New Delhi: As we celebrate the Poshan Maah 2021, it is very important to talk about the needs, to right nutrition as well as the challenges we face as a nation. Despite being one of the world’s largest producers of food items like milk, pulses, wheat, rice, fruits, vegetables among others and a country with multiple schemes addressing malnutrition, India is still far from achieving the national and global nutrition targets. In a Facebook live session with NDTV-Dettol Banega Swasth India, Dipa Sinha, Assistant Professor, Ambedkar University Delhi answers common questions on nutrition and discusses why India is missing its targets in all the malnutrition parameters – stunting, wasting, underweight, obesity, and anaemia and how can this be corrected.
NDTV: After over 70 years of Independence, we are still struggling with malnutrition. We are unable to provide accessible and affordable nutrition to many people in our country. Where do you think we are lacking?
Dipa Sinha: When you look at malnutrition, the lack of food is the main determinant. Along with food, there are many other conditions that can lead to malnutrition, like infections, Diarrhoea, Malaria as well as factors like access to clean water and sanitation. When you talk about food, it is not every food that fills your stomach, it has to be nutritious, good quality food, particularly during pregnancy and first 2 years of life. When you start looking at each of these factors in India, we are lacking in most of them. And as a combination of all of them, is what we are seeing high malnutrition rates.
The flip side of this is that under nutrition – stunting, wasting – are not decreasing but on the other hand obesity is increasing, mostly in adults but childhood obesity is also showing an increasing trend in India. Relatedly, we continue to have TB and malaria on one end, and hypertension and diabetes on the other, which is related to being over weight.
NDTV: Food security is a huge challenge in India. We are the leading food producer, it is not a shortage issue. Where are we going wrong?
Dipa Sinha: When it comes to food security in India, the problem is not with the availability since we grow enough staples. The problem is distribution, one aspect is Public Distribution and the other is that people are not able to access these due to low wages or unemployment.
We are lacking at the resources at a household level as well as at the state level, in terms of public support to nutrition.
If more jobs are created, if minimum jobs are guaranteed, rices are kept stable, all of this will adds to how much a household is able to keep their family food secure. If all of these are kept stable, families can ensure food security.
NDTV: The government and the nation are talking about nutrition thanks to initiatives like Poshan Maah, Aneamia Mukt Bharat, etc. How important is it to speak about such issues?
Dipa Sinha: it is critical. A lot of studies show that childhood stunting is not a problem only during childhood but it predicts adult outcomes, in terms how productive people are, how susceptible to disease they are and even how long do they live. So from the point of view of economic development. Beyond a point, if our human development is so low, then that can become a barrier that can stop how much we can reach the potential. Therefore, malnutrition is not an issue that only affects a child, but it can also affect the overall health of the nation. It is investment that will give you returns.
NDTV: What nutritious food can actually keep us healthy?
Dipa Sinha: Nutritious food is what we know as a balanced diet. India is a diverse country, so the thali will look different in different parts of the country. But it basically has the main food groups of pulses, rice, grains, curd, and green vegetables. The challenge is to get this every day, otherwise nutritious food is not something that needs to come from outside, but it is what we have been eating traditionally with diversity.
NDTV: What food should be given to children without malnutrition?
Dipa Sinha: Even if a child has malnutrition or not, there are WHO guidelines about how for six months they need exclusive breastfeeding and nothing else. Mother’s milk is enough to give nutrition and immunity to a child, till the child is six months old.
One of the problems in our country is that when you have to shift to complementary feeding, wherein start feeding your baby semi-solid foods, they still give them milk. They should be given food like Khichidi with ghee as the child has a small stomach, mashed vegetables, among others and slowly start giving other food that the family eats. The only thing recommended different for young children is to add more fat because it has to be calorie dense. This is why ghee is traditionally added in foods for young children in our households.
NDTV: At what age are children at most risk for malnutrition and what can be given to malnourished children?
Dipa Sinha: As per the data of our country, 20 per cent children are born malnourished, i.e., with low birth weight and that is to do with the mother’s nutrition. But by the time they are 2 years old, there are 40 per cent children who are malnourished. So that age group is the most vulnerable for children.
For malnourished children, local foods, regular feeding, cleanliness and hygiene are most recommended. Because these children are very susceptible to infections and nutrients are not absorbed, so hygiene needs to be really specifically looked at. And regular food in regular intervals, preferably in every two hours.
What is also very important is care and a care giver; because at this age child can not ask for food himself, there needs to be someone to be with the child most times. Among poor family this is also a crisis, wherein the mother is working and older sibling is left with the child who can’t understand what the child’s needs are.
NDTV: How can we achieve our nutrition targets? Is there any research published on the issue of nutrition?
