We have only a small window of opportunity before our demographic dividend ends. We must make the most of it.
To address the challenge of malnutrition, we need a basic understanding of the social, behavioural and cultural practices that promote healthy dietary behaviour, both at the individual and community level.
As pointed out by Edward Fischer, ‘Food is more than macro- and micronutrients, it is intimately linked to identity and social relations.’ Food and nutritional practices passed on through the generations have shaped social identities.
Annadana, the sharing of available food resources, has been a common cultural practice in India, and continues to be an important aspect of people’s way of life. The concepts of annabahulya (growing an abundance of food) and annadana traditionally formed the essence of dharmik living in our country. In fact, annadana was recognized as the most effective way of a civilized living. As pointed out by J.K. Bajaj and M.D. Srinivas of the Centre for Policy Studies, this noblest of all acts is considered to be the foundation of civilized living.
‘Indians in the past have laid extraordinary emphasis on growing food in abundance and sharing it in abundance. In fact, Indians, up to the present times, seem to have always looked upon an abundance of food as the primary condition of civilization, and sharing of food was for us the primary discipline of civilized living. And indeed it is the discipline of civilised living that we call dharma. This attitude towards food and the sharing of food is enshrined in the most basic texts of Indian antiquity. A text like the Taittiriya Upanishad, gives expression to this Indian attitude towards food with unsurpassable intensity.’
While traditional Indian dietary practices and culinary culture have taken care of our nutritional needs in a myriad ways, over the decades, our food cultivation and consumption patterns have undergone significant shifts. If we are to address the challenges of hunger and malnutrition comprehensively, we need to revisit and learn from ancient traditions and cultural heritage. For instance, we would do well to encourage the cultivation and consumption of traditional foods. Millets like ragi, jowar, and bajra, which were an integral part of traditional Indian diets, have been replaced by wheat and rice, which are also more profitable to grow. Millets are still grown in many parts of the country, however, and including them in our diets will help improve the overall nutritional status of people.
While adopting strategies to tackle malnutrition, it is also essential to consider local diets, availability of food and in-season food. Fruits and vegetables begin to lose their nutrients within two or three days of harvest, so fresher produce is more nutritious. Eating seasonal food is always a better choice. Foods that are available throughout the year are likely to have more preservatives and ripening agents in order to extend their shelf life. Similarly, local diets and culinary traditions are often rooted in local weather conditions and the culture of communities. If one were to remove fish from the diet of many of our coastal communities, for instance, we would take away a lot of vital nutrition, irreplaceable through food items brought from other regions.
Keeping the importance of local foods in mind, the Ministry of Women and Child Development is working on developing the Poshan Atlas or the Bharatiya Poshan Krishi Kosh. The Atlas will map the crops and foodgrains grown in different regions of the country to promote diverse, local, protein-rich foods. It will allow us tomake changes at the local level to suit the needs and requirements of the population, ensuring adequate supplies of nutritious, locally available food and improving nutritional outcomes. The levels of malnutrition in India are high, and successive governments have tried to address the problem. Several programmes across different ministries have been dealing with it. The Integrated Child Development Services (ICDS) scheme, one of the largest preschool programmes in the world, provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under six years of age, and their mothers. The Mid-Day Meal Scheme provides lunch to children in primary and upper-primary classes of government and local schools across the country. These twoschemes together constitute the backbone of India’s efforts to end malnutrition. The National Food Security Act, 2013 has made food an issue of rights, and not of welfare.
However,historically, many programmes and schemes have worked in silos. Malnutrition is a complex, multidimensional issue, impacted by a number of socio-economic factors including poverty, inadequate food consumption caused by problems of access and availability,inequitable food distribution, improper maternal, infant and childcare practices, inequity and gender imbalances, poor sanitary and environmental conditions, and restricted access to quality health, education and social care services. It needs a multisectoral and multi-pronged solution. One sector, one organization, or one scheme alone cannot tackle this problem.
The government has recognized this and accorded the highest priority to malnutrition. While several ideas are converging to tackle India’s burden of malnutrition, the prime minister’s inspired vision of a Jan Andolan, a janbhagidaari or people’s movement, will lead the way to a malnutrition free India. A Jan Andolan will make people aware of the interlinkages between nutrition and health and build health-seeking behaviour. Any initiative will not have the desired effect until its beneficiaries respond and take action, becoming stakeholders in their own nutritional outcomes and improving their own health. To convert motivation intoaction, the Poshan Abhiyaan provides some simple, doable strategies to involve people.
