According to the World Health Organisation (WHO), good nutrition comprises a balanced diet and regular physical activity. It also emphasizes that poor nutrition leads to loss of immunity, increases susceptibility to diseases and affects our daily life.
With the advent of the new economic policy of 1991, India got access to the global market. The chains of “fast food” market and the new age of consumerism started to take place, which affected the diet and nutrition of the people in our country. We have all become so used to fast foods that we think that filling our tummies is the only job of food and are not aware of the right type of diet to follow in our lives.
Due to a patriarchal mindset, women’s health and education have often been neglected in our country. This neglect has not only deteriorated their health, but it is also a reason behind their children’s unhealthy condition. The lack of information about a balanced diet is primarily because low education levels of women.
There are different initiatives at the national and global level, which are working for the nutritional improvements of women and children. However, a change in the mindset right from family to the entire society is the need of the hour.
With the help of UNICEF, the Ministry of Health and Family Welfare recently conducted the first-ever “Comprehensive National Nutrition Survey“(CNNS). The survey analysed aspects of malnutrition, including micronutrient deficiencies and details of non-communicable diseases such as diabetes, hypertension, cholesterol and kidney function in children and adolescents.
As per the survey, around 10% of the children in the age group of 5 to 9 and adolescents in the age group 10 to 19 are pre-diabetic. About 5% of them were overweight, and around 5% suffered from blood pressure. The survey proves the coexistence of “obesity and undernutrition”. One in five children in the age group 5 to 9 were found to be stunted, and Tamil Nadu and Goa had the highest number of adolescents who were obese or overweight.
The Rural-Urban Divide
Interestingly, the survey highlights the difference in deficiencies among children based on their location viz. rural or urban. Malnutrition among children in urban India is characterized by relatively poor levels of breastfeeding, higher prevalence of iron and Vitamin D deficiency as well as obesity due to long commute by working mothers, prosperity and lifestyle patterns. It is believed that wealthier households in urban areas and sedentary lifestyles of children may also be responsible for a higher deficiency of Vitamin D in urban areas (19%) as compared to rural areas (12%).
However, the rural parts of the country see a higher percentage of children suffering from stunting, being underweight and wasting and lower consumption of milk products. Rural children also lag in intake of zinc, which causes diarrhoea, growth retardation, loss of appetite and impaired immune function. Among children aged 1–4 years, zinc deficiency is more common in rural areas (20%) compared to urban areas (16%).
The Role Of Mother’s Education And Poverty
The survey also brings forth the link between a mother’s education and the nutritional levels of children. Data from CNNS shows that children receive a better diet if their mothers’ level of education is high. Women with high education level, feed their children with more diverse foods as compared to women with lower education levels.
The monotonous food often leads to nutritional deficiency. The more diverse the food is, the more healthy a child becomes. Low nutritional levels lead to stunting, underweight children, and affects various activities of a person throughout their life. This also results in the reduction of overall productivity and opportunity.
There is an intersection of low education in women, poverty, and malnutrition. Experts find that poverty is the leading cause of the lack of access to education for women and their early marriage. Because of early marriage, women become pregnant early, without checking their nutritional or overall health status. This results in the transferring of diseases such as anemia to the newborn. Thus, a cycle of poverty and low health rotates.
Another dimension covered in the survey talks about “obesity” for the first time. Since the first National Nutrition Policy, the focus has mostly been on tackling malnourishment. The problem of obesity was not given due attention in the policy framework. However, there is a rise in obesity among children because of fast foods, sedentary lifestyles and more screen time.
Obesity is found mostly among affluent families where “easy food” becomes an alternative to the traditional, “time-consuming” food. Also, it can be found that new patterns of education—often filled with a lot of homework, assignments—provide very little time for children to devote time to exercise, sports or yoga. Therefore, there needs to be an awareness of how a ‘balanced diet would lead to balanced health’ among children.
The NFHS-4 (National Family Health Survey) conducted by the Ministry of Health and Family Welfare provides a lot of health-related and population-based information. It showcases the prevalence of ‘anemia’ among women. According to the survey, only 2% improvement has been made so far since 2005. This is worrisome.
About 40% of the women are mildly anemic, 12% are moderately anemic, and 1% are severely anemic. Anemia also varies by maternity status: 58% of women who are breastfeeding are anemic, compared to 50% of the women who are pregnant and the other 52% who are neither pregnant nor breastfeeding.
About 60% of female students in Delhi colleges are anemic as per the new survey carried out by the Delhi government. This shows that the problem of anemia and other diseases is not only found in underprivileged sections but also among affluent societies—all because of our collective neglect towards women’s health.
The facts tell us that because of traditional rules, women are still not provided with adequate diets. In joint families or even modern families, women often eat last after making sure that every member of the family has eaten. Also, there exists a rule in rural India that women should not take meals before the elders are served, in no case whatsoever. Why? Because it is ‘disrespectful’ and women are required to have the inbuilt mechanism to ‘honour’ family everywhere, be it at her father’s home or her husband’s home.
