Only 23% of children aged 6-23 months received an adequately diversified diet, according to the study by Sutapa Agarwal from Tata Trusts, Rockli Kim and S V Subramanium from the Harvard Center for Population and Development Studies of Harvard University, and others, published in the European Journal of Clinical Nutrition in February 2019.

Among the poorest households, 18% of children had a sufficiently varied diet as compared to 28% of children from the richest households, a difference of 10 percentage points. At the same time, 17% of children of mothers with no education ate an adequately diversified diet as compared to 30% of mothers with a high school or higher education, a difference of 13 percentage points, the study found.

An “adequately diversified diet” entailed consuming at least four items from seven food groups used for the purpose of the study–grains, roots and tubers, legumes and nuts, dairy products, flesh foods (meat), vitamin A-rich fruits and vegetables, and other fruits and vegetables.

Eating a varied diet is as important, if not more, than the quantity and quality of nutrition. In the study, most children had a higher consumption of grains and a poor consumption of fruits and vegetables, nuts and legumes, eggs and meat.

“More than animal versus plant–we need to think of macro nutrients related to the balance between fat, protein and carbohydrates,” said Subramaniam, one of the co-authors of the study, in an email. “And for young children fat intake is critical. There is an emerging recognition to focus on proteins, but not nearly enough for fat intake among very young children. And here is where dairy consumption–including milk–is important for addressing the burden of child undernutrition.”

Wealth and education gap

“For the poorer strata it is affordability and accessibility, while for the better-off strata it could be lack of knowledge,” said Subramaniam, explaining the study’s findings. Food is an industry now, he said, adding that dietary preferences among the well off need to be interpreted in the larger context of global trends towards homogenous food.  

Home to almost a third of the world’s stunted children under five (46.6 million), India is not on track to reach the World Health Organization’s 2025 global nutrition targets, IndiaSpend reported in January 2019.

Of Indian children under two years of age, 90.4% did not receive an adequate diet, the National Family Health Survey-4 (NFHS-4) 2015-16 found. Some 18% of children aged 6-23 months ate iron-rich foods, and more than half the children in this age group were anaemic. About 54% consumed vitamin A-rich foods, the lack of which can lead to childhood blindness and poor immunity.

The present study on dietary diversity also used NFHS-4 data, in which mothers were asked to choose from a list of 21 food items they had given their children in the preceding 24 hours.

The items were then divided into seven food groups: grains, roots and tubers, legumes and nuts, dairy products, flesh foods, vitamin A-rich fruits and vegetables, and other fruits and vegetables.

The mean score of dietary diversity of Indian children was found to be 2.26, on a 0-7 scale, where 0 means children are not fed any of the 21 food items and 7 means they are fed at least one from all seven groups.

The biggest difference between children of different wealth groups was in consumption of dairy products–children in the richest households were three times more likely to consume dairy products as the poorest households.

Meanwhile, children of mothers with high school or higher education had a greater likelihood of consuming all seven food groups and had twice the odds of eating an adequately diversified diet as those with mothers with no education.

Grains consumed most

Among the seven food groups, children mostly ate grain–74% were reported to have consumed roots and tubers, 55% dairy products, 37% other fruits and vegetables, and 29% vitamin A-rich fruits and vegetables.

Children’s consumption was the lowest for eggs (14% of respondents), legumes and nuts (13%), and flesh foods (10%), the study found.

Between the richest and poorest households, the difference in consumption of dairy products was the highest (39% in poorest households vs 72% in richest households), followed by vitamin A-rich fruits and vegetables (26% vs 33%) and other fruits and vegetables (34% vs 40%).

Consumption of dairy products varied most by mothers’ education level–44% for uneducated vs 73% for educated–followed by vitamin A-rich fruits and vegetables (25% vs 34%), and other fruits and vegetables (32% vs 43%).

Although dietary diversity increased in 2016 as compared to 2006, it was poor throughout and actually reduced in the upper two wealth groups (out of five). Despite the reduced gap, the upper groups consumed 2-4 times more diversified diets than those in lower groups.

