Malnutrition in India is a worry in a modern scenario
Good nutrition has the power to empower the present and future generations. India’s greatest national treasure is its people — especially women and children — but even after 75 years of independence, a majority of them do not get the required diet to meet their nutritional needs.
A child’s nutritional status is directly linked to their mother. Poor nutrition among pregnant women affects the nutritional status of the child and has a greater chance to affect future generations. Undernourished children are at risk of under-performing in studies and have limited job prospects. This vicious cycle restrains the development of the country, whose workforce, affected mentally and physically, has reduced work capacity.
Marginal improvement
● While there has been some progress in tackling malnutrition among children and women over the past decade, the improvement has been modest at best.
● This is despite declining rates of poverty, increased self-sufficiency in food production, and the implementation of a range of government programmes.
● The National Family Health Survey (NFHS-5) has shown marginal improvement in different nutrition indicators, indicating that the pace of progress is slow.
● Children in several States are more undernourished now than they were five years ago.
Stunting, wasting, anaemia
● While there was some reduction in stunting rates (35.5% from 38.4% in NFHS-4) 13 States or Union Territories have seen an increase in stunted children since NFHS-4; this includes Gujarat, Maharashtra, West Bengal and Kerala.
○ Stunting is defined as low height-for-age.
● Malnutrition trends across NFHS surveys show that wasting, the most visible and life-threatening form of malnutrition has either risen or has remained stagnant over the years.
○ Wasting is defined as low weight-for-height
● India also has the highest prevalence of anaemia in the world. The NFHS-5 survey indicates that more than 57% of women (15-49 years) and over 67% children (six-59 months) suffer from anaemia.
Impact of Anaemia in the Economy
● It reduces the work capacity of individuals, in turn impacting the economy and overall national growth. Developing countries lose up to 4.05% in GDP per annum due to iron deficiency anaemia; India loses up to 1.18% of GDP annually.
Suggestions
Step up the financing:
○ There is a greater need now to increase investment in women and children’s health and nutrition to ensure their sustainable development and improved quality of life.
○ While the Government’s focus has been on the consolidation of several programmes to improve outcomes, there is a need for increased financial commitment.
○ Experts have pointed out that Saksham Anganwadi and the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) 2.0 programme have seen only a marginal increase in budgetary allocation this year (₹20,263 crore from ₹20,105 crore in 2021-22).
○ Additionally, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilised.
Monitor constituencies too
○ India must adopt an outcome-oriented approach on nutrition programmes.
○ It is crucial that parliamentarians begin monitoring needs and interventions in their constituencies and raise awareness on the issues, impact, and solutions to address the challenges at the local level.
○ There has to be direct engagement with nutritionally vulnerable groups (this includes the elderly, pregnant women, those with special needs and young children), and contribute toward ensuring last-mile delivery of key nutrition services and interventions.
○ This will ensure greater awareness on the one hand and proper planning and implementation of programmes at the grass-roots level on the other, which can then be replicated at the district and national levels.
○ With basic education and general awareness, every individual is informed, takes initiatives at the personal level and can become an agent of change.
○ Various studies highlight a strong link between mothers’ education and improved access and compliance with nutrition interventions among children.
○ We must ensure our young population has a competitive advantage; nutrition and health are foundational to that outcome.
Other steps
○ There should be a process to monitor and evaluate programmes and address systemic and on the ground challenges.
○ A new or existing committee or the relevant standing committees should meet and deliberate over effective policy decisions, monitor the implementation of schemes, and review nutritional status across States.
Conclusion
This is critical to make an India that is malnutrition-free and anaemia-free a reality, and not just an aspiration. Every one is a stakeholder and should contribute towards ending malnutrition and anaemia. We should not become part of a tragedy that is preventable. The country’s response to malnutrition and its growing anaemia burden should be practical and innovative.
The way to end child marriage
Background
● It is defined as a marriage of a girl or boy before the age of 18 and refers to both formal marriages and informal unions in which children under the age of 18 live with a partner as if married.
● The Prohibition of Child Marriage (Amendment) Bill, 2021, fixes 21 years as the marriageable age for women.
Prevalence of child marriage in India
● NFHS-5 data show that about 25% of women aged 18-29 years married before the legal marriageable age of 18.
● Marginal decline: The proportion has declined only marginally from NFHS-4 (28%).
● Higher in rural India: Expectedly, the prevalence is higher in rural than urban India (28% and 17%, respectively).
● West Bengal has the highest prevalence (42%), followed by Bihar and Tripura (40% each).
● Oddly, the decline in child marriage has been paltry at best in these high-prevalence States.
● At the other end of the spectrum are Goa, Himachal Pradesh and Kerala (6% to 7%).
● 39% of child marriages in India take place among Adivasis and Dalits.
● The share of advantaged social groups is 17% and the remaining share is of Other Backward Classes.
Role of structural issues in adverse health and educational outcomes
● Impact: Studies associate early marriage of women with early pregnancy, lower likelihood of accessing ante-natal care, higher risks of maternal morbidity and mortality, poor nutritional status of women and poor nutritional and educational outcomes of children.
● These studies seem to provide a rather compelling case for increasing the age of marriage of women from 18 to 21 years, as a delayed marriage might offer significant public health dividends.
● Structural factors at play: But a closer reading of the evidence shows that the association between child marriage and adverse health outcomes does not emerge in a vacuum. Rather, it is abetted by structural factors, including social norms, poverty, and women’s education.
● Role of social norms: It is because of social norms in many regions and cultures that parents begin preparations for a girl’s marriage once she has reached menarche.
● Role of poverty: A large proportion of child marriages take place primarily because of poverty and the burden of the huge costs of dowry associated with delayed marriages.
● Role of education: The NHFS-5 data confirm that a significant proportion of child marriages take place among women with less than 12 years of schooling and households that are socially and economically disadvantaged.
● The average age at marriage increases from 17 years among women who are illiterate and have had up to five years of schooling to 22 years among women who have had more than 12 years of schooling.
● This indicates that an increase in years of schooling goes hand in hand with an increase in age at marriage.
● While an increase in education is most likely to delay marriage, the increase in age at marriage may or may not increase women’s education.
Why the age of marriage of women matters?
● Age of marriage has bearing on maternal mortality rates, fertility levels, nutrition of mother and child, sex ratios, and, on a different register, education and employment opportunities for women.
● It is also argued that other factors — such as poverty and health services — were far more effective as levers for improving women’s and children’s health and nutritional status.
● Child marriage curtails a girl’s opportunities to continue her education.
● And in turn, the lack of educational opportunities plays an important role in facilitating child marriage.
Will the increasing legal marriageable age help?
● Increasing the age of marriage without a commensurate improvement in women’s education is least likely to yield better health and nutritional outcomes. Instead, it might adversely impact the poor and illiterate.
● A mere increase in age at marriage without an increase in education is no guarantee that their nutritional conditions will be better.
Way forward
● Ensure education for at least up to 12 years: Much of the benefits can be reaped by ensuring that women complete education at least up to 12 years.
● Bangladesh shows that improving women’s education and imparting modern skills to them that increase their employability reduces child marriage and improves health and nutrition.
● Educational attainment criteria in schemes: Schemes which ease the financial burden of marriage but the eligibility criteria of which should essentially link to educational attainment in addition to age demand attention.
● The lessons from Janani Suraksha Yojana and the zeal demonstrated in ending open defecation might provide valid insights here.
Conclusion
A legalistic approach to increasing the age at marriage will produce positive results only if it leads to an improvement in women’s education and skill acquisition for employability. In the absence of an enhancement in women’s schooling or skills, a legalistic approach to ending child marriage might become counterproductive.