Poshan Abhiyan- Its time for national self reflection

News: National Family Health Survey (NFHS-5) which was released a few months back indicates slow improvement in India’s malnutrition situation. 

What have been the positives regarding nutritional status in India? 

Substantial improvement in maternal-child health services, including antenatal care (ANC) services, child immunizations and diarrhoea management. 

Significant improvement in fixing the underlying causes of undernutrition, such as improved sanitation services, a lower total fertility rate, 10 years of schooling etc. 

These positive outcomes were achieved through greater political commitment, and initiatives like Jandhan Yojana ,Mission Indradhanush and Janani Suraksha Yojana under the National Health Mission, Swachh Bharat Abhiyan, Ujjawala Scheme, Beti Bachao Beti Padhao . 

What are the areas where India needs improvement? 

NFHS also presents some negatives facts and figures like

Every third child under five and a fifth of women is undernourished, while more than every second child, adolescent and woman is anaemic.  

Lack of essential nutrition interventions during the first 1,000 days of life (270 days of pregnancy and 730 days 0-24 months). 

No maternal nutrition policy and weak implementation of Infant and young child feeding policy

Although, there has been an Infant and Young Child Feeding (IYCF) policy since 2000. Caregivers are not well-informed about what, when and how often to feed a child over six months, contributing to obesity, micronutrient deficiencies and increased chances of adult-onset non-communicable diseases. 

Behavioural Changes: Some studies show that 20% of undernourished children are from communities with the highest wealth index which highlights that the main reason behind these issues is a failure to effect behavioural problems and lack of awareness. 

Nutrition care is divided into prevention and care between our health system and ICDS: ICDS is the main government program to improve the nutritional status, but has no opportunities for direct contact with the young mother to influence nutrition practices. 

On the other hand public health system that is in charge of ANC (Ante-Natal Care), child delivery and immunization has an advantage of a minimum of 15 contact occasions with mothers, from the start of pregnancy. 

What is the way forward? 

Training mothers for early care and breastfeeding: Only 9.8% of the children of such trained mothers were underweight at six months, compared to 18.1% of the children of untrained mothers. 

Complementary feeding of semi-solids also needs attention. Only one in 10 children above 6 months receives an adequate diet in line with the recommended frequency of semi-solids. 

Frequent interpersonal counselling by health workers/medical teams at the right time can be a game changer. 

Merging the human resources of ICDS with India’s primary healthcare system would strengthen maternal-child nutrition and healthcare workforce and teamwork. This could cost-effectively lower child mortality, as 68% of India’s under-5 mortality is associated with undernutrition. 

Source: This post is based on the article “Poshan Abhiyan- Its time for national self reflection” published in Livemint on 4^th Jan 2022