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Author : Santosh Jain Passi,  Akanksha Jain

Article 47 of the Constitution documents that it is “duty of the state to raise the level of nutrition and the standard of living and to improve public health”. 

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National Nutrition week (1-7 September), initiated by the Food and Nutrition Board in 1982, is an annual event of immense significance.

It aims at intensifying nutrition/health related awareness among the masses which can profoundly impact productivity, economic growth and ultimately development of the nation. During this week, major emphasis is laid on nutrition education and training programmes carried out by the governmental/non-governmental organizations.

“The theme for 2016 is “Life Cycle Approach for Better Nutrition”

Nutrition constitutes the very foundation of human development by imparting immunity and, thus, reducing morbidity, mortality and disability. In addition, it promotes lifelong learning capacities and enhanced productivity. Malnutrition, on the other hand, tends to lower IQ and impairs cognitive ability of the children, thus, affecting their school performance and productivity in later life. Low-birth weight babies not only have impaired immune function but are at a greater risk of non-communicable diseases during their adulthood.

Global Nutrition Report-2016 clearly indicates how India still lags behind in tackling malnutrition effectively. Malnutrition manifests in the form of stunting, wasting, micronutrient deficiencies and over­weight/obesity. In terms of stunting, India ranks 114th out of 132 nations (incidence: 38.7%) while for wasting, it is 120th among 130 countries (incidence: 15.1%). Regarding anaemia prevalence among women of reproductive ages, India ranks 170th out of 185 countries (incidence: 48.1%) – and this is a matter of grave concern.

Over the years, the Government has accorded the highest priority to combat malnutrition among its people. The Integrated Child Development Services (ICDS) scheme was launched in 1975.

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ICDS is one of the world’s largest and most unique outreach programme for early childhood care and development and covers all the districts and blocks in the country.

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Similarly, the Mid- Day Meal Scheme was universalized in 1995. However, there is a lack of multi­sectoral coordination which is most essential to address the inter­generational and multifaceted nature of malnutrition.

Similarly, although, globally it is well acknowledged that focusing on the first 1000 days (conception to 2 years post-partum) is a critical window of opportunity to address child malnutrition; in India, focus of the nutrition programmes has chiefly been post­birth. Researches indicate that 50% of the growth failure accrued by the age of 2 years occurs in the womb itself, mainly owing to poor maternal nutrition –during and prior to pregnancy. Therefore, maintaining an adequate nutritional status (pre-conception and first trimester when majority of the women may not even be aware of their pregnancy) is rather crucial for appropriate foetal development.

Undernourished girls have greater chances of becoming undernourished mothers as they inevitably bear low birth weight babies, and thus, perpetuate an intergenerational cycle of malnutrition. This gets further compounded in adolescent mothers, who simultaneously carry the burden of two physiological stages (adolescence and pregnancy). This also holds true for closely spaced high parity pregnancies – often exacerbating nutrition deficits, which are passed on to their offspring/s.

For inclusive growth, under the eleventh 5­year plan, universalization of ICDS coupled with setting up of mini­ Anganwadi centers in deprived areas was undertaken; yet, there is a need to further strengthen ICDS in poor­ performing states based on the lessons learnt from various successful models.  Overhauling of ICDS by the Ministry of WCD (May 2016) is expected to improve nutrition scenario of the country.

The Government is now working on close Monitoring of the Nutrition programmes by digitisation of the Anganwadis.

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Anganwadis

This is expected to turnaround the entire system since it will help in real time monitoring of nutrition status of each child and take up immediate interventions wherever required. Similarly, diarrhoea has a direct impact on nutrition status of a child. Constructing toilets and providing clean drinking water are being taken up by the Government on a war footing to provide clean living conditions and good health to one and all.

In 2013, government passed the food security bill entitling 5 kg food grain/person/month at highly subsidised rates. It is commendable that food and nutrition security is being promoted through several national level programmes like TPDS, MGNREGA, ICDS and MDMS. Further, programmes like Swachh Bharat, ‘Beti Bachao, Beti Padao address critical nutrition­ sensitive issues. Fortification of food items especially those being distributed through the PDS is also being taken up to address the issue of malnutrition in the country.

A high level responsiveness is mandated to effectively manage the emergency situations like droughts, floods, and infection. It is important that nutrition related data are collected more frequently (currently gathered once in 5-7 years) to reflect the changing nutritional needs as well as impact of the nutrition interventions. It is important that a national nutrition strategy is designed to ensure that under-nutrition gets utmost priority. India’s nutrition challenges call for urgent action for ensuring faster, gender-sensitive, inclusive and sustainable growth.

Nutrition is a double edged  sword  both under and over nutrition being harmful…. 

…. Optimum nutrition combined with regular physical activity is the cornerstone of good health!!

*Dr Santosh Jain Passi – Public Health Nutrition Consultant; Former Director, Institute of Home          Economics, University of Delhi

* Ms Akanksha Jain Ph D Scholar, – works in the field of Public Health and Nutrition.

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