Consumption of some food items was influenced more by maternal education than household wealth. These included: pumpkin, carrots, squash, dark green leafy vegetables, liver, heart, organ meat, fish, shellfish, legumes and nuts, and flesh food.

Consumption of packaged items such as canned juices increased with increased wealth and mother’s education, which the researchers called “alarming”. They suggested that food items that are cheap in India such as pumpkin, carrots and dark green leafy vegetables should be encouraged.

Can more meat help?

To improve dietary diversity, children should be eating more animal-sourced foods. Indians consumed 194 gm and 242 gm of protein a day in rural and urban areas, respectively, against the recommended 459 gm, according to an analysis published in Livemint in January 2019.

Although dairy and poultry foods are cheaper in India than in some low- and middle-income countries, they remain beyond the reach of many. Here, cash transfers can play a role, said a study on child feeding practices in 2006 and 2016 conducted by the agriculture research group International Food Policy Research Institute (IFPRI) and published in the journal Maternal and Child Nutrition.

It would also be important to remove cultural barriers to meat consumption among young children, the study said. Among the one-third households that did not consume animal protein,  improving consumption of legumes/nuts and fruit and vegetables could help, said Phuong Nguyen, a co-author of the IFPRI study, on email.

Another study from IFPRI had found that despite health and nutrition education increasing three-fold from 3.2% in 2006 to 21% in 2016, the poorest mothers had the second worst coverage of health and nutrition services (after the richest group), IndiaSpend reported in March 2019.

(Yadavar is a principal correspondent with IndiaSpend.)

Courtesy: India Spend

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For many of us, a better diet means eating more fruit and vegetables. iStock, CC BY-NC

These are the findings our the EAT-Lancet Commission, released today. The Commission brought together 37 leading experts in nutrition, agriculture, ecology, political sciences and environmental sustainability, from 16 countries.

Over two years, we mapped the links between food, health and the environment and formulated global targets for healthy diets and sustainable food production. This includes five specific strategies to achieve them through global cooperation.

Right now, we produce, ship, eat and waste food in a way that is a lose-lose for both people and planet – but we can flip this trend.

What’s going wrong with our food supply?

Almost one billion people lack sufficient food, yet more than two billion suffer from obesity and food-related diseases such as diabetes and heart disease.

The foods causing these health epidemics – combined with the way we produce our food – are pushing our planet to the brink.

One-third of the greenhouse gas emissions that drive climate change come from food production. Our global food system leads to extensive deforestation and species extinction, while depleting our oceans, and fresh water resources.

To make matters worse, we lose or throw away around one-third of all food produced. That’s enough to feed the world’s hungry four times over, every year.

At the same time, our food systems are at risk due to environmental degradation and climate change. These food systems are essential to providing the diverse, high-quality foods we all consume every day.
 

A radical new approach

To improve the health of people and the planet, we’ve developed a “planetary health diet” which is globally applicable – irrespective of your geographic, economic or cultural background – and locally adaptable.

The diet is a “flexitarian” approach to eating. It’s largely composed of vegetables and fruits, wholegrains, legumes, nuts and unsaturated oils. It includes high-quality meat, dairy and sugar, but in quantities far lower than are consumed in many wealthier societies.

Many of us need to eat more veggies and less red meat. Joshua Resnick/Shutterstock

The planetary health diet consists of:

• vegetables and fruit (550g per day per day)
• wholegrains (230 grams per day)
• dairy products such as milk and cheese (250g per day)
• protein sourced from plants, such as lentils, peas, nuts and soy foods (100 grams per day)
• small quantities of fish (28 grams per day), chicken (25 grams per day) and red meat (14 grams per day)
• eggs (1.5 per week)
• small quantities of fats (50g per day) and sugar (30g per day).

Of course, some populations don’t get nearly enough animal-source foods necessary for growth, cognitive development and optimal nutrition. Food systems in these regions need to improve access to healthy, high-quality diets for all.

The shift is radical but achievable – and is possible without any expansion in land use for agriculture. Such a shift will also see us reduce the amount of water used during production, while reducing nitrogen and phosphorous usage and runoff. This is critical to safeguarding land and ocean resources.

