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COVID-19 Will Worsen The Already Abysmal State Of Nutrition Among Women

This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.
By Mini Varghese, Country Director – India, Nutrition International

A few weeks ago, Twitter was in awe of the resilience of 15-year-old Jyoti Kumari who bicycled all the way to Bihar, covering 1,200 kilometers with her wounded father. Like many other migrant workers, Jyoti and her father had no money or food left to cope during the nationwide lockdown.

A few days later, the media applauded Zareen–an Anganwadi Workers and Accredited Social Health Activists (ASHA) worker in Noida who arranged for a pregnant woman to be taken by bike at night to the nearest hospital after her calls to emergency service helplines had failed.

Although both these stories of life under lockdown portray women as champions and public health warriors in times of a pandemic, the reality on the ground is much different.

The COVID-19 pandemic has both marginalized women from accessing primary care as well as severely affected the nutritional intake of adolescent girls and women, who typically eat last, and least, in their family. The existing challenging gender norms are further deepened by the lack of access to basic health and nutrition services like iron-folic acid and calcium supplementation, antenatal and postnatal checkups, and sexual and reproductive health services.

Although the impact of malnutrition may not visible now, it will have a lasting effect on women and adolescent girls, both of whom have unique and increased micronutrient requirements.

Pregnancies During The Pandemic

Woman lying next to her daughter.
Minimal and strenuous access to healthcare, combined with poor maternal nutrition during this time, is likely to cause an increase in low-birth weight and preterm births. Credits: UNFPA

Pregnant women and those who will become pregnant during the pandemic are significantly affected by the disruptions in healthcare services.

The need for social distancing and isolation on one hand, and overburdened health facilities and services on the other, have resulted in contradictory messages about the accessibility of primary care to pregnant women.

Although village health and nutrition days (special days allocated for conducting antenatal checkups for pregnant women) are slowly restarting in many states, there are still many women who cannot access these services due to other personal priorities, continued restriction on mobility or lack of public transport.

Minimal and strenuous access to healthcare, combined with poor maternal nutrition during this time, is likely to cause an increase in low-birth-weight and preterm births, leading to delayed cognitive, motor and social development.

Adolescent Girls Lag Behind

53% of adolescent girls in India are already anaemic; 80% are thin, short, or obese; 31% suffer from vitamin B12 deficiency, and 37% have folate deficiency. Nutritional and dietary inadequacies and restrictions during a pandemic put these already malnourished girls at higher risk of developing or increasing micronutrient deficiencies and other forms of undernutrition, compromising their immune system and ability to fight off illnesses.

Their challenges are worsening with the shutdown of educational institutions, restricting their access to mid-day meals and weekly iron and folic acid tablets. Due to the economic distress, there are high chances of many marginalized girls dropping out of school to contribute to domestic responsibilities and family income or even being married off early to reduce their parents’ burden.

Already 27% of young women in India are married, of which 8% experience their first pregnancy before turning 18. It is likely that their numbers increase significantly after the pandemic, continuing the cycle of malnutrition. With no education about their sexual and reproductive rights, these girls may continue to be in poor health, thereby limiting their participation in the formal labour market – which provides them with a chance to be financially independent and eventually alleviate their families out of poverty.

Women At The Frontlines Of Health Services

Women comprise 70% of the global health force, shouldering the highest-burden of care. In India, most of the community health workers ranging from Auxiliary Nurse Midwives (ANMs) to Anganwadi Workers and ASHAs are women whose main responsibilities include delivering medical services, administering vaccinations to newborns, ensuring nutrition, institutional deliveries of pregnant women, etc.

Being tasked with additional COVID-related duties, these frontline workers are putting in extra hours at work which is taxing their own health as well as their children’s. The lack of personal protective equipment or basic sanitizers and gloves is putting their safety at risk, making them highly susceptible to the disease.

Breaking The Cycle Of Malnutrition

Iron with Folic Acid tablets
Their challenges are worsening with the shutdown of educational institutions, restricting their access to mid-day meals and weekly iron and folic acid tablets.

Public health emergencies have disproportionately affected women and young girls. The spread of COVID-19 and the migrant crisis that ensued in India have brought the current state of malnutrition to light.

If left unchecked, it could potentially compromise the future of millions of vulnerable people, especially young girls and women, undoing some of the hard-won development gains of the past decade.

It is crucial to address the malnutrition storm affecting women, adolescents and children, and the solution to it can be found in the social avenues which women are typically discouraged from participating.

It is important, now more than ever, for young girls to continue their education and achieve their full potential. We cannot allow more young girls to meet the same fate as Devika – a 14-year-old girl from Kerala who committed suicide due to her inaccessibility to technology, electricity and the internet to attend online classes.

Learning programs with a focus on nutrition can potentially be adopted to instil practices of embracing nutritious diets.  Strengthening the supply and distribution of food and supplements is another way of bridging the gap, which many state governments have successfully adopted with the support of organizations like Nutrition International, United Nations and others.

To ensure continued care during pregnancy, governments should also review options of conducting antenatal care and creatively delivering care packages at home for pregnant women. It is also important to clarify confusion about the delivery of pregnancy care during COVID-19 to reinstate the correct practices about birth preparedness, breastfeeding and nutrition.

While developing policies and interventions, governments must accommodate gender-based approaches with targeted measures to support the health and nutrition of women and girls. This approach must be integrated into every phase of the pandemic response – the immediate response, the resilience building, and the recovery.

The author Mini Varghese is the Country Director of Nutrition International in India.  

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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.

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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.

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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.

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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.

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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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