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How Can We Tackle Malnutrition In India’s Marginalised Communities?

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India ranks 102nd among 117 countries, in the recently published, Global Hunger Index 2019. In 2018, India was 103 out of 132. In 2017, India was at 100 out of 119. Despite being the highest growing, developing country, what made India stagnant in the Global Hunger Index? A major embarrassment is that India is now behind its neighbours – Nepal, Pakistan, Sri Lanka, Bangladesh and Myanmar in the Report.

The hunger problem in India is serious, and the marginalised communities are the worst affected. Despite India’s 50% increase in GDP since 1991, it has failed to address the Human Development Index, which is a grave concern for a developing country like ours.

More than one-third of the world’s malnourished children live in India. (Source: “Putting the smallest first”, The Economist). Since the adoption of neo-liberal economic policy, India has witnessed a significant inequality among its population. The poor are getting poorer, and the rich are getting richer, which is a global scenario in first world capitalist countries and the third world developing countries.

One of the major causes of malnutrition is growing economic inequality. And In the case of India, it’s not just economic inequality, but religion and caste also play a major role.

The hunger problem in India is serious, and the marginalised communities are the worst affected around the globe.

What Is Malnutrition? 

Malnutrition is a violation of a child’s right to survival and development, and its consequences often remain invisible until it’s too late. As UNICEF puts it, malnutrition is a kind of an unseen emergency but it has a million faces.

According to UNICEF, malnutrition can be defined as:

  • “A child who never reaches full height due to poverty, poor sanitation, lack of breastfeeding and limited access to nutritious foods.
  • A young woman who becomes anaemic during her pregnancy and gives birth to an underweight baby who later faces developmental delays.
  • A child rendered blind by vitamin A deficiency.
  • A child who becomes obese through overconsumption of low-quality food.
  • A desperately thin and wasted child, at imminent risk of passing.”

Malnutrition is more than a lack of food; it is also a combination of various factors, such as insufficient protein and micronutrients, poor care and feeding practices, inadequate water, sanitation, frequent infections or disease, and inadequate health services.

It can lead to a low weight-for-height (wasting) or a low height-for-age (stunting) or sometimes to a combination of both. According to the Global Nutrition Report 2018, a third of the world’s stunted children, an estimated 46.6 million, under five years of age, who have low height for their age, live in India. India is also home to about 25.5 million wasted children; a strong predictor of under-five mortality.

How Does Malnutrition Affect India’s Marginalised Communities?

The nutritional problem in marginalised communities, in India, is full of obscurity, and their habitat and socioeconomic conditions also influence the condition. A majority of people live in rural India.

Poverty, lack of awareness of government schemes, illiteracy, and poor accessibility of health care are the major obstacles in eliminating malnutrition among the marginalised communities. The level of malnutrition is consistently high among Scheduled castes, Scheduled Tribes and Other Backwards Classes, as compared to other castes and the general population.

“Among these social groups, stunting is highest amongst children from the Scheduled Tribes (43.6%), followed by Scheduled Castes (42.5%) and Other Backwards Castes (38.6%). Whereas Prevalence of wasting is highest in Jharkhand (29.0%) and above the national average in eight more States (Haryana, Goa, Rajasthan, Chhattisgarh, Maharashtra, Madhya Pradesh, Karnataka and Gujarat) and three UTs (Puducherry, Daman and Diu and Dadra and Nagar Haveli).

Prevalence of underweight is also highest in Jharkhand (47.8%) and is above the national average in seven more States (Maharashtra, Rajasthan, Chhattisgarh, Gujarat, Uttar Pradesh, Madhya Pradesh and Bihar) and one UT (Dadra and Nagar Haveli).” (Sources: FNSA, 2019, WHO).

Malnutrition is a killer in the mainly tribal-dominated states, like Jharkhand. It has always been a hazard for the Tribal Community, followed by the Dalit Community and other ‘backward’ castes. The common reasons for the prevalence of malnutrition are interconnected or complementary to each other. Economics plays a crucial role. After all, families need money to be able to provide a healthy diet and sanitary living conditions.

A mother feeds her malnourished child in the Nutritional Rehabilitation Centre of Sheopur district in the central Indian state of Madhya Pradesh. Credit: REUTERS/Reinhard Krause.

In India, the unequal distribution of resources is a highly significant problem among rural populations. A majority of the marginalised population are involved in agricultural labour and mostly depend upon the informal sector. Besides income, an absence of health and nutrition awareness is another cause of malnutrition.

The government has taken various initiatives to prevent this problem – these include the Public Distribution System, Mid-day Meal Scheme, ICDS, Village and Child Development Centres, and The Integrated Child Development Services (ICDS) Scheme. These schemes have benefitted people, including children, pregnant women and lactating mothers.

However, problems are being observed in ensuring supply of quality food, and uniform distribution. Anganwadi centres were established under ICDS, to provide basic healthcare education and services across the country. But the problem here is that many of the workers are not skillfully trained, so they are unable to play an effective role in addressing the problem of malnutrition. And often, the mothers are blamed. A lack of organised orientation programmes and technical knowledge are major causes of the failure of policy implementation.

Often, even after developing a decisive nutritional scheme, we have seen the failure in service delivery. The economic and political factors tend to interfere with the very purpose of nutritional programmes. Needless to say, in a country like India, where a majority of people live in such vulnerable conditions, adequate funds are needed for the successful implementation of any nutritional scheme.

Both the Union and State Governments should configure more sustainable nutrition schemes to tackle the malnutrition problem. Most importantly, I believe an educated mother can be the sole driver to take care of her child. So, the government should give special importance to mother awareness programmes, relating to food and nutrition.

As ICDS and Anganwadi centres are the primary institutions in service delivery, the government should be more invested in their training.

The state government, civil society, and NGOs have to adopt a comprehensive and coordinated, multi-sectoral approach, to account for the varied nature of local-level challenges. Our civil society must respond responsibly, to demonstrate better governance to eliminate malnutrition.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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