By 2040, our food systems should begin soaking up greenhouse emissions – rather than being a net emitter. Carbon dioxide emissions must be down to zero, while methane and nitrous oxide emissions be kept in close check.

How to get there

The commission outlines five implementable strategies for a food transformation:
1. Make healthy diets the new normal – leaving no-one behind
Shift the world to healthy, tasty and sustainable diets by investing in better public health information and implementing supportive policies. Start with kids – much can happen by changing school meals to form healthy and sustainable habits, early on.
Unhealthy food outlets and their marketing must be restricted. Informal markets and street vendors should also be encouraged to sell healthier and more sustainable food.

2. Grow what’s best for both people and planet
Realign food system priorities for people and planet so agriculture becomes a leading contributor to sustainable development rather than the largest driver of environmental change. Examples include:

• incorporating organic farm waste into soils
• drastically reducing tillage where soil is turned and churned to prepare for growing crops
• investing more in agroforestry, where trees or shrubs are grown around or among crops or pastureland to increase biodiversity and reduce erosion
• producing a more diverse range of foods in circular farming systems that protect and enhance biodiversity, rather than farming single crops or livestock.

The measure of success in this area is that agriculture one day becomes a carbon sink, absorbing carbon dioxide from the atmosphere.

Technology can help us make better use of our farmlands. Shutterstock

3. Produce more of the right food, from less
Move away from producing “more” food towards producing “better food”.

This means using sustainable “agroecological” practices and emerging technologies, such as applying micro doses of fertiliser via GPS-guided tractors, or improving drip irrigation and using drought-resistant food sources to get more “crop per drop” of water.

In animal production, reformulating feed to make it more nutritious would allow us to reduce the amount of grain and therefore land needed for food. Feed additives such as algae are also being developed. Tests show these can reduce methane emissions by up to 30%.

We also need to redirect subsidies and other incentives to currently under-produced crops that underpin healthy diets – notably, fruits, vegetables and nuts – rather than crops whose overconsumption drives poor health.

4. Safeguard our land and oceans
There is essentially no additional land to spare for further agricultural expansion. Degraded land must be restored or reforested. Specific strategies for curbing biodiversity loss include keeping half of the current global land area for nature, while sharing space on cultivated lands.

The same applies for our oceans. We need to protect the marine ecosystems fisheries depend on. Fish stocks must be kept at sustainable levels, while aquaculture – which currently provides more than 40% of all fish consumed – must incorporate “circular production”. This includes strategies such as sourcing protein-rich feeds from insects grown on food waste.

5. Radically reduce food losses and waste
We need to more than halve our food losses and waste.

Poor harvest scheduling, careless handling of produce and inadequate cooling and storage are some of the reasons why food is lost. Similarly, consumers must start throwing less food away. This means being more conscious about portions, better consumer understanding of “best before” and “use by” labels, and embracing the opportunities that lie in leftovers.

Circular food systems that innovate new ways to reduce or eliminate waste through reuse will also play a significant role and will additionally open new business opportunities.

For significant transformation to happen, all levels of society must be engaged, from individual consumers to policymakers and everybody along the food supply chain. These changes will not happen overnight, and they are not the responsibility of a handful of stakeholders. When it comes to food and sustainability, we are all at the decision dining table.

The EAT-Lancet Commission’s Australian launch is in Melbourne on February 1. Limited free tickets are available.

Alessandro R Demaio, Australian Medical Doctor; Fellow in Global Health & NCDs, University of Copenhagen; Jessica Fanzo, Bloomberg Distinguished Associate Professor of Global Food and Agriculture Policy and Ethics, Johns Hopkins University, and Mario Herrero, Chief Research Scientist, Food Systems and the Environment, CSIRO
 

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Mother and child at nutrition rehabilitation centre in Chitrakoot, Uttar Pradesh. 50.9% of children under 5 are stunted in Chitrakoot as compared to 38.4% nationally.

India is not on track to achieve any of the World Health Organization’s (WHO) nine nutrition goals–reduce child overweight, wasting and stunting, diabetes among women and men, anaemia in women of reproductive age and obesity among women and men, and increase exclusive breastfeeding–by 2025, says the report.

The nine goals were adopted by WHO member countries in 2012 and 2013 to reduce all forms of malnutrition by 2025.

