Malnutrition Among Children And Pregnant Women: Elected Women Representatives To The Rescue

Data from NFHS-4 reveals that  a quarter of women of reproductive age in the country are undernourished. India has multiple Government policies and programmes around ensuring nutrition, however for these to work as envisioned, local and community-based support are imperative. Mission Poshan 2.0, launched in February this year, merged four health schemes — the ICDS, Poshan Abhiyan, Scheme for Adolescent Girls and National Creche Scheme. It also included health and nutrition in the Gram Panchayat Development Plan and allocated more financial and implementation powers to Panchayats. In the past one-year disruptions affecting the implementation of services has affected the nutrition profile in rural areas, devolution of powers is pivotal to programme delivery and to accelerate the rebuilding process. In the ‘Lived Realities’ survey conducted by Centre for Catalyzing Change (C3) in nine states across India between April and August 2020, 65% women, 68% daily wage labourers and 52% of cultivator and small business owners reported having lack of access to essential food supplies.

 Improving nutrition outcomes require, nutrition specific and nutrition sensitive interventions the impact of which is also mediated by intersecting factors of poverty, gender and social exclusion. Malnutrition has an inter-generational dimension- Malnourished girls are more likely to become malnourished mothers, and when children are born from malnourished mothers, they are likely to suffer from malnutrition too, leading to stunted growth, micronutrient deficiencies (like anaemia), and various other health complications.

 Adequate nutrition is crucial to ensuring maternal and child health, in reversing developmental defects in children, and even in fostering larger social and economic growth. Nutrition has a positive impact on the learning outcomes and productivity of both young people and adults. While the prevalence of anaemia among women decreased from 55% in 2005-06 to 46.1% in 2015-16, as recorded in the fourth round of the National Family Health Survey (NFHS-4), the numbers from 2019-20 tell a different story. In the first phase of the fifth National Family Health Survey (NFHS-5), which collected data from 22 states and UTs for 2019-20, a staggering 66.4% women and 68.4% children were found to be suffering from anaemia, while more than half the surveyed states reported that three in one children under the age of 5 years was suffering from chronic malnourishment.

 However, among these surveyed states, Bihar – a state with a history of high malnutrition – recorded promising improvements. Not only did the incidence of stunted children decrease from 48.3% in 2015-16 to 42.9% in 2019-20, but so did the incidence of underweight children (from 43.9% to 41%). Meanwhile, there was a promising rise in the number of mothers who had taken their iron folic acid tablets (which prevents and reverses anaemia) while they were pregnant. While more can be done in the state in terms of improving nutrition of women and young children, government policies like that of the POSHAN Abhiyan and the tireless efforts of local frontline workers like ASHAs, Auxiliary Nurse Midwives (ANMs) and Anganwadi Workers (AWWs) are leading to sustained on-ground change, particular in grassroots rural communities.

 While the POSHAN Abhiyan involves various inter-sectoral strategies that lead to improving awareness and health service delivery around nutritional concerns, the real heroes on the ground have been elected women representatives (EWRs) from Panchayati Raj Institutions, who have been ensuring the implementation of these strategies by directly engaging with their communities.

 These Elected Women Panchayat Representatives uniquely positioned to understand the specific nutritional needs of the people within their communities in informed and nuanced ways. Given the trust they have built among the people as they are part of the community, women elected representatives are able to influence the choices and perspectives of these communities in a way few others can. Through on-ground initiatives that builds the capacities of elected women representatives in Bihar and empowers them to be better leaders, they have been bringing nutrition related discussions directly to the community through various platforms like that of mata baithaks (meetings with mothers and pregnant women), kishori baithaks (meetings with adolescents), and engagement with community members to help them understand nutrition, growing (through kitchen gardens) and consuming locally available food resources, hygiene and cleanliness, the importance of iron folic acid tablets and ante-natal checkups for pregnant women, and the need for breastfeeding, complementary feeding and dietary diversity for children. They also organize rallies on nutrition, nutrition-related sessions at schools, anaemia screening camps, while also monitoring the growth of local children (especially those who are the most vulnerable), assisting local ASHA and Anganwadi workers in home visits of new-born babies, leveraging technology to share audio and video messages on nutrition awareness with their communities, running community kitchens and providing food support during crisis periods like the COVID-19 pandemic.

 “Ever since the pandemic began, there has been less prioritization of nutrition-related services in my ward compared to COVID-19 prevention and control,” says Phulwanti Devi, a Ward Member from Ward No. 5, Banjari Panchayat, Bihar, who, through her sheer commitment was successful in convincing her district and block administration of the need for constructing an Anganwadi Centre in her ward, “but there is a need to fight malnutrition side by side with COVID-19. Right now, issues of nutrition are even more important.” While Phulwanti Devi was ensuring nutritional issues are adequately addressed even during the pandemic, Rasulan Bibi, another ward member from the Banjari panchayat, had devised her own unique strategy to work towards putting an end to malnourishment, improving breastfeeding practices and timely start of complementary feeding, anaemia and other related burdens. This feisty leader constituted a support group called the ‘Suposhan Sahyog Sahayta’ – s a network for economically backward and marginalized sections of her ward to reach out to for women to help them follow positive nutrition-related practices.

These are small but impactful examples of the sustained change elected women representatives are bringing. Through their tireless work, more and more women and children are being monitored and made aware of their nutritional needs, while male family members too are being made an active part of the conversation around the importance of proper nutrition for pregnant women and newborns - which ultimately paves the way for equal marital relationships and more support from husbands, yielding better health benefits for women and children in the long term. In an end-line survey of C3’s interventions with elected women representatives, it was found that elected women representatives are becoming more actively involved in participating in and organizing Village Health Sanitation and Nutrition Days (VHSNDs) and are more active in raising issues of women and child nutrition in Panchayat-level meetings and orientations.

These elected women representatives are proof that the needle can be shifted through positive community-led and community-centric interventions, and that women’s grassroots leadership can go a long way in not only ensuring greater awareness and uptake of nutrition in rural levels, but also break the inter-generational cycle of malnutrition and shape a brighter future for our country. More than anything, it could epitomize a set of solutions that converge around achieving the United Nations Sustainable Goals 2 (to end hunger by 2030) and 3 (to achieve good health and wellbeing).

(The author is a Sr. Advisor, Gender Equity and Governance, Centre for Catalyzing Change (C3).