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.
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.
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 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.
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.