and young child nutrition to be met by 2025. These require governments to reduce stunting by 40 per cent in children under 5 and wasting to less than 5 per cent. The prevalence of anaemia should be reduced by 50 per cent among women in the age group of 19 — 49 years and ensure 30 per cent reduction in low — birth weight and no increase in childhood overweight. It also called for increasing the rate of exclusive breastfeeding in the first six months up to at least 50 per cent.

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