How Cultural Norms And Poverty Lead To Poor Nutrition Among Indian Women

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. 

What Does The Comprehensive National Nutrition Survey Says About The State Of Children’s Health?

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.

Rural children lag in intake of zinc, which causes diarrhoea, growth retardation, loss of appetite and impaired immune function.

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. 

Obesity

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. 

Facts Relating To Women’s Health

Image credit: Stella Paul/Via Flickr

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. 

Poverty-Nutrition Link

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 Bihar govt failed miserably to ensure that children get proper nutrition in the state.

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. 

Is The Government Doing Enough To Enhance Nutrition Levels Among Women And Children?

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. 

Possible Solutions

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.

Featured image via Flickr
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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 Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’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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