Sunday, July 26, 2015

Not enough on the plate: Nutrition plan for poor mothers buried?

Not enough on the plate: Nutrition plan for poor mothers buried?

A nutrition plan within the National Food Security Act meant forpregnant women and lactating mothers, a vulnerable group that skews India's hunger indices, looks quietly buried. It still runs as a trial in 52 districts, two years after the landmark legislation was signed into law.

The Centre hasn't yet begun budgeting for it to expand the maternal health scheme to cover the whole country. While a parallel scheme under the food law for children, the school lunch programme called mid-day meals, is funded jointly by the Centre and states, the maternal scheme has to be funded entirely by the central government.

The maternity scheme, aimed at mostly anaemic pregnant women among the poor, provides for cash of 6,000 in instalments for medical expenses and nutritious food during the course of pregnancy. For up to six months after the childbirth, such mothers can also have a free hot meal that meets nutritional standards.

Such benefits may look like largesse, but India is an outlier even among its south Asian neighbours when it comes to maternal mortality rate, or women who die during pregnancy or shortly after delivering. At 190 for every 100,000 live births, India's figure is worse than Bangaldesh's 170 and Bhutan's 120.

In contrast to images of Sudan's scrawny children with distended bellies, hunger in India remains largely invisible because it is driven not by near-death starvation but by sweeping malnourishment and calorie deficiencies.

Simply put, too little food lacking in essential nutrients has resulted in the world's largest proportion of stunted children with poor brains. Worse, their poor health actually begins even before they are born: in the womb of their half-fed mothers.

According to the Lancet medical journal, poorly fed mothers are more likely to give birth to underweight children (see graphic) and malnourishment in the first year of a child's life is irreversible.

Miles to go

Child malnourishment, notoriously high, has shown considerable improvements over the past decade, but despite the achievements, nearly one in three are poorly fed.

A latest study yet to be made public by the government, conducted jointly with the Unicef, has shown that India's proportion of underweight children was 30%. China's by contrast is 3%.

This is an improvement from a decade ago, when the National Family Health Survey (NFHS) in 2005 showed 42.5% of children under five were underweight. Sub-Saharan Africa had the next largest proportion of poorly fed children at about 21%.

Much of this improvement has to do with policies to fight hunger, such as the public distribution system.

Other surveys too have found improvements in India's hunger situation. According to the Food and Agricultural Organization's World Hunger report 2015, India saw a 36 percentage point drop in the number of undernourished people between 1990-92 to 2014-16.

According to FAO, undernourishment means "a person is not able to acquire enough food to meet the daily minimum dietary energy requirements, over a period of one year". FAO defines hunger as being "synonymous" with chronic undernourishment.

The report attributes the improvement to the country's focus on food security policies. "…the extended food distribution programme also contributed to this positive outcome. Higher economic growth has not been fully translated into higher food consumption, let alone better diets overall, suggesting that the poor and hungry may have failed to benefit much from overall growth", the FAO report states. The food security law is actually intended to improve upon this by expanding coverage to 75% of the rural population and 50% of urban dwellers.

Rich States, poor health

Generally, the latest child health data show that states with higher per capita income and better sanitation had made bigger improvements.

This isn't always true. Apart from large states as UP, even richer states such as Gujarat and Maharashtra have done quite poorly (see graphic) on parameters such as underweight, stunted and wasted. There was a clear correlation between open defecation and poor child health, the data showed. Moreover, states that have robust public distribution systems, such as Kerala, have been the best performers.

Yet, the FAO report showed that India was still home to a quarter of the world's hungry. The country had 194.6 million undernourished people, which constitute 15.2% of its population during 2014-2016. China, a country India aspires to overtake in GDP, has 133.8 million undernourished people, which is 9.3% of its population.

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