We always talk about the need for Sustainable Development Goals (SDGs) and making policies and programmes to achieve these SDGs. Most of these goals are not achievable without good WASH and nutrition practices. An overall study of the SDGs shows that a good WASH environment plays a crucial role in shaping the nutritional outcome as well as achieving other SDGs — including No Hunger, Good Health, Quality education and clean water and sanitation. Safe water for drinking, sanitation and hygiene services is a fundamental part of healthy life and leaves a good impact on nutrition uptake from food.
WASH (WASH typically refers to activities aimed at improving access to and use of safe drinking water and sanitation as well as promoting good hygiene practices (handwashing with soap and water)) is a collaborative term used for Water, Sanitation and Hygiene. The three are interlinked to each other.
Water plays important role in our daily lives. Over 663 million people all over the world don’t get safe and potable water (UNICEF/WHO, 2015). Further, 1.9 billion people are drinking fecally contaminated water (Bain et al.2014). All over the world, one-third population is facing inaccessibility of an improved sanitation facility (WHO/UNICEF, 2015).
In India, 40% of the people don’t have a dedicated place for washing their hands (JMP, 2017). Out of 66,101 health facilities across 54 low- and middle-income countries, 38% don’t have any water source, 19% don’t have improved sanitation and 35% don’t have water and soap for handwashing (WHO/UNICEF, 2015).
The act and process of nourishing or being nourished is called nutrition. Good nutrition doesn’t only mean the amount of food one has or how much one is fed. Good nutrition is provided through breastfeeding and good food in the required quantity and quality within a healthy environment. Giving nutrition in the first 1,000 days of childbirth (from the date of pregnancy to the second date of the baby’s birth) helps to develop the child mentally and physically. Good nutrition ensures a healthy life to the child forever.
Nearly half of the deaths of children under the age of five happen due to undernutrition (i.e. when the nutritional requirement of the body is not unmet as a result of that its causes the baby’s health.) World Bank, UNICEF and WHO say that undernutrition puts children at high risk. There are three major causes of undernourishment: insufficient food intake, improper care practice or diseases. These three causes majorly identified in children are said to happen due to the lack of safe water for drinking, proper hygienic care and unavailability of sanitation practices.
Undernutrition can cause stunting in a child (Stunting is an indicator of chronic undernutrition and often reflects general poor health and more distal economic and social factor), diseases such as diarrhea and pneumonia, and it also affects the immunity of children. Over 50% of undernourished children in the world are suffering from diarrhea, the second leading cause of death. In 2017, diarrhea was responsible for 8% of the deaths among children under-5 (WHO Maternal child Epidemiology Estimation, 2018).
In India, 144 million children under five were found stunted and 47 million were suffering from wasting (it is an indicator of acute undernutrition and is associated with increased mortality) in 2019 (UNICEF, WHO and World Bank, 2020). The most crucial growth period in every child’s life is the first 1,000 days. Appropriate nutrition during these days is essential for the physical and brain development of the child.
At the end of 1,000 days (or two years), a child’s brain growth is completed by up to 75%, hence, this time is crucial for brain growth. Deficiencies of nutrition in this period can not only cause death, but also have long-term consequences on cognitive (i.e. relating to the mental processes of perception, memory, judgment, and reasoning, as contrasted with emotional and volitional processes) and social abilities, school performance, learning ability and working capacity in adulthood. If the mother is suffering from nutrition deficiency, her child is also likely to suffer from deficiencies.
Undernutrition has risen to cause other diseases such as diarrhea (50% of diarrhea happens due to unsafe drinking water) and pneumonia, and also affects the immunity of the child. Due to all these diseases, children become ill (unwell). Illness gives rise to more diseases, which make the child ill (unwell), perpetuating a cycle of illness.
This happens due to only inadequate facilities of WASH, which can lead to diarrhea, cholera and pneumonia, and affect the immunity of the child. If the child’s immunity is not good and the amount of feed given to the child is untuneful, the frequency of diseases will increase.
Nutrition is useless without a good WASH facility. Water, Sanitation and Hygiene are interlinked to each other. For example, without proper toilets, water sources can become contaminated; without clean water, following basic hygiene practices is not possible. WASH practices give a healthy environment, which helps in getting good nutrition and health to the child. According to estimates by the Global Burden of Disease project, access to improved WASH can prevent 361,000 diarrheal deaths per year among children under five years of age, i.e. 58% of the global diarrheal death (Pruss-Usun et al, 2014).
A simple practice of handwashing with soap can prevent 50% of diarrheal cases (Lancet, 2003) and 15% of the rate of stunting under-five age group (Public Health Nutr, 2012). Handwashing also prevents the attack of pneumonia. Good WASH practices reduce the chances of contamination of water and provide an environment for good sanitation. It also helps us keep our diets healthy and uncontaminated.
Therefore, the WASH programme is often implemented on a large scale by the government to provide a platform for enhancing the coverage and effectiveness of nutrition supply interventions. Following are the programmes that help provide nutritious food to each and every child.
1) Integrated Child Development Services Scheme (ICDS): ICDS is the world’s largest child development programme. Its main aim is to provide health services and nutrition to children, adolescent girls and pregnant women. These health services are provided with the help of ASHA and Anganwadi workers to the community.
2) Mid-day Meal programmes (MDM): Mid-day meal is a programme run by the government of India to fulfil the better nutrition requirement of school children. It is provided on working days in primary and secondary school. The programme started in 1995 and is still running all over the country.
3) Special Nutrition Programme (SNP): The programme was introduced in 1970 to improve the nutritional status of children under the age of six years.
4) Wheat-based Nutrition Programme (WNP): This supplementary nutrition programme is a Centrally-sponsored programme that was introduced in 1986, but has now been transferred to the States. This programme follows the norms of SNP or the nutrition component of the ICDS.
5) Applied Nutrition Programme (ANP): It was introduced in Orissa in 1963 as a pilot and later got extended to Tamil Nadu and Uttar Pradesh. With the objective of promoting the production of protective food such as vegetables and fruits, the programme is meant to make people conscious of their nutritional needs and provide supplementary nutrition to children aged between 3-6 years as well as pregnant and lactating mothers.
6) Balwadi Nutrition Programme (BNP): This programme was introduced in 1970 to provide nutritional support in rural areas to children between 3-6 years of age. The programme is run under the Department of Social Welfare and is currently being phased out in favour of the ICDS.
Nutrition is always dependent on water, sanitation and hygiene. A good WASH environment plays the most important role in the physical, mental and social growth of the child as well as for other people. Without better WASH practices, billions of lives are at high risk during times of disaster or crisis. Good nutrition and WASH will play an important role in bringing a bright future to our nation.
WASH Nutrition document by SUN
Improving Nutrition Outcomes With Better Water, Sanitation and Hygiene: Practical Solutions For Policies And Programmes by UNICEF WHO, 2015