Why govt's National Nutrition Mission should focus on women's well-being

Studies have shown how women can influence their child's nutrition indirectly through their own nutritional status, therefore, well-being of women in terms of education among others should be ensured

About 400 metres from the sub-divisional magistrate’s office in Manikpur block of Uttar Pradesh’s Chitrakoot district, 18-month-old Chandni Kol sat crying outside her mud hut on a sweltering May afternoon. Her legs and arms were skinny while her belly was inflated–typical symptoms of malnourishment. Her eyes were glazed over and her nose showed some kind of an infection. Barely able to walk or crawl by herself, she looked much smaller than her age.

Born at home, Chandni’s birth was not registered in her village, Khudariya in Nihi gram panchayat, also in Manikpur block, which lies in a dense forest. The village lacks basic amenities and armed robberies are common, so Savita had brought her daughter to a relative’s house in Khichari village, 7 km away.

Government health workers do not visit Khudariya, and she is too poor to afford to visit a doctor or buy medicines, Savita said. This is why, despite having previously lost a two-year-old son to an infection, she did not deliver Chandni in a hospital and has been unable to take her to the doctor for treatment.

It is to target such mothers and infants that Prime Minister Narendra Modi launched POSHAN Abhiyan or National Nutrition Mission (NNM) on International Women’s Day on March 8, 2018. Set up with a budget of Rs 90.46 billion ($1.3 billion), NNM aims to reduce, on a “war-footing”, stunting and low birth weight in children as well as anaemia in women and children.

 

 

Uttar Pradesh’s Chitrakoot, 230 km from the state capital of Lucknow, is one of the 314 districts selected to be a part of the mission. Part of the rocky and arid Bundelkhand region, since 2006 Chitrakoot has featured among India’s most backward districts, qualifying to receive funds from the Backward Regions Grant Funds Programme. In 2018, it became part of the ‘Transformation of Aspirational Districts’ programme that aims to “quickly and effectively transform some of the most underdeveloped districts of the country”.

IndiaSpend visited Chitrakoot, which had reported some of the worst health indicators in Uttar Pradesh (UP) in the fourth National Family Health Survey (2015-16), as well as Farrukhabad, among UP’s better-performing districts, as part of an ongoing effort to assess government schemes aimed at tackling child malnutrition.

In the first of our series examining government programmes to bring down child malnutrition, we examine how a stagnant economy and a near-complete failure of the government’s social safety nets are imposing a cost on Chitrakoot’s children’s health.

No jobs, no social security

Harsh geographical conditions, feudal social structures, inefficient government services and poor upkeep of law and order makes the Bundelkhand region one of the most backward regions in the world, according to the United Nations’ 2012 Human Development Index report.

With little by way of industries, farming employs the largest proportion of people. However, land holdings are tiny, water scarce and harvests poor, the report noted. About one-third (30 per cent) of the region’s population is below the poverty line.

Within Bundelkhand, Chitrakoot ranked 12 among 13 districts on the index, and it is easy to see why. With just 51.14 per cent of land under cultivation and supporting just one crop a year, people’s food security is severely compromised, said Ramji Pandey, chief medical officer, Chitrakoot. Eighteen per cent of children are born underweight (below 2.5 kg), he said.

While the district’s economy stagnates, all government safety nets have failed, from ration cards to jobs under the Mahatma Gandhi Rural Employment Guarantee Scheme (MGNREGS). Take Savita’s case.

The relatives’ home where she was living with her infant daughter Chandni had no electricity and no toilet. There was barely enough food to go around, and the family had no ration card. No one in the family had received MGNREGS work since 2011, they said, adding that occasional daily wage labour supplemented the money sent by a son who has migrated to the city.

Their neighbours are no better off. Mahesh and Phulkali, who also go by the last name Kol, which stands for their tribe, have four children. The youngest, Ruby, 3, has rough brown hair, a swollen belly and thin limbs–clearly malnourished. “Ruby falls ill so often, once we didn’t think she would make it,” said Phulkali, who has previously lost two toddlers to malnutrition and disease.

Mahesh and Phulkali work as daily wage labourers but work is difficult to come by on most days, they said. When IndiaSpend visited, they were selling tendu leaves (from the East Indian Ebony tree, used to roll beedi cigarettes) and earning upto Rs 200 per day together. Their ration card, which enabled them to buy government-subsidised food, expired two years ago and each time they applied to have it renewed, they were asked to submit documents that they did not have, Mahesh said.

Their eldest daughter is married and their middle daughter, Arati, 15, has given up her studies to take care of her younger siblings.

Dysfunctional anganwadis

NNM’s main strategy is “intense monitoring” and “convergence” between various schemes. These linkages are entirely missing in Chitrakoot, where half the children under five are stunted (50.9 per cent) and underweight (52.5 per cent), one-third are wasted (33.3 per cent) and nearly one-sixth are severely wasted (14.7 per cent). This is much worse than the rate in Uttar Pradesh and India overall.

 

 

While poor families are entitled to subsidised rations under the public distribution scheme (PDS), children up to age six get meals at the anganwadi (government-run daycare centres). Under the Integrated Child Development Services (ICDS) scheme, the world’s largest childhood care programme, it is the responsibility of the anganwadi to improve the nutritional and health status of children under six. It is also tasked with providing preschool education, immunisation, health check-ups and referral services. Anganwadi workers are responsible for maintaining records of children under six, regularly weigh them and track their growth.

Families such as the Kols’ are getting neither subsidised food nor anganwadi services.

Anganwadis have to provide children below six with morning snacks in the form of milk, banana, eggs and seasonal fruit, as well as one hot, cooked meal in the afternoon. Children younger than three years as well pregnant and lactating women are entitled to take-home rations.

However, all over Chitrakoot district, no hot, cooked meals have been served in the 1.5 years since January 2018, anganwadi workers and local ICDS officials admitted, nor have take-home rations been distributed. Uttar Pradesh’s ICDS director Rajendra Kumar Singh and principal secretary for the women and children’s department, Anita Meshram, did not respond to emails from IndiaSpend.

Food being the key attraction for impoverished families, parents such as the Kols stopped sending their children to the anganwadi in January.

It is no surprise, then, that ICDS centres in Chitrakoot note that 17.9 per cent of children under three and 18 per cent of children aged 3-5 were moderately underweight, and 7.1 per cent of children under three and 5.3 per cent of children aged 3-5 years were severely underweight.