Rachel Forst
Nutrition in India
From:Secretary of Health, India
To: Minister of Finance, India
Introduction:
Under nutrition in India is a pressing issue putting the health of our country in a state of emergency. Almost half of all children under the age of three are underweight, 30% of newborns are born with low birth weight, and 52% of women and 74% of children are anemic.[1] The largest determinant of under nutrition among the population is micronutrient deficiency of Vitamin A, iodine, and iron. The most highly affected populations are children under 3, women who are pregnant or lactating, and more specifically, those in rural areas and “scheduled castes and tribes.”[2] Risk factors for this nutritional emergency include food insecurity, education level (especially of mothers), inappropriate feeding practices, inadequate health services, and is plagued further by the vicious infection-undernutrition cycle. The implications of this nutrition crisis extend into the education and productivity of children and the future economic growth of the country. There has already been a great deal of progress made in our country through projects like the Integrated Child Development Scheme (ICDS) and the Tamil Nadu nutrition program, yet more must be done. If we are to change the nutritional status of our citizens for the better, effective food fortification policies must be implemented, and feeding practices of young children and mothers must be improved.
Nature and Magnitude of the Problem:
Under nutrition in India is among the highest in the world, far exceeding that of sub-Saharan Africa. Nearly ¾ of Indian children are underweight, 19% are wasted (in fact, Indian children account for one-third of the world’s wasting), and 38% are stunted.[3] While under nutrition has been steadily declining over the past few years, the rate of under nutrition remains unacceptable, accounting for 22% of the burden of disease. Over half of child deaths are associated with under nutrition. [4]
Micronutrient deficiency is the major cause of under nutrition. Vitamin A deficiency affects 57% of children ages 6 to 59 months, iodine deficiency effects 33% of the population, and iron deficiency ranges from 78.5% of children 6 to 35 months to 57.9% of pregnant women.[5] Micronutrients are one of the most fundamental components of a healthy and a well-nourished society and must become a central pillar of our efforts.
Affected Population:
Children between the ages of 0 and 2 years are among the most vulnerable because this growth period constitutes the vital window during which irreversible nutritional damage occurs. The health of pregnant or lactating women and their children are inextricably linked. Thus children whose mothers are uneducated and undernourished themselves are more likely to experience complications due to under nutrition. Under nutrition is more pronounced in rural areas (with an underweight prevalence of 50%) than in urban ones (with an underweight prevalence of 38%). The states most affected by inadequate nutrition in India are Maharashtra, Orissa, Bihar, Madhya Pradesh, Uttar Pradesh, and Rajasthan. Finally, children from scheduled tribes and castes, which fall in the lowest wealth quintile, suffer from the highest rate of under nutrition across the board ranging from 53.2% to 56.2%. [6]
Risk Factors:
Risk factors include a lack of education, low socioeconomic status, limited access to nutritious food and inappropriate feeding practices (especially regarding breast-feeding), inadequate health services, and infection. These issues are exacerbated in the first 2 to 3 years of life. Additionally, a mother’s education is an important indicator of her child’s health. For instance, the prevalence of severe underweight is 5 times higher in children with uneducated mothers than those with educated mothers.[7] Food security, and access to nutritious food in particular, is also major risk factor that varies from rural to urban areas. Populations living in rural areas have less access to a diverse and reliable food supply. Appropriate feeding behavior during childhood is a key indicator of one’s productivity as an adult. Among the most important feeding practices, breastfeeding within the first hour of birth and then exclusively thereafter for six months, is practiced by only 48% of mothers.[8] Although health services have been implemented to address nutrition throughout the country, the NFHS 2005-2006 survey shows that less than 25% of our children receive supplementary foods through ICDS, which is reflective of the larger failure of the health system. Finally, infections such as pneumonia and diarrheal disease create a vicious infection-undernutrition cycle, increasing the morbidity and mortality of this already alarming state of under nutrition.
Social and Economic Consequences:
If undernutrition is left unaddressed, it will have grave consequences for development and prevent our country from reaching its full productive potential. If children are undernourished, especially in the critical window of opportunity leading up to 3 years of age, irreversible damage can occur. Inappropriate feeding practices can compromise cognitive ability and immunity to infectious disease, again reinforcing under nutrition status. Children that are undernourished enter school at a later age, have a harder time paying attention, and finish fewer years of school then well nourished children. Students that do not do well in school will not enter the work force as productive laborers. In addition, women who often have lower social status are likely to be undernourished themselves, “which in turn can lead to lower infant birth weight and may affect the quality of infant care and nutrition.”[9] Under nutrition impedes productivity, creates an unhealthy population, and perpetuates poverty; indeed, “Micronutrient deficiencies alone may cost India US$2.5 billion annually.”[10]
Priority Action Steps
Our country already has several projects underway, such as the Tamil Nadu program which has championed small-scale interventions for high-risk women and children, but which lacks effective referral systems and evaluation methods. Although Tamil Nadu is “one of a very few programs around the world which have had a substantial impact on malnutrition on a large scale (more than 20,000 villages)” programs like this and ICDS must continue to be strengthened. [11] We must provide more immediate nutritional assistance and shift our focus to correcting feeding practices, micronutrient intake, and assistance for the poorest and most marginalized populations.
A surprising number of children are stunted, wasted, or underweight, and we can only resolve this problem by placing an emphasis on immediate and exclusive breastfeeding for the first six months of life as well as appropriate food supplementation. Because we have seen a direct correlation between the education of a mother and the health of her child, we must school women in proper feeding habits.
Food fortification is one of the most cost-effective ways of addressing micronutrient deficiencies and should be a top priority. Double fortifying salt, a common staple in the Indian diet, with iron and iodine would double the intake of these micronutrients and consequently reduce levels of anemia.[12] Likewise, introducing nutrients into other staple crops such as wheat flower will make a dramatic impact. In addition, our government should support Vitamin A supplementation, especially to children, every six months to reduce the risks of compromised immunity and xerophthalmia. Finally, the prevalence of under nutrition is substantially lower in urban areas than in rural ones, so we must reduce this discrepancy by focusing on poor and marginalized populations outside of cities.
Under nutrition is one of the most pressing issues of public health in India today. If we do not address the problem and begin to make immediate progress, we will delay economic and social development. This is a vital matter that concerns all, and if we are able to extend projects such as Tamil Nadu and ICSD and continue working with the international community, we will improve the livelihood of our citizens and make considerable steps in the right direction.
[1] “India: Nutrition” UNICEF.
[2] “India: Nutrition” UNICEF.
[3] “2005-2006 National Family Health Survey (NFHS-3): National Fact Sheet: India” Ministry of Health and Family Welfare, Government of India.
.org/india/resources.html
[4] Granolati, Michele, et al.“India’s Undernourished Children: A Call for Reform and Action” World Bank.
/223546-1147272668285/IndiaUndernourishedChildrenFinal.pdf
[5] “India: India Country Profile” Micronutrient Initiative.
english/view.asp?x=603
[6] Granolati, Michele, et al. “India’s Undernourished Children: A Call for Reform and Action” World Bank.
[7] “India: Nutrition” UNICEF.
[8] “India: Nutrition” UNICEF.
[9] “India: Nutrition” UNICEF.
[10] Granolati, Michele, et al. “India’s Undernourished Children: A Call for Reform and Action” World Bank.
[11] Heaver, Richard. “India’s Tamil Nadu Nutrition Program: Lessons and Issues in Management and Capacity Development” World Bank.
.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/
Heaver-IndiasTamil-whole.pdf
[12] Agarwal, K.N., et al. “Anemia in Pregnancy – Interstate Differences” Nutrition Foundation of India.