By Bijayini Mohanty
Nutrition justice will only be achieved when women are empowered and when policies and programmes are gender responsive. Adequate nutrition is especially critical for women because inadequate nutrition wreaks havoc not only on women’s own health but also on the health of their children. Children of malnourished women are more likely to face cognitive impairments, short stature, lower resistance to infections, and a higher risk of disease and death throughout their lives.
Recent data of decline in Infant Mortality rate (IMR) from 65 in 2005-06 to 40 in 2015-16 and Child Mortality Rate from 91 to 49 per 1,000 live births hoodwinked the reality of malnutrition death of children in Nagada and Malkangiri area. There is decline in percentage of underweight and stunted children under 5 years however percentage of wasted children in the same age category has increased in between NFHS-3 and NFHS-4. In 1992-93 half of the children under three were stunted and underweight and at present according to NFHS-4, every third child (34.1 -34.4 %) under 5 years is either stunted or underweight.
Not only the IMR situation in the state is agonizing but also the high Maternal Mortality Rate (MMR) is a serious issue. According to the Census, 2011, the MMR of the Odisha was 258 per 1 lakh population, which has decreased to 222 in the year of 2013 (SRS -2013). Though there is an eye catching reduction in MMR (SRS- 2006 to SRS -2013) of Odisha, still the issue is a matter of concern.
One fourth of women have BMI below normal and every second women in reproductive age group is anaemic as per NHFS-4. It is not to refute the improvement made in reduction of hunger, starvation and malnutrition but the progress made does not show an intense effort by the state govt. to reduce malnutrition. There has been little measurable progress can be noticed in addressing the specific nutritional problems of women and adolescent girls.
The NFHS -4 data says that only 23.1% of mothers has taken full antenatal care, the result is not at impressive but if we see the result of Post Natal Care i.e 73.3% of mothers has taken PNC is quite notable. Even the percentage of Institutional birth has increased more than double in these ten years which is one of the main reasons of decreasing MMR in the State. But we should not forget that Pregnancy is typically the first point after early childhood when receiving health services is so vital that nutrition interventions need to be integrated into antenatal care programs.
Even if we can see the picture of early pregnancy, the percentage of women who are already mothers and pregnant in the age of 15-19 years is 7.6% which was almost double ten years before. And the consumption of IFA (Iron Folic Acid) tablet by the pregnant women for 100 days or more is only 36.5%.
Malnutrition poses a variety of threats to women. It weakens women’s ability to survive childbirth, makes them more susceptible to infections, and leaves them with fewer reserves to recover from illness. Malnutrition undermines women’s productivity, capacity to generate income, and ability to care for their families.
Improve Nutrition throughout Women’s Lives
Addressing the needs of girls and women throughout their lives — the “life cycle approach” — can improve women’s nutritional status. Many nutritional deficits experienced in infancy and childhood have irreversible consequences, so interventions to support adequate nutrition from infancy onward directly benefit women later in life. In policy paradigm first 1000 days of a child is being given significance.
Exclusive breastfeeding during the first six months of an infant’s life benefits both mother and child. Breastfeeding protects infants and children from illness and helps ensure healthy growth and development, and starting breastfeeding soon after birth may help prevent excessive maternal bleeding. Breastfeeding for up to two years can also help mothers keep their iron levels up by delaying the return of menstruation. Estimates suggest that improving breastfeeding practices by encouraging women to breastfeed their infants immediately after birth and to avoid supplemental feeding for at least the first six months could save the lives of 1.5 million children each year.
Even Adolescence is a time of rapid physical growth, second only to the first year after birth. During adolescence, children gain up to 50% of their adult weight and skeletal mass and more than 20% of their adult height. Poor nutrition during adolescence will not only affect adult body size, resulting in shortness or thinness, but may also affect the nutritional status of any children born to mothers who were malnourished during adolescence.
Food & Nutrition Security through different Govt. sponsored schemes
Integrated Child Development Scheme (ICDS) is one of the major interventions for combating nutrition challenges and health status of children below the age of 6 years as well as pregnant and lactating mothers. Six services under ICDS are being provided through AWC to the pregnant and lactating women, children under 6 years and adolescent girls. Following the philosophy of taking a life-cycle perspective on human development, it tries to meet the basic developmental needs of the above; the critical nine months of intrauterine growth, the vulnerable first six years of life, and the most neglected adolescent period (Nair and Mehta 2009).
The Supplementary Nutrition Programme (SNP), which is meant for the children of 6 months-3 years of age and the Hot Cooked Meal which is meant for the children of 3 -6 years of age to improve the nutritional content (supplementary food) of food provided at the AWC for children 6 months to three years of age.