The fifth such report, compiled by GNR’s Independent Expert Group comprising academics, researchers and government representatives, was released at the ‘Accelerating the End of Hunger and Malnutrition’ conference in Bangkok, Thailand on November 29, 2018. The conference was jointly organised by the International Food Policy Research Institute (IFPRI) and the Food and Agriculture Organization (FAO) of the United Nations.

India has shown improvement in reducing child stunting but with 46.6 million stunted children, according to the report, the country is home to over 30.9% of all stunted children under five–the highest in the world.

India, however, has shown no progress or declining parameters related to six other global nutrition goals (information on two goals is not available).  
Only 94 of 194 countries are on track to achieve at least one of the nine global nutrition targets, says the report. “While [globally] there has been progress in reduction of stunting, there has been slow reduction of anaemia and underweight in women while overweight and obesity is getting worse,” said Corinna Hawkes, co-chair of the report and Director of the Centre for Food Policy, at the release of the report.

India reduces numbers of undernourished, but still bears 23.8% of the global burden of malnourishment
India had 195.9 million undernourished people–or people with chronic nutritional deficiency–in 2015-17, down from 204.1 million in 2005-07, according to FAO data. The prevalence of undernourishment has also gone down from 20.7% in 2005-07 to 14.8% in 2015-17.

India, however, still accounts for 23.8% of the global burden of malnourishment, and has the second-highest estimated number of undernourished people in the world after China, according to FAO.

In 2015, all WHO members including India adopted the United Nations’ 17 Sustainable Development Goals, which include achieving zero hunger–or zero undernourished population–by 2030.

IndiaSpend’s analysis shows that to achieve zero hunger by 2030, India will have to lift 48,370 people out of hunger everyday. India’s reduction in undernourished population from 2015 to 2017 was 3.9 million, which is about 10,685 people per day–less than one-fourth needed to meet the target by 2030. Even at its highest reduction of undernourished population–15.2 million in 2006-2008–India could lift only 41,644 people per day out of hunger.

Globally, hunger is rising
With almost 821 million people malnourished in 2017–up from 804 million in 2016 and equal to levels eight years ago–the goal of ending global malnutrition is under threat, said FAO and IFPRI at a joint press conference on November 27, 2018, in Bangkok.

“This is the third consecutive year that progress in ending hunger has stalled and now has actually reversed,” said Shenggen Fan, Director General, IFPRI.

While Africa has the highest number of people with undernourishment–21% of the total population–the situation in South America is also worsening, while the decreasing trend in Asia has slowed down, according to FAO’s State of Food Security and Nutrition in the World Report, 2018.
Conflict, climate change and economic slowdown were the main causes for the increasing global trend of undernourishment, said the FAO report.

“Business as usual cannot be the way to go,” said Kostas Stamoulis, FAO Assistant Director-General, at the press conference. “There are only 12 years to achieve the target of zero hunger (by 2030) and it will mean lifting 185,000 people out of hunger every day, which is why we have to go faster,” said Stamoulis.

India’s many challenges in reducing malnutrition
Malnutrition was the top cause of death and disability in India in 2017, followed by dietary risks including poor diet choices, according to the 2017 Global Burden of Disease study by the University of Washington. Obesity and overweight increased by 9.6 and 8 percentage points in men and women, respectively, in 2015-16 compared to a decade ago, while non-communicable diseases were responsible for 61% of all deaths in 2016.

One of the earliest interventions to prevent malnutrition and disease in children is breast feeding; yet, only 54.9% of Indian babies are exclusively breastfed and only 41.6% of babies are breastfed in the first hour of birth, according to the ministry of health and family welfare’s National Family Health Survey-4 (2015-16). Further, less than 10% of children receive adequate nutrition in the country, said the survey.

Also, while India is slated to become the third largest market for packaged food by 2020, only 12% of beverages and 16% of foods sold by nine leading Indian food and beverage companies were of “high nutritional quality”, according to the Access to Nutrition Index India Spotlight, 2016.

