Kurukshetra August 2023

ADEQUATE NUTRITION FOR WOMEN AND CHILDREN

Women’s nutrition directly influences their own health, which in turn affects the well-being of their children and the family as a whole.
Inadequate intake of nutritionally appropriate diets - both In terms of quantity and quality, can lead to malnutrition, deficiency diseases, and other ailments/ disorders as well as lower life expectancy.
Malnutrition and poor health among women, both prior to-and during pregnancy, is a matter of serious concern; it may lead to high incidence of low-birth weight (LBW)/ pre-term deliveries, stillbirths, and abortions, as well as high maternal mortality rates.
Anaemia among pregnant women is an established cause of higher maternal mortality during childbirth.
Nutrition education highlighting the importance of appropriately balanced diet and eating right needs to be imparted to everyone irrespective of their age, gender, education, class, and creed.
As per the latest National Family Health Survey 201921 (NFHS-5), 18.7% women In the reproductive age group (1549 years) have a body mass index below normal (BMI<18.5 kg/m?) and 57% of them suffer from anaemia.
NFHS-5 data also reveals that of the children aged less than five years, nearly 35.5% are stunted (low height-for- age), 19.3% and 7.7% wasted/severely wasted (low weight-for height) and 32.1% underweight (low weight-for- age); this again highlights an alarmingly high prevalence of malnutrition among children.
The figure below shows the Estimated Average Daily Requirement of Energy, Protein and Visible Fat for Men, Women, Children & Adolescent Girls (Adapted from ICMR-NIN, 2020; 2023)
In India, unhealthy diaetary pattern and nutritional deficiencies remain a public health problem; and achieving food, nutrition, and health security a major challenge.
Most of our nutrition programmes have primarily focused on feeding-centred interventions post childbirth while it is well known that 50% of the growth failure in children accrued by the second year occurs during their foetal life owing to poor maternal nutrition - both prior to and during pregnancy.
The National Nutrition Policy (1993) and the National Plan of Action on Nutrition (1995) have laid ample emphasis on the importance of adequate nutrition for women and children.
NITI Aayog (Government of India) drew up the National Nutrition Strategy document entitled “Nourishing India”.
This document emphasises the importance of reducing/preventing undernutrition across the life cycle, especially during the first three years of life, so as to prevent irreversible and cumulative growth/ development deficits compromising their health and survival.
Prime Minister’s Overarching Scheme for Holistic Nutrition - POSHAN Abhiyan,the flagship programme of the Ministry of Women and Child Development (Gol), is Implemented in a mission mode for improving the nutritional outcomes of children, pregnant women, and lactating mothers.
It involved convergence of various programmes, such as Integrated Child Development Services (ICDS), Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for Adolescent Girls (SAG), Janani Suraksha Yojana (ISY), National Health Mission (NHM), Swachh Bharat Mission, Public Distribution System (PDS), Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), and initiatives of the Ministry of Drinking Water & Sanitation.
In 2022, the Government of Indla approved the Integrated Nutrition Support Programme “Saksham Anganwadis and POSHAN 2.0” which seeks to address the challenges of malnutrition in children (till 6 years), adolescent girls (14-18 years), pregnant women and lactating mothers through a strategic shift in nutrition content and delivery of services.
For bridging the nutritional gaps, supplementary nutrition including morning snacks, hot cooked meals and takehome ration (THR) are provided to children till the age of 6 years (including SAM Children), adolescent girls (14-18 years), pregnant women, and lactating mothers at the Anganwadi Centres for a minimum of 300 days/ year; diversified diet including locally available fresh foods, fortified rice and millets are provided to the beneficiaries.
Conditional cash transfer schemes – Pradhan Mantri Matru Vandana Yojana (PMMVY) and Janani Suraksha Yojana (SY) cater to the needs of pregnant women/lactating mothers by providing them cash incentives on fulfilling certain conditions.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA; Ministry of Health & Family Welfare) aims at providing assured, cost-free, comprehensive, and quality antenatal care to all pregnant women on the 3™ day of every month and guarantees 3 minimum package of antenatal care services to women in their 2°/3” trimesters of pregnancy.
JananiShishu Suraksha Karyakram (JSSK), launched in 2011 aims to achieve 100% institutional delivery and elimination of out of pocket expenditure for both pregnant women and the sick neonates.
Pregnant women are also entitled to free of cost facilities such as cashless-delivery/caesarean section, drugs/ consumables, diagnostics, daily diet (during the stay), transport, etc.
The Poshan Tracker — a governance tool by the MoWCD (2021) is envisaged to bring transparency and strengthen the nutrition delivery support systems.

Conclusion

Although there are numerous well-planned initiatives undertaken for tackling malnutrition and ensuring adequate nutrition among women and children, the real challenge lies In their effective implementation; and to some extent, this can be overcome by regular monitoring, evaluation and innovative modifications of the schemes as per the need at the grassroots level.

