7 PM Editorial |Malnutrition- Determinants and Solutions| 14th September 2020

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Malnutrition- Determinants and Solutions

Overview – The determinants of huge levels of malnutrition in the population and its solutions.


The target of ending all forms of malnutrition by 2030 is a target under Sustainable Development Goal (SDG 2) of Zero Hunger. The Government has initiated “Poshan Maah” to contribute towards a malnutrition free India by 2030. The government has invited citizens to send nutritional recipes and thus help in awareness generation for community mobilisation.

What is the status of malnutrition in India?
  1. The report, “The state of Food Security and Nutrition in the World” for 2017-19, states that there were 673 million undernourished peoplearound the globe. Out of this, India accounts for 189.2 million (28 percent).
  2. Additionally, India accounts for 28 per cent (40.3 million) of the world’s stunted children(low height-for-age) under five years of age, and 43 per cent (20.1 million) of the world’s wasted children (low weight-for-height) in 2019.
  3. As a proportion of India’s own population, around 14 per cent were undernourished during 2017-19. The corresponding number for China and Brazil is less than 2.5%.
  4. As per the National Family Health Survey (NFHS, 2015-16), the proportion of underweight and stunted children was as high as 35.8 percent and 38.4 percent respectively. In several districts of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and even Gujarat, the proportion of underweight children was more than 40 percent. The map below depicts the status across states.

National Nutrition Mission: Also known as the POSHAN Abhiyan, it aims to reduce stunting, underweight and low birth weight each by 2 per cent per annum; and anaemia among children, adolescent girls and women, each by 3 per cent per annum by 2022. However, the Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.
What are the determinants of this level of malnutrition?

A research study using unit-level data of NFHS (2015-16) (with a sample of 2,19,796 children under five years age) on the determinants of malnutrition was conducted. The results include:

  1. The mother’s education, particularly higher education, has the strongest inverse association with under-nutrition. As per NFHS, only 13.7% of the women have received higher education. This is below other countries at same level of income.
  2. The second key determinant of child under-nutrition is the wealth index, which subsumes access to sanitation facilities and safe drinking water.
  3. The diet plays a huge role in determining malnutrition. So, the role of agricultural policies and diet diversification becomes important.
  4. Exclusive breastfeeding and the introduction of complementary foodsand a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.
  5. Access and utilisation of prenatal and postnatal health care servicesalso play a significant role in curbing undernutrition among children.
What should be done to address the levels of malnutrition?
  1. The programmes that promote women’s higher education such as liberal scholarshipsfor women need to be accorded a much higher priority. Also, lack of separate toilets for girls, distance from home affect dropout rates among girls. State Governments need to provide these facilities. Initiatives such as bicycle distribution among girls could help minimise dropout rates.
  2. WASHinitiatives, that is, safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes. The Swachh Bharat ABhiyan has helped bring down open defecation and bring in behavioural changes in hygiene and sanitation. Government records show that rural sanitation has gone from 38.7% in 2014 to 100% in 2019 while that in urban areas is 99%. However, behavioural change towards personal hygiene still needs to be promoted at the grassroots level.
  3. Food-based safety nets in India are biased in favour of staples(rice and wheat). They need to provide a more diversified food basket, including coarse grains, millets, pulses and bio-fortified staples to improve the nutritional status of pre-school children and women of reproductive age.
The Harvest Plus programme of the Consultative Group on International Agricultural Research (CGIAR): It has been implemented successfully in many countries around the world. The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops such as iron and zinc biofortified pearl millet, zinc-bio fortified rice and wheat; iron biofortified beans in India.
  1. Anganwadi workers and community participation can bring significant improvements in child-caring practices and antenatal care for mother and childrenthrough comprehensive awareness programmes.

For “POSHAN Maah” to contribute towards the holistic nourishment of children and a malnutrition free India by 2030, the government needs to address the multi-dimensional determinants of malnutrition on an urgent basis. The challenge has only become bigger with the outbreak of COVID-19.

Source: The Indian Express

Mains Question:
  1. What are the reasons because of which India carries a huge burden of malnourishment among its population? Suggest measures for effective resolution of the issue.
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