India has made efforts to counter the trend of slowing decline in malnutrition rates. The Poshan Abhiyan–National Nutrition Mission–aimed at reducing malnutrition in women and children was launched in March 2018. India also became one of 59 countries to impose a sugar tax on sweetened beverages, according to GNR 2018. The Goods and Services Tax on soft drinks was increased from 32% to 40% in 2017.

However, to speed up progress on both reducing all forms of malnutrition by 2025 and achieving zero hunger by 2030, India can learn from successes elsewhere.

Lessons from Bangladesh, Brazil and China
A combination of public policies, agricultural research and economic growth has led to reduction in malnutrition in several countries. The GNR 2018 cited progress made by China, Ethiopia, Bangladesh and Brazil in reducing hunger and malnutrition. “Those successes hold important lessons for the places currently struggling to make significant progress,” said Fan.

Bangladesh has seen the fastest reduction in child underweight and stunting in history. Stunting in children under five, which was 55.5% in 2004, has been reduced to 36.1% in 2014, “largely by using innovative public policies to improve agriculture and nutrition”, said a statement by IFPRI and FAO. While agriculture growth was spurred by supportive policies, other policies such as family planning, stronger health services, growing school attendance, access to drinking water and sanitation and women’s empowerment also played a role.  

In China, it was high economic growth (per capita income rose from $5,060 in 2005 to $16,760 in 2017) that lifted millions out of both hunger and poverty.

Brazil and Ethiopia transformed their food systems and diminished the threat of hunger through targeted investments in agricultural research and development and social protection programmes, according to FAO.

“Starting in the mid-1980s and continuing over two decades, crop production in Brazil grew by 77% and that–combined with the country’s Fome Zero programme [Zero Hunger], established in 2003 to provide beneficiaries a wide range of social services–saw hunger and undernutrition nearly eradicated in just ten years,” said the statement.

(Yadavar is a principal correspondent with IndiaSpend.)

Courtesy: India Spend

The IFPRI sponsored Yadavar’s trip to attend a media workshop and the ‘Accelerating The End of Hunger and Malnutrition’ conference at Bangkok.
 

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This is a common practice in many Indian households, but among the rural poor it makes women and children, some of the weakest in the world, hungrier and sicklier, sparking a cascade of slow development, eventually implicated in holding back national economic progress.

“Particularly among the rural poor, food distribution in households is not based on need,” reads Right to Food in India, a 2003 paper of the Centre for Economic and Social Studies, Hyderabad. “The breadwinner gets sufficient food, the children get the next share, and women take the remains.”

A two-year-old project in Rajasthan used an unusual strategy to break this pattern among poor tribal communities in the southwestern district of Sirohi and eastern district of Banswara. Instead of simply increasing their food supply and access — the standard approach for dealing with malnutrition — it attempted to break the tradition of prioritising men’s needs first.
“We were advised to serve meals only after all the family members are seated so that everyone gets served equally and we discuss food,” said Rukmani (who uses only one name), one of the project beneficiaries.

Behind this strategy of the Rajasthan Nutrition Project, launched in 2015, was a baseline survey of 403 women. It revealed that those with a lesser say in running their household were more likely to have less food for their children and were themselves vulnerable to malnutrition.

Malnutrition is one of the leading causes (about 50%) of all childhood deaths in India, and malnourishment at an early age can lead to long-term consequences, as it affects motor, sensory, cognitive, social and emotional development, IndiaSpend reported in July 2014.

“Stunted children (low height for age) face a lifetime of lost opportunities in education and work,” said a global study called End of Childhood Report 2017. “They are also more likely to succumb to illness and disease, and can die as a result.” Only one child in 10 in India gets adequate nutrition, IndiaSpend reported in May 2017.

So, the Rajasthan campaign, executed by Freedom from Hunger India Trust and Grameen Foundation, both nonprofits, through local partners Pradan and Vaagdhara, made women more health and nutrition-aware and sensitised their husbands to gender equality.

Source: Freedom from Hunger India Trust and Grameen Foundation

“We chose to address intra-household food consumption disparity — the fact that in one household alone, the women and children could be food insecure while the men are food secure,” said Saraswathi Rao, CEO, Freedom From Hunger India Trust.

