The National Family Health Survey (NFHS-5) released in November indicates a slow improvement in India’s malnutrition situation. The problem remains persistent, widespread and serious, with one in five and one-fifth of women being malnourished, and up to a quarter of women who are overweight. More teens and women are anemic than every other child. This is despite substantial positive trends in maternal-child health services, including antenatal care (ANC) services, child immunization and diarrhea management, which, in addition to nutrient intake, are immediate determinants of maternal and child nutritional status. Interestingly, there has also been significant improvement in addressing the underlying causes of malnutrition, such as improved sanitation services, and on proxy indicators of women’s empowerment: low total fertility rates, 10 years of schooling, mobile phones and their bank accounts. ownership of, access to clean cooking fuel, marriages after 18 and a reduction in husband-wife violence. These positive results were achieved through greater political commitment, a systematic push to Jan Dhan Yojana and Mission Indradhanush under National Health Mission and Janani Suraksha Yojana, Swachh Bharat Abhiyan, Ujjwala Yojana, Beti Bachao Beti Padhao and women’s self-help. initiatives such as Group.
So, where are we failing? Unfortunately, these positive trends are not in agreement with other notable and needed nutritional interventions during the first 1,000 days of life (270 days of pregnancy and 730 days 0–24 months), the ‘window of opportunity’. We do not have a maternal nutrition policy, but have an infant and young child feeding (IYCF) policy since 2000. Promoting IYCF practices, such as ensuring exclusive breastfeeding and ‘effective’ nursing for the first six months, remains vulnerable to semi-solids suitable for supplementation with subsequent introduction breastfeeding. Rupal Dalal of CTARA at IIT-Bombay conducted a study in Gujarat’s Banaskantha district, which showed that mothers trained in breastfeeding and breastfeeding skills by health workers during ANC and postpartum care (PNC) made significant gains. Only 9.8% of such trained mothers were underweight at six months, compared to 18.1% of untrained mothers. NFHS-5 data suggest that dietary supplements containing semi-solids also need attention. Only one in 10 babies above 6 months of age receive adequate feedings made up of items from at least four food groups at 6-8 months with the recommended frequency of semi-solid foods being fed 3-4 times a day .
In other Asian countries the situation is almost five times better. The main reason for our poor performance is lack of information. We cannot ignore the fact that 20% of malnourished children are from the communities with the highest wealth index. Additionally, families with overweight mothers often have malnourished children. Caregivers are not well informed about what, when and how often to feed a child over six months of age and whether to continue breastfeeding. Poor IYCF practice also contributes to an increased likelihood of obesity, micronutrient deficiencies and adult-onset non-communicable diseases. Often parents are unaware of the harm caused by improper feeding, take pride in spending 25-30 per day on feeding packaged breakfast to your children in place of family made pulses, curd, vegetables, ghee, eggs. The belief that 6-8-month-old babies cannot swallow semi-solids is often fed watery pulses instead of khichdi. The NFHS-5 findings confirm that we have failed to make the behavioral changes necessary to improve nutritional care during the critical first 1,000 days of life – a core strategy of the National Nutrition Mission.
Frequent mutual consultation by health workers/medical teams at the right time is essential. Integrated Child Development Services (ICDS) scheme is our flagship program for this, but the caregivers/mothers are not reaching adequately. In contrast, public health systems that are in charge of ANC, child delivery, PNC, home-based neonatal and young child care and immunization services must have at least 15 contact opportunities with mothers from the beginning of pregnancy to the beginning of pregnancy. get the benefit of. The baby is 16 months old, and can affect nutritional practices. However, under government regulations, this public health system is not the principal agency responsible for preventive nutrition interventions such as promoting children’s diet in India, although it is in charge of managing institution-based care of children with anemia, obesity and acute illness. Is. Malnutrition.
Nutrition care is divided between our health system and the ICDS into prevention and care. Between the two, solving prevention problems at the community level is a convenient notion, but in actual practice, it is highly impractical and time-consuming, as pointed out by nutritionists.
To make a real difference in nutritional care practices and service delivery, it is time for the government to explore alternative nutrition delivery mechanisms. Policy makers should examine whether the regular health system should be empowered to intervene instead of ICDS. Integrating the human resources of ICDS with our primary health system will strengthen the mother-child nutrition and healthcare workforce and teamwork. This can effectively reduce child mortality, as 68 per cent of India’s under-5 mortality is linked to undernourishment.
Sheela C. Veer is Senior Nutritionist and Founder Director, Center for Public Health Nutrition and Development, Delhi
Never miss a story! Stay connected and informed with Mint.
download
Our App Now!!
,