Dipa Sinha: We don’t seem to be doing very well. As per the the latest National Health and Family Survey 5, which was released for only 22 states, the data was recorded in late 2019 and early 2020 before COVID. As compared to the previous NFHS 4, conducted in 2015-16, we almost made no progress. In some states, stunting and Aneamia went up, whereas, some places it reduced very minor. This trend will be further impacted by COVID, so it doesn’t seem like we will reach our national or international targets. This is a cause for worry, we need to pull up our socks and take nutrition in our country more seriously.
NDTV: Not everything we eat is healthy for us, what can be the minimum nutrition for everyone who are not getting enough to eat.
Dipa Sinha: ICMR bring out recommendation diets for Indians, which is very detailed and categorised for active males, active females, sedentary lifestyle, for children of various age groups etc. Over all if we want to say that we want learn the food pyramids and how much to eat what from different food groups. What to eat the most is the grains, then carbohydrates, then proteins and then the vitamins and minerals that come from fruits and vegetables.
When we talk about proteins, animal proteins is also quote important important as well, milk, eggs and non vegetarian items comes in, and lastly, fats and oils and water. These are the things that make a good meal.
Who wouldn’t like to eat a balanced meal? The issue is that they can’t afford it. Data shows that we have a cereal heavy diet, other items people can’t afford them. Animal protein and fruits and vegetables are extremely important.
NDTV: What should be done to remove malnutrition in India?
Dipa Sinha: At one level, when it comes to the issue of malnutrition and those working for the cause, there are a lot of commonalities and people agree with what needs to be done. We have been talking food security, that would be the main framework to fix the issue. The second is a short term or immediate solution, which us directly addressing the vulnerable population that is women and children, for which we have programmes like ICDS and mid-day meals. But the current issue is that the Anganwadis – the main institute for nutrition – there are many gaps there that need to be fixed.
NDTV: How much has COVID pushed the nutrition issue backward?
Dipa Sinha: It has done that quite a bit. Especially, when things were beginning to revive a little bit, when Anganwadi centres were opening back, we had the second wave. We know that the second wave was much worse and more spread to the rural areas as compared to the first wave.
Therefore, this crisis of health has led to closure of schools and anganwadis. Despite the policy of children to continue getting supplementary food in forms of mid day meals, or dry ration or cash, this has been very adequate.
Right to Food Campaign did a field survey on this in November 2020, we found that less than 50 per cent of the children who were eligible for the dry rations were actually receiving them. Even those who were getting it, it wasn’t every month, it was once in a while.
In Delhi, a school child will get like Rs 120 for the whole month. That doesn’t really translate into one meal a day and mostly it is such a hassle to go to the bank and avail that Rs.120. Services have been disrupted, not just in terms of food distribution but anganwadis do many other things like growth monitoring and counselling, none of which has happened since the pandemic began.
NDTV: Is there a huge gender gap in the country that needs to be addressed?
Dipa Sinha: Gender affects nutrition in multiple ways. There is a puzzle that Africa has better nutritional outcomes than india, one of the explanation that has been given after various studies is that Africa has better gender relations than we do. How do gender relations impact nutrition? Eating last and the least. This is how it is in India in most households and it means a woman will feed everyone first and then eat in the end.
In poor households this can mean she doesn’t have enough food in the end to eat. If there is an egg, the woman doesn’t get. Due to this you have a pregnant woman who is not getting the nutrition she needs and ends up giving birth to an undernourished child and that cycle continues. What is interesting is that in childhood this gender gap is not seen, it is seen when the girl child begins to grow, from adolescence you see that gap begins to grow.
When it comes to exclusive breastfeeding, if it’s a two months old child, he or she needs to be fed in every two hours. Poor women in our country don’t have the kind of privilege of Time. 95 per cent of these women work in the unorganised sector, they don’t have maternity leaves or childcare services, all of these factors affect the Child’s nutritional outcomes.
The fact that the entire burden of childcare goes on to the mother also leads to malnutrition.
NDTV: What can be done to maintain a healthy life?
Dipa Sinha: Obesity is an issue we are not paying enough attention in our country. On one hand we have people who are unable to afford a balanced diet, but on the other hand we have a population that is increasingly consuming processed foods. It is a very simple formula – go local, do what you ave been doing traditionally but we are all moving to packaged foods in various forms.
So even the poor people in urban area are able to afford Maggi more than buying fruits; or even a packet of biscuits more than banana or apple. Thats the kind of eco system we have in our country currently. Processed foods caused a double burden in India because we have stunted children consuming high fat and sugar, causing obesity. But this doesn’t mean they are over nourished because they did not get any nutrients.
We should all keep in mind that we shouldn’t have a lot of ultra processed food.
Fruits and vegetables give us the most amount of vitamins and minerals that we need, so if we are substituting these with Maggi, it is definitely not healthy. Eating right is critical.
It is good to have an initiative like Poshan Maah cause it forces us to think about topics which we otherwise may not. Nutrition is not a season issue like Flu or Dengue, it is an everyday issue. It needs to be continuously in the public eye. We need to ensure and encourage the right kind of food habits. Not just in terms of having these weeks and months, but in terms of investing more to the cause of Nutrition.
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.