It is essential to focus on the nutrition of adolescent girls and young women before they get married, to ensure they have the proper Body Mass Index and nutrition to handle pregnancy, and also focus on the critical interventions during pregnancy, which will together help address 50 percent of the battle against stunting and malnutrition in the country, says Dr Rajesh Kumar, former Mission Director, POSHAN Abhiyaan.
“If India has to harness its demographic dividend in the true sense, there is a need to ensure that we focus on our adolescent girls, the would-be mothers, the pregnant women, the children, and also the lactating mothers. In this context, the importance of 1,000 days assumes major significance,” Dr Kumar told Outlook in a chat.
The 1,000 days starts from conception, the day a woman becomes pregnant, right up to 2 years of a child – comprising 9 months of pregnancy and till the child is two.
“It is significant to note that the development of a child takes place immediately after conception, and it is important to ensure proper maternal nutrition, rest to the mother, proper vaccination, and ante natal check ups, which should be four-plus optimally, and interventions like iron, folic acid, calcium supplementation, and institutional delivery at the time of child birth. If that is ensured, there is no reason we should be getting many children who are born with low birth weight,” Dr Kumar added.
Elaborating on the malnutrition situation in India, he said: “Roughly about 20 percent children have low birth weight, of which about two-thirds are due to poor maternal nutrition and diet, and one third are because of Intra Uterine Growth Retardation, or IUGR. So if maternal nutrition, and critical interventions during pregnancy are ensured, we may perhaps address about 14 percent of low birth weight, which will immediately bring down the level of stunting drastically. These are the children who are prone to be stunted when they grow up.”
“How do we address the other one-third of low birth weight, which is IUGR. There is a need to focus on nutrition of adolescent girls, when she crosses adolescence and gets married or gets into a relationship before she gets pregnant -- so that she has the height and weight and haemoglobin level, and when she conceives, she has properly developed pelvic bones so that proper space is there for the foetus to grow. Unless we ensure proper Body Mass Index of the pregnant women, by effectively tackling adolescent nutrition, pre-marital nutrition, we may not be in a position to tackle IUGR effectively. If these two are done, and a lot of focus is given, we would be addressing 50 percent of the battle against stunting and malnutrition,” he said.
Besides medical and nutritional interventions, the other critical interventions required are proper drinking water and sanitation.
According to Dr Kumar, frequent intestinal infections, diarrhoea due to water borne diseases, cause loss of nutrients and proteins and also debilitation which can affect the overall health. “If proper drinking water and sanitation are not there then we are prone to have high level of worm infestation, especially of round worms and hook worms, which cause malnutrition and anaemia. The majority of such cases have mixed infections of both round worms and hook worms. In that context deworming twice a year, on February 10 and August 10 of those between one and 19 years assumes significance,” he said.
Another important factor in the fight against malnutrition, is to ensure that the health and wellness centres and Anganwadi centres, the Auxiliary Nurse Midwife and ASHA (Accredited Social Health Activist) have the right capacity and right resources to provide basic medical services to everyone.
In order to ensure a healthy population in the country, there is also need for a “radical change in the behaviour of the population at large and the need to educate an entire generation on the importance of nail clipping, hand washing, having proper diet, on dietary diversification, encouraging milk consumption, encouraging backyard poultry and kitchen garden wherever feasible, proper meals for women, and ensuring there is no discrimination between women and men at home. And also eating healthy food.”
Dr Kumar, who had organised an Agri-Nutrition Conference on Nutrition in March 2019 that saw all stakeholders come together, including all the relevant ministries, development partners and international organisations, said there should be a grassroots-level convergence in the efforts made by each and every stakeholder. “This would ensure we have proper advocacy for behaviour change, we also have proper medical interventions, proper immunisation, institutional deliveries, counselling, proper nutrition through Anganwadi systems, and we also promote dietary diversification, consumption of animal protein, milk and eggs etc.”
He termed the launch of the POSHAN Abhiyaan – PM’s Overarching Scheme for Holistic Nutrition – on March 8, 2018 by the Prime Minister as “the biggest thing” to happen in the fight against malnutrition.
Dr Kumar also said that around 50 percent of anaemia in the country is nutritional and therefore one way of addressing it and other micro nutrient deficiencies would be to go in for largescale food fortification. In 2017, the Ministry of Women and Child Development advised states to use double fortified salt, fortified oil, and fortified wheat flour in the Integrated Child Development Services (ICDS) system. The ministry has also suggested using fortified rice and milk in the ICDS earlier this year.
“With fortification of food articles we are almost trying to fill the gap about deficiency of Vitamin D and iron parallely… More than 50 percent of the population is Vitamin D deficient. People spend so much money on Vitamin D testing and take Vitamin D supplements. So it is essential that oil and milk should contain Vitamin D,” he added.
To ensure the farming community also benefits from food fortification, he said that “local chakki level sprinklers” should be set up to ensure that at least the wheat flour for the poor farming community gets micro nutrients. The WCD Ministry has been advocating, in consultation with the Indian Council of Agricultural Research and the Indian Rice Research Institute, for Bio Fortification of crops through Conventional Plant Breeding, which does not need introducing of GM crops, Dr Kumar said.
“Conventional plant breeding is an accepted and right way of doing bio fortification. There is a time to scale up bio fortification in the country because a lot of species have been developed by ICAR and the Rice Research Institute. We must try to scale up in the next 5-7 years’ time, and unless this is done maybe the fruits of fortification may not reach the most vulnerable,” he added.