1000 days to build a healthier and prosperous India

By Dr. Pankaj Verma,

With the release of Global Hunger Index (GHI) 2021, the nationwide nutrition status has again taken centre-stage amid the ongoing Covid-19 pandemic. Notwithstanding the questions around the report, few can doubt that undernutrition still remains a lived reality for millions of Indians, mostly children and pregnant and nursing women. The NFHS-5 survey has also highlighted the gaps in interventions and Covid-19 pandemic has necessitated a quick, assertive and focused approach to address the nutrition challenge. In the recent years, the government has aimed to reduce malnutrition through the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan which has shown remarkable progress in terms of affecting behavioral change, capacity building, convergence and making use of efficient technology in bridging service-delivery gaps. One of the key highlights of POSHAN Mission and its other associated initiatives has been the adoption of an integrated, multi-stakeholder approach towards targeted nutrition delivery for vulnerable populations, particularly children and pregnant and nursing women.

Women and children are a key demography that needs to be specifically targeted when taking action against malnutrition, as the malady has an inter-generational dimension. Malnourished girls are more likely to become malnourished mothers, and when children are born from malnourished mothers, they are likely to suffer from malnutrition too, leading to stunted growth, micronutrient deficiencies, and various other health complications. Hence, to break the vicious cyclic nature of malnutrition, we must proactively focus our attention on the 1,000 days between a woman’s pregnancy and her child’s second birthday.  This is a critical period where adequate nutrition needs to be given to the expecting mother and her child. Inadequate nutrition in this 1,000 day window can cause irreversible damage to a child’s health, set the stage for a lifetime of health problems and also pose a potential risk to the mother.

Early initiation and exclusive breastfeeding during the first six month of the child’s birth is essential for the overall health and development of the child. Beyond the six month period, however, the child needs to be compulsorily provided with complementary feeding, rich in macronutrients (carbohydrates, protein, fats) and micro nutrients (Vitamin A, Zinc, Iron, and other vitamins and minerals). Any deficiency during the first 1,000 days can cause irreversible damage. Nationally, the prevalence of stunting reaches a peak around 18-24 months, after which age corrective interventions have minimal effect. Thus, one cannot overstate the importance of timely intervention when it comes to battling malnutrition

What needs to be pointed out here is that malnutrition is not only a health challenge facing the country, but it also has a socioeconomic dimension. Studies show that countries that fail to invest in the well-being of women and children in the first 1,000 days lose billions of dollars to lower economic productivity and higher health costs, leading to reduced productivity, slashed income earning capacity and participation in adult life. Several leading economists have called for greater investments in the nutrition and well-being of mothers, babies, and toddlers as a way to create a brighter and more prosperous future for us all.

The Government of India has taken direct and indirect steps to improve the nutritional status of children (between 0-6 years of age) and pregnant women and lactating mothers. Poshan Abhiyan was launched in 2018 to tackle malnutrition in mission mode. It aims to reduce child stunting, underweight and low birth weight by 2 percentage points per annum and anemia among children (and young females) by 3 percentage points per annum. In order to achieve this, it relies on convergence and coordination so that benefits of various government initiatives reach women and children in the first 1000 days.

Other central sponsored schemes such as Pradhan Mantri Matru Vandana Yojana, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakaram have been launched to reduce maternal and neonatal mortality and to improve the nutritional health of the new-born and the mother.

In the last few years, interventions such as these have indeed yielded positive results. Maternal Mortality Ratio (MMR) of India was 130/ 100,000 live births in 2014-16. It has reduced by 17 points to 113/100,000 live births for the period 2016-18. According to the NFHS-5, 14 out of 22 states/UTs registered a decline in neonatal mortality. Infant mortality rate has also dipped in most states out of the 22 surveyed states in the first phase. Another encouraging data as pointed out by the NFHS-5 shows an improvement in exclusive breastfeeding in 16 states and UTs. There has been a consistent increase in institutional delivery as well, with 14 out of 22 states and UTs having more than 90 per cent of newborns being delivered in institutional facilities.

While the progress on such essential health indicators is laudable, changes are still marginal and hence, one must not lose sight of the fact that the prevalence of malnutrition and undernutrition in the country is still one of the highest in the world.  In fact, the 2020 Global Nutrition Report mentions India amongst the 88 countries that are likely to miss their global nutrition targets by 2025. There is still a long way to go before undernutrition is substantially mitigated in the country.

India has committed to achieve Sustainable Development Goal (SDG)-2 of ending hunger, achieving food security and improving nutrition by 2030. By taking timely and proactive action in the critical window of a 1,000 days between conception and a child’s second birthday, India stands a good chance of stepping out of the vicious cycle of malnutrition. Intervention delayed will not only cost precious lives, but also the future of the country as a whole.

(The author is Vice-President, Vitamin Angels, India. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.