PROMOTING HOUSEHOLD FOOD AND NUTRITION SECURITY

Nutrition security is achieved ‘when all people at all times consume food of sufficient quantity and quality in terms of variety, diversity, nutrient content and safety to meet their dietary needs and food preferences for an active and healthy life, coupled with a sanitary environment, adequate health, education and care’ (FAQ, 2012).
The causes of food and nutrition insecurity are complex, interconnected, and derive from structural and economic constraints.
Poverty is the root cause of nutrition insecurity. Lack of access to education, affordable housing, and healthcare, transportation, employment, and living wages can impact a household’s ability to access adequate and nutritious food.

Pillars of Household Food and Nutrition Security

It encompass a range of interconnected factors such as-

Food Availability: This pillar focuses on ensuring an adequate and consistent supply of diverse food options.
FoodAccess: It includes factors such as affordability, physical access to markets, infrastructure for storage and transportation, and social safety nets.

Strategies to improve food access include promoting income-generating opportunities, improving market infrastructure, ensuring fair and transparent pricing, and implementing targeted social protection programmes for vulnerable populations.

3.Food Utilisation: It focuses on maximising the nutritional value of food and ensuring optimal health outcomes.
4.Food Stability: This refers to the ability of households to maintain access to food during shocks and crises.
5.Governance and Policy- It involves the development and implementation of coherent policies, strategies, and programmes that address all dimensions of food security.
6.Empowerment and Capacity Building: It involves empowering individuals and communities to make informed decisions about food choices, promoting gender equality, and strengthening local institutions and community participation.

Key methods for ensuring households to have access to sufficient, safe, and nutritious food are as:

Sustainable Agriculture Practices
Diversification of Food Production
Enhancing Access to Inputs and Technologies
Social Protection Programmes
Nutrition Education and Behaviour Change
Strengthening Health and Nutrition Services
Policy and Governance
Research and Innovation

Achieving household food and nutrition security in India is crucial for meeting the Sustainable Development Goals (SDGs). Promoting household food and nutrition security in India contributes to SDGs in following ways-

SDG 1: No Poverty- By ensuring access to sufficient, nutritious food, vulnerable households can break the cycle of poverty, improve their health and productivity, and enhance their overall well-being.
SDG 2: Zero Hunger- By ensuring that all individuals have access to nutritious food year-round, India can significantly reduce hunger and malnutrition.
SDG 3: Good Health and Well-being- nutrition security contributes in reducing undernutrition, stunting, wasting, and micronutrient deficiencies, leading to improved overall health and well-being.
SDG 5: Gender Equality- Empowering women with knowledge, resources, and decision-making power in food production and consumption can contribute to achieving gender equality.
SDG 12: Responsible Consumption and Production- By encouraging the production and consumption of diverse and locally grown foods, India can reduce food waste, conserve biodiversity, promote sustainable farming methods, and minimise and environmental impact of agriculture.
SDG 13: Climate Action - Promoting climate smart agriculture, agroforestry, and sustainable farming practices can enhance resilience to climate change, reduce greenhouse gas emissions, and mitigate the environmental impact of agriculture.
SDG 17: Partnership for the Goals- Achieving household food and nutrition security requires strong multi- stakeholder partnerships.

Promoting kitchen gardening can play a significant role in enhancing househeld food and nutrition security in India by increasing access to fresh and nutritious food, promoting sustainable agriculture practices, and empowering individuals to take control of their own food production.
Dietary diversification is crucial for enhancing household food and nutrition security in India.
Dietary diversification refers to the inclusion of a wide variety of foods from different food groups to ensure a balanced and nutrient-rich diet.
Food fortification is a strategy aimed at enhancing the nutritional value of food by adding essential vitamins, minerals and other nutrients. It also plays a crucial role in attaining household food and nutrition security.

Governmental Initiatives for Promoting Food and Nutrition Security:

The National Food Security Act (NFSA, 2013) aimed to provide for food and nutritional security by ensuring access to adequate quantities of quality food at affordable prices.
Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) is a new Integrated Food Security Scheme that has been approved to provide free food grains to Antyodaya Anna Yojana (AAY) and Primary Household (PHH) beneficiaries from 1 January 2023.
Under the Pradhan Mantri Matru Vandana Yojana, registered women have been provided Rs 5000/- on the birth of their first child for wage support and nutritious food during pregnancy and post-delivery period.
Poshan Maah is celebrated every year to strengthen the efforts of the Government to address malnutrition in the country and to involve the country’s wide population through a Jan Andolan.
Saksham Anganwadi and Poshan 2.0 is an Integrated
Nutrition Support Programme that seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women, and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness, and immunity.
Under Pradhan Mantri Poshan Shakti Nirman (PM POSHAN), there is provision of hot cook

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