Over two years, the project has touched the lives of 30,000 people and among the 403 women who were sampled, more than doubled the number of women and children who always have enough to eat.

Before the intervention, 31% women had reported that their husbands alone decided how much food to serve the family. After being told to make decisions jointly, no more than 3% of men continued to take this call alone, while the number of couples making joint decisions increased from 12% to 19%. Also,  53% households reported eating more meals together as a family.

Why better nutrition for women needs a change in attitude

The Rajasthan Nutrition Project’s approach is significant in another respect. Economists have long wrestled with a problem often referred to as the India Enigma: Despite greater economic progress India’s child health indicators fare worse than that of sub-Saharan African nations.

India has more malnourished children than sub-Saharan Africa, IndiaSpend reported in May 2017. Indian babies are more than twice as likely to have lower birth weights than those born in sub-Saharan Africa, 28% to 13%, IndiaSpend reported in November 2016. Low birth weight is the single largest predictor of undernutrition, write S Mahendra Dev and Alakh Sharma in a 2010 Oxfam publication.

The problem, Dev and Sharma said, could be empowerment. “Women in South Asia tend to have lower status and less decision-making power than women in sub-Saharan Africa,” wrote the authors.

So, the solution does not appear to lie in increasing household food supply and access to food—as the government does through the Public Distribution System and Integrated Child Development Services (ICDS), respectively, as a baseline study conducted at the start of the project confirmed. The ICDS is a national programme that provides medical services to preschoolers through a local anganwadi (creche).

Interviews with 403 women revealed who made household decisions about food, mobility and communication. This, in turn, was found to closely correlate with their own and their children’s food security. Nine in 10 were married, of tribal origin and had an average of 3.21 children, including at least one under the age of two, and a third were from families with monthly income Rs 2000-2500.

Among the women who reported having greater autonomy, 39% respondents and 42% of their children had enough to eat. Only 12% women with lower levels of autonomy and 17% of their children reported having enough to eat.
 

Source: Freedom from Hunger India Trust and Grameen Foundation

Women who had a greater say in household decisions were more likely to use government health services, breastfeed their children and enjoyed a better relationship with their husbands.
The study revealed that any effort designed to improve food security and nutrition had to aim at improving women’s autonomy and decision-making within the household, Kathleen Stack, executive vice president of the Grameen Foundation said.

The other benefits of abandoning gender hierarchy

In a one-room tenement in Morthal, with a television blaring in the background, a group of women were talking of what they had learned: How control over nutrition, health and household finance helps their families become healthier.

Zuhra Bano and Meera Gujjar, leaders of local Self Help Groups (SHG), were the most vocal. With 1,250 other mostly illiterate leaders of SHGs, they had signed up for training under the nutrition project.
 

The 1250 trained Self Help Group (SHG) leaders were called Community Nutrition Advisors, and given the job of imparting information to their SHG members and the women’s husbands. They also held rallies to spread the word.

Having qualified as community nutrition advocates, Zuhra, Meera and the other SHG leaders disseminated their new knowledge to their group members—women like Santosh, Hemlata, Rukmani.

One of the project aims was to increase the food available for the sample set of women and children. This was measured by moving them up at least one point on a four-point scale.
 

Source: Freedom from Hunger India Trust and Grameen Foundation

Women were also encouraged to use the food distributed to pregnant and lactating women and young children under the ICDS. Some women had not used this service because they did not know of it, others because their families restricted their movements.

“We never knew that the anganwadi provides children (aged 3 to 6 years) a free daily meal, a variety of meals like daliya (porridge) and khichdi (a rice and lentil preparation), and take home rations for infants,” said Meera, the SHG leader.
 

The Rajasthan Nutrition Project, an initiative in Rajasthan’s Sirohi and Banswara districts involved training 1250 mostly illiterate Self Help Group (SHG) leaders in health, nutrition and managing household finances. Here, Meera (in green), a SHG leader, is seen with a few members of her SHG, with who she shared her learning. The 1250 SHG leaders reached out to over 8000 women, and through them, touched the lives of 30,000 people.

Having learned of what was available, the women of Morthala wondered if they would be permitted to walk to the nearest anganwadi, a couple of kilometres away, in the neighbouring village.