The stronger the communication on health and malnutrition, the greater will be the impact of the Poshan Abhiyaan or National Nutrition Mission. While the central government has an important role to play in envisioning far-reaching policies and pushing progress on our nutrition goals, state governments also need to be vigilant and proactive. Health is a state subject in India, which means that though fund allocation, policy and legislation are decided at the central level, states have a wider scope of implementation of these policies and legislations and can do more than what the Centre prescribes.
However, progress in promoting nutrition is not uniform across the country, as is evident in the stark inter-state variations in nutritional status. The onus also lies with the state governments to ensure that these programmes and services reach the last mile. While the government is responsible for coming up with far-reaching policies, it is incumbent upon all of us, including political representatives, experts, health workers and grassroots organizations, to take up the mantle and help improve nutrition in the country. Given the complexity of factors that cause malnutrition, especially lack of access to water and sanitation and poor hygiene, no single intervention will achieve lasting results. Improving nutrition outcomes effectively and sustainably calls for a coordinated, multi-sectoral approach among the health, water, sanitation and hygiene (WASH) and agricultural sectors, along with strong community engagement. The Poshan Abhiyaan recognizes the need for multi-stakeholder coordination, and calls upon multiple sectors – beyond health – to combat nutrition and food insecurity in the country. It aims to synergize resources, departments, and frontline workers by leveraging technology to achieve the desired goals.
There is a need for on-ground operational guidance for the Poshan Abhiyaan to ensure that multiple programmes effectively reach the motherchild duo within the first 1,000 days of a child’s birth – the critical period for nutrition for both child and mother. Proven and simple interventions exist to combat undernutrition, such as exclusive breastfeeding, appropriate complementary feeding practices, micronutrient supplementation where needed, handwashing with soap, and use of hygienic toilets. Child health and nutrition is nested within the spectrum of childcare and development. In the past, nutrition care interventions focused only on treating malnutrition, and overlooked environmental, social and economic factors. Poshan aims to integrate programmes such as Swachh Bharat,Pradhan Mantri Matru Vandana Yojana, Mission Indradhanush (immunization programme) and supplementation programmes to improve the coverage and quality of all essentialnutrition actions. We also need improved and more effective mechanisms to capture the on-ground impact of various nutrition linked programmes in the country. The Poshan Abhiyaan is now providing a platform for convergence and we are hopeful that we will soon begin to see changes at every level – community and state. As we work to build a movementamong the masses, it is equally important that we create mechanisms to ensure regular monitoring and evaluation of programmes and interventions at the district/village levels.
In this respect, political representatives have a far greater role to play in ensuring sustained implementation of on-ground interventions. They enjoy a great connect and following in their constituencies and districts. We must leverage this reach to spread awareness on good nutrition practices and encourage uptake of nutrition services, particularly among pregnant and lactating mothers. Political representatives and legislators must also be involved inorder to build ownership and accountability for monitoring nutritional outcomes in their constituencies. They must also be empowered with the tools to monitor nutritional outcomesand assess the prevailing challenges in their respective areas.
By including nutrition as a discussion point in DISHA (District Development Coordination and Monitoring Committee) meetings, parliamentarians must regularly hold reviews to track progress of activities and gauge their impact. Through flagship programmes such as the Sansad Adarsh Gram Yojana (SAGY), members of parliament can work to build model nutrition villages in their states anddistricts. National strategies, focused on maternal health and other high-impact interventions, have dramatically improved health outcomes across India, but more work remains to be done.
Average life expectancy has risen from 64 years in 2005 to 68 years in 2015, and further to 69 years in 2019. Infant mortality rates have declined from 88.6/1,000 live births in 1990 to 29.9 in 2018. India has been polio free since 2014. None of this would have been possible without galvanizing multiple stakeholders, synergizing efforts, unlocking innovative tools,and strategic planning to tackle public health challenges. India’s nutrition conundrum needs a similar approach. Various stakeholders from India’s nutrition landscape must now come together and leverage the platform provided by the Poshan Abhiyaan. It is time we combine our expertize and resources, and strengthen our resolve to overcome this problem. We must take a vow that no child in this country goes hungry, and beyond that, that everychild’s holistic nutritional needs will be met. We have only a small window of opportunity before our demographic dividend ends. We must make the most of it. As the prime minister said in his clarion call for a malnutrition-free India by 2022, ‘Karenge aur karke rahenge!’
(The author is President, Indian Council for Cultural Relations (ICCR), MP (Rajya Sabha); and BJP National Vice President )
Copyright Seminar Publications. This article was published in Seminar's June 2020 edition. Seminar is a monthly journal that discusses various national and international issues. Each issue of the journal focuses on a single problem, bringing together different viewpoints, to provide in-depth insights to readers and decision makers.