September 1, marks the commencement of the POSHAN Maah (Nutrition Month) aimed at raising awareness on the significance of nutrition and the need to adopt a healthy, sustainable lifestyle. This awareness initiative comes at a critical time as the ongoing COVID-19 pandemic, has led to a socioeconomic and health crisis, impacting personal incomes, food availability and healthcare provisioning.
Malnutrition is a global challenge, significantly contributing to negative health outcomes of women, infants and children. Despite remarkable economic growth, amongst 107 countries, India ranked 94th on the 2020 Global Hunger Index. The consequences of India’s nutrition crisis are enormous. In addition to being the attributable cause of one third to one half of child deaths, malnutrition causes stunted physical growth and cognitive development that last a lifetime. According to a recent study, preventing malnutrition, especially during the 1000-day golden period – conception to 2 years of age – has emerged as one of the most critical challenges for India’s development planners in recent times. The mother’s nutrition status prior to pregnancy is a key determinant of this outcome.
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According to data from the fourth National Family Health Survey (NFHS 4 2015-16), a quarter of women of reproductive age (15-49 years) in India are undernourished and 53 per cent of girls and women in this age group are anaemic. Data from the first phase of the NFHS 5 (2019-20) showed that the 17 states and 5 union territories surveyed have a total of 32.8 million undernourished women in the 15-49 age group.
It is an established fact that healthy mothers are most likely to have healthy babies and healthy babies are most likely to achieve their potential in their lifetime. However, there is evidence to show that adolescent mothers are vulnerable to pregnancy and childbearing related complications. Of all mothers, adolescent mothers are more likely to have preterm births. Prevailing social norms, such as early marriage, teenage pregnancies, unsafe abortions further compromise nutritional and health status amongst young girls and also their infants.
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Family planning is an underutilised, but powerful tool for improving maternal and child nutrition. Access to quality family planning services and increased contraceptive use has the potential to improve pregnancy outcomes, child survival and health by widening the interval between successive pregnancies and longer periods of breastfeeding. Increased contraceptive use can reduce the number of maternal deaths by reducing unintended pregnancies. Family planning contributes to improved maternal health status by decreasing the risk of anaemia and micronutrient deficiencies. In contrast, women with early or closely spaced pregnancies are at high risk of adverse pregnancy outcomes and thus, their infants are at higher risk of death.
It is important to recognize that reproductive, maternal and child health cannot be addressed in isolation as these are closely linked to the health status of the girls and women in various stages of their life cycle. As mentioned earlier, the health of an adolescent girl impacts pregnancy while the health of a pregnant woman impacts the health of the newborn. Integration of family planning and sexual and reproductive health services in nutrition programming is, therefore, an important intervention to consider at scale.
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The National Nutrition Week and Poshan Maah in September as part of the POSHAN Abhiyan of the Government of India provides a great opportunity to highlight the importance of using an integrated approach of programming pertaining to nutrition by states. It is equally important to ensure that POSHAN Abhiyaan becomes a community-owned, community-led, community-driven movement. Increased community demand for services will lead to improved service delivery in Integrated Child Development Services (ICDS) and other nutrition programmes.
Finally, social and behaviour change communication (SBCC) strategies must be used to address the social determinants of health, such as early marriage and teenage pregnancy and to sensitize mothers, families and communities to adopt appropriate nutrition, contributing to positive nutritional health outcomes for both the mother and child. Finally, governments and civil society organizations must work towards strengthening and expanding the reach of nutrition-related interventions and programmes.
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Poonam Muttreja, Executive Director of the Population Foundation of India, has for over 40 years been a strong advocate for women’s health, reproductive and sexual rights, and rural livelihoods. She has co-conceived the popular transmedia initiative, Main Kuch Bhi Kar Sakti Hoon – I, A Woman, Can Achieve Anything. Before joining PFI, she served as the India Country Director of the John D and Catherine T MacArthur Foundation for 15 years and has also co-founded and led the Ashoka Foundation, Dastkar, and the Society for Rural, Urban and Tribal Initiative (SRUTI).
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.