To address this social constraint, community facilitators like Baldev Kumar, also trained under the project, and community nutrition advocates conducted gender dialogues to explain to husbands why it was important for couples to make decisions jointly.

After these conversations, more than  twice the number of women were permitted to visit a market or healthcare centre than before, increasing the use of anganwadi services by 32%. The number of couples taking joint decisions about buying food also doubled.

Ensuring dietary diversity in a few, cost-effective steps

To improve their family’s nutrient intake, women were advised dietary diversity, especially to eat more fruit and vegetables. This was unthinkable for many of the tribal women, who had no money to buy extra food.

“So, we sourced seeds from local government agencies and helped them create kitchen gardens, even those with limited water supply started using waste wash water to grow a few vegetables,” said Baldev.

Women now reported consuming an average of three additional foods a day. Their intake of green leafy vegetables increased 344%, their consumption of yellow/orange coloured veggies rose 940% and their milk intake rose 70%.

Nutrition tips the women took to implementing included guidelines such as “cook in an iron pot” and “make more nourishing rotis (Indian flat bread) by mixing a couple of grains like wheat, corn and pearl millet instead of using only wheat” and “breastfeed your children in the first hour after birth”, reported Zuhra and Meera.

Among the 403 study participants were 21 pregnant women, an intentional inclusion to gauge how women’s autonomy affected breastfeeding.

When the women were first interviewed, it turned out that those with a say in their household finances were more likely to report exclusively breastfeeding their child for six months.
Over the course of the engagement, the percentage of new mothers who breastfed infants within the first hour of birth increased from 47% to 83%.

Autonomy empowers rural women to deal with illness more promptly

Having been shown how to make Oral Rehydration Solution (ORS) and to keep a child with diarrhoea well hydrated, the number of women who had treated a child with diarrhoea with ORS increased by 140%—from 34% to 84%.

“Now we take care of diarrhoea ourselves by making ORS,” said Meera, the SHG leader

Better knowledge of health services at the anganwadi encouraged more women to promptly seek healthcare for themselves as well as their children.

Savings on health increased from 65% to 80% while 52% women reported an overall increase in savings.

“Now we put aside a little money every month for our health, just in case we need it,” said Zuhra.
 

Zuhra Bano (in orange), a Self Help Group (SHG) leader, signed up to be trained as a Community Nutrition Advisor, which meant she would share health, nutrition and household finance information with members of her SHG and interact with the women’s husbands to tell them how important is it to make decisions about health and food jointly.

Make the community a part of the solution

“We found the methodology effective because it involves the community; making local women a part of the solution always works better than advocacy by an external agent,” Roli Singh, secretary of Rajasthan’s department of women and child development told IndiaSpend.

“Also, the initiative is cost-effective, and the kitchen garden component to enhance the supply of fresh and nutritious food can be made more effective by synergising it with a livelihoods initiative and agriculture extension schemes,” said Singh.

To involve the community even more closely, Singh would also like the manufacturing, packaging and supply of supplementary nutrition to be outsourced to SHG clusters with experience in health and nutrition advocacy.

At recent national and state level consultations in Delhi and Jaipur, Arun Panda, (then) additional secretary and mission director, National Rural Health Mission, released a policy brief and a technical guide based on the Rajasthan project.

Prepare nutritional dos and don’ts in simple language, including Hindi, and share these with the ministry of health and family welfare to be disseminated in other states, Panda requested the Freedom From Hunger India Trust. “Simple and cost-effective solutions can easily be understood, adopted and sustained,” he said.

Back in Morthala, Meera and others’ lives are changed forever. Thanks to a small change in their mealtime routine.

(Bahri is a freelance writer and editor based in Mount Abu, Rajasthan.)
 

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As India’s 70th year of Independence begins, widespread progress is evident, but in rural India, where 833 million Indians (70%) live, people are consuming fewer nutrients than are required to stay healthy, according to a National Nutrition Monitoring Bureau (NNMB) survey.
 
On an average, compared to 1975-1979, a rural Indian now consumes 550 fewer calories and 13 gm protein, 5 mg iron, 250 mg calcium and about 500 mg vitamin A lesser.
 
