7 PM Editorial |India may miss Global Nutrition Targets: On Global Nutrition Report 2020| 16th May 2020

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India may miss Global Nutrition Targets: On Global Nutrition Report 2020

 What has happened:

World Health Organisation (WHO) has released ‘The Global Nutrition Report 2020’.
The Global Nutrition Report (GNR) is the world’s leading independent assessment of the state of global nutrition. The 2020 report presents the most comprehensive picture of the state of nutrition at the global, regional, and country level, and tracks progress against global nutrition targets and the commitments made to reach them. The 2020 report focuses on equity and unpacks the role of inequities in ending malnutrition in all its forms. The report says India is likely to miss the Global nutrition target 2025. It also identified the India as country with the highest rates of domestic inequalities in malnutrition.

This bring us to the question of continued prevalence of malnutrition in the world (and in India) and steps to tackle this problem. In this article we will discuss the following:

• What do we mean by Malnutrition?
• What is the extent of problem of malnutrition in India?
• Why Malnutrition is prevalent in India?
• What are Major Recommendations of Global Nutrition report to fight malnutrition?
• What are steps taken by India to fight Malnutrition
• Conclusion

What do you mean by Malnourishment?

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients.

The term malnutrition addresses 3 broad groups of conditions:

1. Undernutrition– It includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
2. Overnutrition– Overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).
3. Micronutrient-related malnutrition– It includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess.

Note – Double Burden of malnourishment – It is coexistence of undernutrition along with the overnutrition (such as overweight, obesity etc)

Extent of problem: Prevalence of Malnourishment in India

As per the Report, Malnutrition is still a challenge for India. Though, the malnutrition has declined over a period of time, much more needs to be done

• Between 2000 and 2016, rates of underweight have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls. However, this is still high compared to the average of 35.6% for boys and 31.8% for girls in Asia.
• 38% of children under age five years is stunted (too short for their Age) (Asia average is 22.7). It is a sign of chronic under nutrition. Stunting is higher among children in rural areas (41%) than Urban areas (31%).
• 21% of children under age five years are wasted (too thin for their height) (Asia Average is 9.4%). It is a sign of acute undernutrition
• 36% of children under age five years are under weight
• 50% women of reproductive age is anaemic.
• 2% of children, 21.6% adult women and 17.8% adult men are overweight

With this coexistence of undernutrition and overweight or obesity, India faces the double burden of malnutrition

• The Report identifies India among the three worst countries (along with Nigeria and Indonesia) for steep within country disparities on stunting, overweight and obesity.
  • Stunting prevalence is 10.1% higher in rural areas compared to urban areas
  • Stunting level in Uttar Pradesh is over 40% and their rate among individuals in the lowest income group is more than double those in the highest income group at 22.0% and 50.7%, respectively.
  • Rate of Obesity in females is 5.1% as compared to 2.7% in males
• India is among 88 countries that are likely to miss global nutrition targets by 2025. India will miss targets for four nutritional indicators i.e. stunting among under-5 children, anaemia among women of reproductive age, childhood overweight and exclusive breastfeeding.

Why Malnutrition is prevalent in India?

Malnutrition in India is due to multiple factors.

1. Immediate Factors
   • Inadequate food intake by the children. It may be due to poverty and unemployment leading to low purchasing power. Discrimination with the girl child also lead to malnutrition
   • Poor breast feeding practices along with inadequate complementary feeding practices by mother, mainly due to lack of awareness
   • Early marriage of girl child which result in teenage pregnancies (child born has low birth weight)
2. Intermediate Factors
   • Improper child immunization to prevent and eradicate the diseases that contribute to lower nutritional status
   • Lack of Antenatal care facilities
3. Underlying factors
   • Inadequate and unsafe drinking water
   • Poor sanitation and unhygienic practices leads to many diseases in children (diarrhea)
   • Poor socio-economic status of women. Poverty and illiteracy among women.
   • high rate of population growth and low access of population to health education
   • Lack of diversity in dietary system. Focus is on consumption of food grains such as wheat and rice and less on fruits and vegetables.

After discussing the basics of malnutrition, its status in India and why it is prevalent in India, let us understand the major recommendations of the Report to tackle malnutrition in India

The report emphasises on the link between malnutrition and different forms of inequity, such as those based on geographic location, age, gender, ethnicity, education and wealth malnutrition in all its forms. It emphasises that inequity is a cause of malnutrition – both undernutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle.

The report says that Food systems must be inclusive, local and diverse to address food security and malnutrition and build economic and climate resilience. The report has placed equity as the cornerstone of all efforts to overcome global malnutrition

Major recommendations of the report to tackle Malnutrition

The report highlights that to end malnutrition in all its forms and achieve nutrition equity – we must focus on three key areas: Food Systems, Health Systems and Financing

1. Nutrition Inequities in food system must be addressed: Healthy food is accessible, affordable and desirable choice for all.

• Strong regulatory and policy framework to support healthier diets
• Diversification of crops – move from staple food grains to fruits, vegetables, nuts etc. In India, focus should be on non staples like fruits, fish nuts etc and make them available to people. Further, In India, focus can be on incentivising millets production and consumption to provide nutritional food, especially for rural poor. It may be included in the Public Distribution System, ICDS and Mid-Day Meal Scheme.
• Strengthen supply chain system to provide fresh food products especially to nutritionally disadvantaged or harder-to-reach groups
• Strengthen and increase research spending to identify cost effective solutions to address major nutrition question

2. Nutrition inequalities in Health system must be addressed:Mainstream nutrition as basic health service

• Provide nutrition service within health service to cover all forms of Malnutrition (i.e. Integration of nutrition services with health service delivery)
• Invest in human resources to increase the number of qualified nutrition professionals to provide quality nutrition care
• Include nutrition-related health products like therapeutic foods and innovative technological solutions like digital nutrition counselling, where appropriate – especially when working with more remote and harder-to-reach communities

3. Adequate Investment/Finances to improve nutrition outcomes: For improving the nutritional status of people, the country must invest to improve nutrition outcomes.

• Increase domestic financing to respond to the needs of communities most affected by malnutrition
• Establish an international system of governance and accountability to address power imbalances in the food and health system and hold to account those responsible for creating inequities in food and health systems

Steps Taken by India to tackle problem of malnourishment

To address the problem of Malnutrition government is implementing following scheme

1. POSHAN Abhiyaan with a theme of“Sahi Poshan-Desh Roshan” to tackle all forms
   of malnutrition on a mission mode.
2. Pradhan Mantri Matru Vandan Yojana
3. Aagan-Wadi Services
4. Mission Indradhanush to immunize all children against seven deadly diseases
5. Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services Scheme (ICDS)
6. Mid Day Meal Scheme
7. National Food Security Act 2013
8. Swachh Bharat Abhiyaan
9. National Health Mission
10. Fit India Movement
11. Eat Right India movement

Conclusion

Achieving nutritional security is necessary to ensure inclusive growth and attain SDG – 2 (Zero Hunger). Nutritional security also assume importance in the light of COVID-19 pandemic as lockdown has impacted food supply chain. Empowering local bodies (panchayats and municipalities) and providing sufficient flexibility to states (against one size fits all approach) in determining their strategy to provide nutrition will go a long way to provide healthy nutrition to citizens of India.

Source: The Hindu

Mains Practice Question

1. ‘Nutritional security for all is imperative for inclusive development’. Discuss. Enumerate the challenges in tackling the problem of malnutrition in India? [15 Marks]