Needless to say, women’s education remains low because of the existing gender inequality and patriarchal society. This is also the reason women don’t pay attention to their own health and nutritional intakes.
As per the Global Hunger Index (GHI) 2019, India ranks 103 out of 119, which shows that India is still facing acute poverty. Where poverty is prevalent, child marriages are highly likely to happen. This leads to early reproduction and nutritional problems among young women later.
The recent outbreak of acute Encephalitis in Bihar that took the lives of many children also showcases how poverty leads to hunger in children. It was found that because of hunger, children were consuming ‘lychees’ on an empty stomach which turned out to be fatal. Hunger among children and low levels of nutrition are becoming a cause for ‘stunting’, ‘wasting’, and even deaths.
The government has devised many programmes and policies to contain the malnutrition problem among women and children. Along with covering dimensions of malnourishment, reduction of poverty is also on the list—to increase the intake of food among marginalised sections. Various pilot studies undertaken by researchers prove that an increase in income levels increase nutritional intake among marginalised sections.
India’s National Nutrition Policy was introduced in 1993 to combat the problem of undernutrition. It aims to address this problem by utilising direct (short term) and indirect (long term) interventions.
Direct interventions included ensuring proper nutrition of target groups, expanding the safety net for children—proper implementation of universal immunization, oral rehydration and ICDS services and growth monitoring in 0–3 age group. Other areas focused on were the nutrition of adolescent girls to enable them to attain safer motherhood, and the nutrition of pregnant women to decrease the incidence of low birth-weight.
Indirect policy interventions included food security, improving dietary pattern, the purchasing power of rural and urban poor by public food distribution system, nutrition education et al.
Another program started by the government of India is Poshan Abhiyaan. It was launched on International Women’s Day (March 8) in 2018 to boost nutrition among children and women. The Abhiyaan aims to reduce stunting, undernutrition, anemia (among young children, women and adolescent girls) and low birth-weight by 2%, 2%, 3% and 2% per annum, respectively. The target of the mission is to bring down stunting among children in the age group 0-6 from 38.4% to 25% by 2022. Recently, Poshan Maah was observed during September to increase awareness regarding nutrition in India.
The government has come up with different schemes such as ‘doubling farmers income by 2022’, pension schemes for farmers and unorganised workers, provision of scholarships for women and marginalised groups in education, etc., to contain poverty. But, a plethora of schemes remains unimplemented because of corruption practices prevalent in the provision of services. Also, the food provided by Public Distribution Systems is not of the standard quality because of the corruption in the distributor markets.
The migrants who leave their homes due to economic reasons are also deprived of the rationed food in other states. However, a new scheme by the government, ‘One Nation, One Ration card’ intends to help migrant workers to avail food items from ration shops across the country. Only time will tell how effective this scheme would be in solving the hunger and nutritional problems of the vulnerable sections.
Some surveys show that India is improving in various domains of health and nutrition. However, this improvement is not only slow, but the margins remain low too. Therefore, India needs to bring development across different dimensions to reduce vulnerability to malnutrition.
A video on the Rajya Sabha TV suggests a few measures to increase nutritional intake to tackle hunger in developing countries. Firstly, it states that the government should implement policy in a mission mode by involving various stakeholders. Secondly, farmers need to be incentivised to grow native crops with high nutritional value. Crop diversification would also help to take a variety of meals, which could improve the consumption of micro and macronutrients. Thirdly, it recommends that media and civil society groups should create campaigns and reach out to rural and underprivileged sections to disseminate the importance of nutrition. ‘Anemia Mukt Bharat’ is one such example.
The CNNS also provides ample data that links women’s education and child nutrition. Therefore, there is a need to improve women’s literacy in India. Apart from providing basic literacy, a curriculum on ‘nutrition’ is a must because even if one is educated, they might not know much about the ‘nutritional’ aspects. Thus, bringing in the study of nutrition in syllabus at various levels of education would help sensitise people about the issue.
This case leads to another point: the onus of child-caring should also be balanced between mother and father. A child’s nutrition is an equally important concern for a father, so educating women (considering most men are privileged to be educated) as well as pushing for a behavioral change (making fathers responsible), could bring about a positive change. Also, if a woman is educated, she is more likely to marry late. With increased education, a woman would also become financially independent. This would also result in a later pregnancy, and the maturity of age would help her take better care of her own health and nutritional requirements respectively.
As WHO recommends, regular physical activity and a balanced diet are vital for enhancing nutrition, vitamins, and reducing obesity, stunting, etc. Our society needs to get rid of the traditional beliefs that subjugate women and marginalised sections. We are modernising ourselves through ‘attires, gadgets, lifestyle patterns’, but our minds are still following the old, unequal and discriminatory habits. This needs to be done away with if we wish for a prosperous nation.