Complementary Feeding Needs Scaling Up To Tackle Malnutrition, Say Experts

The first 1,000 days of a child’s life -- from conception through age two -- is a critical window of opportunity to ensure child survival, optimal growth, cognitive development, and lifelong health. Adequate nutrition during infancy and early childhood is critical to the development of a child’s full human potential, and for this complementary feeding needs more focus in order to meet the aims of the flagship Poshan Abhiyaan, experts said.

Poor infant and young child feeding practices, coupled with high rates of infectious diseases, are the proximate causes of malnutrition during the first two years of life. The second half of an infant’s first year is an especially vulnerable time, when breast milk alone is no longer sufficient to meet his or her nutritional requirements and complementary feeding should start.

Many children suffer from under nutrition and growth faltering during this period, with consequences that persist throughout their life. The linear growth retardation acquired early on in infancy cannot be easily reversed after the second year of life. To be nutritionally adequate, the complementary foods should contain all food groups: the staple, proteins, vitamins and minerals.

As per the recommendations of National Institute of Nutrition, the choice of complementary foods should be based on locally available food items, using simple cooking methods and minimal cost. They should be acceptable in taste and consistency and child must gradually be introduced to healthy foods eaten by the rest of the family. 

While India over last few years has made some advances in breastfeeding promotion and reduction of critical malnutrition indicators like stunting and wasting, much more progress is needed in complementary feeding.

The percentage of children receiving adequate diet continues to be poor at less than 10 percent in India, varying between 0-31 percent across states. Although many initiatives have been carried out in India to promote Infant and Young Child Feeding practices, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest.

Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition (including obesity) and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth.

Complementary feeding practices in India needs a real change in the whole narrative and to do the same, Project Concern International and Alive & Thrive under the leadership of the Ministry of Women and Child Development held a day-long national consultation on ‘Complementary Feeding Programming’ in Delhi on Tuesday.

Key representatives of the health and nutrition stakeholder community, including senior government officials, were present to discuss and deliberate on strengthening existing strategies for improving actions across platforms to ensure optimal complementary feeding outcomes for young children.

Complementary feeds are also greatly influenced by cultural factors, beliefs, and knowledge of parents on appropriate practices. All the studies presented by various speakers during the day-long session deliberated on the efficiency and efficacies of the current programmes and pondered over the newer models and strategies to move the communities for better child feeding practices.     

‘Frontline workers play a crucial role in improving the complementary feeding practices and counselling and behaviour change communication play rich dividend,” said Dr Ajay Khera,Deputy Commissioner & I/C-Child Health, Ministry of Health & Family Welfare (MoHFW), Government of India.

“Scaling up of grass root level tested models specially interventions through self-help group platforms, local level solutions, technology, innovations and data driven management would improve complementary feeding behaviours and practices. The launch of POSHAN Abhiyaan with its multi-sectoral convergence model is expected to bring great results,” Usha Kiran Tarigopula, Country Lead – State Health & Community System, BMGF, said.

Panel discussions were held on ‘Improving Complementary Feeding – Best Practices and Evidences – Home grown Solutions from India’ and ‘Improving Child Feeding through Increased Access and Use of Health and Nutrition Services – Key Elements to Consider for an Action Framework’.

Appropriate complementary feeding along with breastfeeding between 6-24 months of age with better quality, quantity and frequency can transform the first one thousand days of the child which is essential for building human capital. Interpersonal counselling through home contacts, synergistic approaches across sectors, addressing myths and misconceptions and social sanction activities with better data and evidences are key drivers of success, said Basanta Kumar Kar, Country Director, Project Concern International.

“Evidences and experiences from Indian states are showing encouraging results to improve complementary feeding practices through focussed and concerted efforts. Introduction of Computer Application Software (CAS) is a great milestone achieved under the POSHAN Abhiyaan,” said Rajesh Kumar, Joint Secretary, Ministry of Women & Child Development and Mission Director, POSHAN Abhiyaan.

Senior officials from the Ministry of Health & Family Welfare, Ministry of Women & Child Development and partner organisations gave their suggestions on possible interventions and strategies on the issue.

A framework for structured interventions focusing on a multi-sectoral ecosystem for improving the complementary feeding practices in India was presented before the policy makers to take forward this important agenda.

Representatives from Bill & Melinda Gates Foundation India, UNICEF ROSA & India Country Office, World Bank, TATA Trust, Piramal Foundation, international & national technical support organizations such as UP TSU (hosted by IHAT), Bihar nutrition Technical Support Unit, Save the Children, JHPIEGO- World Food Program, Nutrition International, CARE, Coalition for Food & Nutrition Security were present at  the meeting. 

Poshan Abhiyaan, which was launched by the Prime Minister in Jhunjhunu on March 8, 2018 has been set up with a three year budget of Rs.9,046.17 crore, commencing from 2017-18.  All States and Union Territories are being targeted in a phased manner.

Under the mission, the government has fixed targets to reduce stunting, anaemia (among young children, women and adolescent girls) and low birth weight by 2 per cent, 2 per cent, 3 per cent and 2 per cent per annum, respectively.

To ensure a holistic approach, all 36 States/UTs and districts are being covered in a phased manner i.e., 315 districts in 2017-18, 235 districts in 2018- 19 and the remaining districts in 2019-20. More than 10 crore people will be benefitted by this programme.