India’s Covid-19 mitigation efforts should be to prevent child undernutrition now rather than to treat it later.
The recent announcement of several highly efficacious Covid-19 vaccines is excellent news for the prospect of ending the current global pandemic, but unfortunately it does not signal an end to the damage it has already caused. What started as a health crisis has developed into a severe economic crisis which disproportionately affects the poor. The World Food Programprojected that the number of people suffering from acute food insecurity will double from 135 million to 270 million by the end of this year. Food shortages and health system disruptions caused by Covid-19 are expected to increase the number of wasted children by an appalling 6.7 million in the first year of the pandemic. Wasting or thinness is a life-threatening condition, making children 3 to 12 times more likely to die than children with a healthy body weight. Recently, the Asian Development Bank projected that India’s GDP will decline by 9% this year. According to one estimate, a reduction of this magnitude could raise the number of moderately and severely wasted children in India from around 23 million before the onset of the pandemic to more than 26 million.
Unfortunately, this rise in child wasting and associated mortality, while devastating, is just a sliver of the damage being done. The consequences of the pandemic-fueled food and nutrition crisis will run much deeper. Reduced household incomes and limited access to foods rich in vitamins and minerals due to supply chain disruptions will leave the world’s most vulnerable people undernourished. This is not a finite problem that will simply end once the crisis has abated. In a recent study, we demonstrated that undernourishment early in life leads to negative outcomes that are both profound and irreversible. Lack of access to a diet that provides all the necessary nutrients can have severe lifelong consequences such as delays in neurocognitive development, lower educational attainment, and reduced earnings in adulthood as well as increased risk of chronic disease and premature death. These problems reverberate beyond undernourished individuals to hinder the future prospects of their societies as a whole. The Covid-19 response must therefore include targeted efforts to prevent child undernutrition from happening in the first place.
Yet even without the urgency of a pandemic diverting attention and resources, policymakers and development practitioners may put their hopes on recovery from undernutrition rather than prevention. For example, there has long been interest in the possibility of reversing stunting (children being too short for their age), a widely used marker for undernutrition — the assumption being that if children suffering from growth retardation could “catch up” to where they should be, they would dodge the broader consequences of undernutrition. But this is a faulty premise, because the negative outcomes are not actually caused by it.
Moreover, we reviewed evidence from adoption studies, neurocognitive and brain development, and developmental epigenetics and found that the effects of undernutrition and deprivation are lasting, that recovering from them is often impossible, and when it is possible, is partial at best — even when adverse home and societal conditions improve. The Bucharest Early Intervention Project, for instance, studied children who had lived in orphanages since birth. Those who went into foster care were able to completely catch up to standard growth levels. But while foster care restored the physical growth of these children, it could not undo all the damage to neural structure or cognitive functioning. A recent studyof subsistence-farming communities in the Gambia likewise showed that poor maternal nutrition around the time of conception induced stable changes in their offspring’s DNA methylation, permanently modifying the function of important genes.
There are important lessons in all this for responding to the ongoing pandemic. Foremost among them is that a key objective of India’s Covid-19 mitigation efforts should be to prevent child undernutrition now rather than to treat it later. It is of paramount importance to keep essential maternal and child health and nutrition services running so that mothers attend antenatal care and have a healthy pregnancy; infants are delivered safely with skilled birth attendants; and infants and young children are immunized, protected from, and treated for infections, receive micronutrient supplements as needed, and are breastfed and fed complementary foods according to recommendations. Households should also receive counseling about nutritious foods and healthy diets. Research evidence overwhelmingly indicates that these strategies are highly effective in preventing undernutrition if implemented well.
In addition, households should receive cash, food transfers, or vouchers to allow them to maintain healthy diets as they cope with the economic recession. Although India, like most low- and middle-income countries have expanded these types of social protection measures or launched new ones in the wake of the pandemic, their cost may be too high to sustain for many months. So governments, donors, and development practitioners must work together to help poor households cope with income loss. Finally, relief programs need to protect mothers and young children from unequal allocation of household resources, and from domestic violence and psychosocial stress.
We must take these steps now to prevent the pandemic from further undermining child nutrition. Failing to do so will have severe negative effects on children today and on the societies and economies that will depend on their contributions in the future.
(Jef Leroy is a Senior Research Fellow at the International Food Policy Research Institute (IFPRI). Marie Ruel is Director of the Poverty Health and Nutrition Division at IFPRI. Edward A Frongillo of University of South Carolina, Pragya Dewan of IFPRI, Maureen M Black of University of Maryland, and Robert A Waterland of Baylor College of Medicine also contributed to this op-ed)