First 1,000 days of life are key to addressing malnutrition
The article has been authored by Dr Shariqua Yunus, United Nations World Food Programme in India
India has made great progress over the years on food production by achieving self-sufficiency, initiating promising models for resilient and sustainable livelihoods, and inclusion through the food safety net.
However, despite this prevalence of malnutrition remains high at 35.5% stunting; 19% wasting, and 32.1% underweight including a high prevalence of anaemia and micronutrient deficiency disorders. While the indicators of undernutrition have shown a reduction between the two rounds of the National Family Health Survey 4 and 5, the prevalence of anaemia and obesity/overweight has increased across all age groups.
The first 1,000 days of life – roughly the time between conception and a child’s second birthday- is a window of opportunity when the foundations of optimum health, growth, and neurodevelopment are established.
Maternal nutrition needs attention during pregnancy not only for the child but also the mother. Studies prove that children are borne with heights at a negative variance with the World Health Organization growth standards pointing to poor nutrition available to the growing foetus in-utero. This is followed by further growth lag between 6-24 months of a newborn’s life, with the level of lag varying between countries. During the first 6 months of life, the child requires only breast milk. Breastmilk production and its nutritional value are largely protected against maternal malnutrition. However, the concentrations of some key nutrients may be sub-optimal because of low maternal dietary intake and there may be consequent adverse effects on the mother’s health. When the mother’s health and nutrition are compromised, the child’s health is also compromised.
This, therefore, continues to point to the need to invest in maternal, infant, and young child nutrition throughout. Yet too often focus is given to a few specific phases during this period, rather than the entire duration.
In India, as per the National Family Health Survey 5, more than 18% of women in the age group of 15-49 years have a low body mass index while more than half of the pregnant women in the same age group are anaemic. Further, slightly more than 6 out of 10 of the children are exclusively breastfed till six months of age while only 11 out of every 100 children between 6-23 months of age receive an adequate diet.
The Integrated Child Development Services (ICDS) scheme is the flagship programme of the government that addresses the health, nutritional and developmental needs of pregnant and lactating women and young children. The program is delivered through Anganwadi Centres (AWC), which provide a package of six services: supplementary nutrition, pre-school non-formal education, immunization, health check-up, nutrition, and health education, and referral services. The supplementary nutrition provided through the scheme consists of hot cooked meals for children aged 3-6 years and a Take-Home Ration (THR) for children aged 6-36 months and for pregnant/lactating mothers.
To ensure better access to appropriate complementary foods, ICDS scheme provides supplementary nutrition to children in the age group of 6-36 months in the form of THRs. The THRs are the ideal platforms to be leveraged to improve complementary feeding practices in the communities because of their focus on the given age group, vast outreach, and provision of THRs.
In other words, THR can play an important role in preventing malnutrition in young children and their mothers.
However, an analysis of the take-home rations distributed as blended foods through the ICDS in several states provides the following insights in terms of trends that need addressing.
The THRs distributed are often high in sugar and lack nutrients in terms of protein quality, fat content, and micronutrients which can help fuel growth in young children.
The same single blended food product is distributed to the ICDS participants throughout their period of association with the ICDS leading to monotony and impacting product acceptability.
The THR is often poorly perceived by the community not only because of the product per se but also because of the packaging of the THRs.
Despite the State spending huge funds on THRs and both THR distribution and nutrition health education being responsibilities of the AWWs, the AWWs are not found to be communicating about the THR to either pregnant/ lactating women or caregivers of young children.
To address the gaps in the THR through a systematic approach, the Department of Women & Child Development and the State Rural Livelihood Mission, Uttar Pradesh (UP) is collaborating with the United Nations World Food Programme (WFP) to ensure the availability of a safe, quality-assured, and nutritious THRs produced locally by women’s self-help groups.
This nutritious THR is already rolled out through two production units run by women’s groups in the blocks of Bighapur, Unnao, and Malwan, Fatehpur, catering to 51,000 ICDS beneficiaries. Quality control and assurance have been built into every step of the THR production process starting from procurement of raw materials to the distribution of the THR. The THR products are packed in top sealed, two-layered laminate, color-coded packaging giving a sense of quality to the community.
To diversify the THR, a set of sweet and savoury blended food products have been developed, aligned to the ICDS norms and including high-quality protein through the addition of milk powder and appropriate fat content. The products are also fortified with micronutrients and have low salt and sugar content.
Each pack also carries information on the preparation of the THR using the pack contents and key nutrition information for the given age group along with all FSSAI-mandated labelling and packaging information. The State is also investing in developing a set of IEC material focussed on the THR and in building capacities of the frontline functionaries to deliver information on the role and importance of the THR to the communities. Additionally, given that local women’s groups are producing the THR, the project also contributes to women’s empowerment, improved livelihoods, and growth of local economies.
The government of UP is already working on scaling up this model of THR production to an additional 200 plus blocks across the state.
(The article has been authored by Dr Shariqua Yunus, United Nations World Food Programme in India)