Children below the age of three are consuming, on an average, 80 ml of milk per day instead of the 300 ml they require. These data explain, in part, why in the same survey, 35% of rural men and women were found to be undernourished, and 42% of children were underweight.
 
In poorer areas, the situation is worse, as a survey conducted by Aajeevika Bureau, a not-for profit organisation, in 2014, across four panchayats in South Rajasthan indicated.
 
Almost half the 500 mothers surveyed had not eaten pulses the previous day, a third had not eaten vegetable and almost none had eaten any fruit, egg or meat. As a result, half of all mothers and their children under three in these areas were undernourished.

The implications of hunger for India’s future

These data have implications for Prime Minister Narendra Modi’s Make-in-India and Skill-India programmes for economic growth.
 
“The consequences of child undernutrition for morbidity and mortality are enormous–and there is, in addition, an appreciable impact of undernutrition on productivity so that a failure to invest in combating nutrition reduces potential economic growth,” this 2015 World Bank report noted.
 
Despite higher economic growth, malnutrition levels are almost twice as high in South Asia as compared to Sub Saharan Africa, V Ramalingasami and Urban Johnson wrote in a seminal 1997 paper, titled Malnutrition: An Asian Enigma. While the lower status of women in South Asia was offered as an explanation, almost two decades later, rural Indians just do not seem to have enough food to eat.  
 
India’s economy has been growing consistently since the early 1990s. The country has survived the recessions that started in USA in 2008 and affected large parts of the world. What is not as well known is that over the same period, more and more people in rural India were eating less and less.  
 
While growth of gross domestic product (GDP) is estimated every six months using different methods, nutrition levels are estimated once every 10 years, leading to data gaps that IndiaSpend reported in July 2016.
 
Nutrition monitoring has been defined by the World Health Organization as the measurement of the changes in nutrition status of a population or a specific group of individuals over time.   
 
The NNMB was set up in the year 1972 to monitor the status of nutrition in rural India across 10 states. The Bureau conducted nutrition surveys in rural areas in these 10 states over three time periods: 1975-79; 1996-97 and 2011-2012. These surveys provide us a temporal understanding of food intake among rural India over the past four decades.

TABLE

One would imagine that with a growing economy over these years, people would have more food in their plates.
 
Instead, as I said, the intake of all nutrients decreased over these four decades. Why is this happening?

The link between landlessness, prices and hunger

Before someone starts saying that rural folks have caught on the urban fad of dieting, let me get the facts right.
 
The same NNMB survey also revealed that, over 40 years, the proportion of landless people in rural areas grew from 30% to 40%, and the proportion of people who were owners and cultivators decreased by almost half. Meanwhile, food inflation in India increased at a faster rate than overall inflation (10% versus 6.7%).
 
Within overall food inflation, the price of pulses, fats and vegetables rose quicker than that of cereals. The result is that fewer people can buy these foods. So, most rural people are neither growing food, nor buying it in adequate quantities.  
 
There is a caveat here. Despite declining nutrient intake, malnutrition levels have decreased over the years. In absolute terms, however, these levels remain among the highest in the world, as IndiaSpend reported in July 2015. India has reduced malnutrition, but it is 13 times worse than Brazil, nine times worse than China and three times worse than South Africa.
 
Yet, India does not take policy action for identifying this hunger, 70 years after Independence. In 2015, the NNMB–the only source of longitudinal data on nutrition levels and food intake across 10 states of India–was shut down.
 
The shutdown may not reveal what we need to know, but it will make sure that we do not encounter such uncomfortable facts in future.
 
(Dr Mohan Pavitra formerly coordinated health and nutrition programmes for UNICEF’s country office in India and is the co-founder of Basic Healthcare Services, a nonprofit that offers low cost, high quality primary healthcare in rural under-served communities. He is also Director, Health Services, of Aajevika Bureau, a nonprofit that provides services to labour-migrants.)

Courtesy: IndiaSpends
 

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^a “Funds will be made available through PPP mode under the National Health Mission, to provide dialysis services in all district hospitals.”

The 2016-17 budget also continues the long-standing trend of ignoring the social sector at the expense of defence:

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