However irregularity in THR distribution, poor quality of Chatua and other food items, low govt. budgetary provision for beneficiaries, lack of interest of frontline worker, corruption, lack of monitoring of officials and absence of strong grievance redressal mechanism are the main reasons of low performance of these schemes as well as responsible for slow decreasing of IMR and MMR.
MAMATA, a State Govt. scheme in which the pregnant and lactating women of age more than 19 years got assistance of Rs. 5000. And the beneficiary numbers is more than 25 lakhs now. But unfortunately the minimum age bar excluding the most vulnerable women in Odisha, as most of them are young women between the age of 15-19 years in Odisha. But if we look at the current fertility levels, a woman in Odisha will have an average of 2.4 children in her lifetime however fertility rate for ST women is comparatively high which is 3.1. Women with no education and in lowest wealth quartile like to have 3 children and she will not get MAMATA benefit for more than 2 children though she would be the neediest.
Even the issue of delay in getting instalment is a major problem for which the amount is not been utilized for the dietary and health needs of mother and child instead spent on payment of loan, buying items like cloth and on ceremony.
Mid Day Meal (MDM) is not only enhancing enrolment, retention and attendance; simultaneously MDM aims to improve nutritional levels among children serving noon meal in the school. In Odisha 86% of primary-school age children (6-10 years) attend school hence the most vulnerable, 14% children in school going age could not avail one time meal provided under MDM. But quality of meal is a measure concern due to irrational per student fund allocation.
PDS under National Food Security Act (NFSA) promises “to provide for food and nutritional security, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity”. 5kg food grain per individual, a pittance can ensure nutrition security, is a puzzle for any sane person. But there is no step taken for the inclusion of pulses, iodized salt, edible oil, millets etc. But still now almost 2 lakh Antodaya Anna Yojana cards which was meant for food security of the poorest of the poor, have not been distributed. This hoarding of AAY cards clearly indicates that government is more concern about financial cost and less committed to human cost. This is showing a lethargic action of the State Govt..
Apart from these, various studies and reports identified that MGNREGA has been successful in increasing minimum purchasing power for food security for the family living below poverty line.
Even in the SABALA Scheme two of the main objectives are to; improve the nutrition and health status of Adolescent girls and to promote awareness about health, hygiene, nutrition, adolescent reproductive and sexual health (ARSH) and family and child care. The programme covers adolescent girls of 11–18 years old under all the ICDS projects in selected 9 districts in Odisha where as this should be universal in nature and also the scheme is not that effective according to the CAG Report, 2015.
Collective and Convergent Action for Nutrition
It is also important that the community be involved in developing and supporting the interventions and those programs ensure that their approaches do not conflict. People need to aware about local foods, such as mangos, papayas, and chicken livers, contain essential nutrients can help diversify diets. Educational programs and public information campaigns can also help address cultural norms that prevent women from eating enough and animal protein like eggs.
Agricultural policies that promote the production of nutritionally rich crops (it can be locally produced like; millets, Raagi etc.) and techniques that add nutritional value to food crops, fish, and livestock can also help promote health.
Providing clean water and improving sanitation & Hygiene can prevent the transmission of intestinal parasites that can aggravate existing malnutrition.
Increasing the amount of time gap between births is also thought to be helpful because it helps women’s bodies rebuild their stores of fat and micronutrients, leading to improved maternal health as well as better pregnancy outcomes.
The State Govt. need to create more awareness for accessing to Nutrition Rehabilitation Centres (NRCs) which has meant for the severely acute malnourished children, and hardly known to any common man/woman. In a suggestion if it would be inside the community, then there will be easy accessibility, and Malnutrition can be checked beforehand.
There is also an immediate need of “State Nutrition Mission” to check the chronic under nutrition (stunting) in a wholistic approach with a convergence of all the sectors/departments which are directly or indirectly connected to Mother & Child Health and Nutrition.
Improve Women’s Status
“Addressing gender inequalities can help ensure that women can get the nutrition they need, improving their own health and that of their families and, ultimately, contributing to the development of their society.”
Policymakers can help to improve women and children’s nutrition by addressing poor status of women’s in our society. Gender inequalities and Women’s sacrifice are often greatest among the poor and vulnerable families, whether it is either health, education or food.
Research indicates that women who have greater control over household resources tend to be healthier and better nourished — as they tend to spend more on the nutrition, health, and well-being of their households. In addition to being responsible for preparing food, women often make significant contributions to their families’ production of essential crops. Therefore programs to improve nutrition should focus on increasing women’s knowledge about nutrition and their decision making power.
Adolescent girls need access to information and services related to nutrition, reproductive health, family planning, and general health. Therefore promoting female education and literacy can improve nutrition and encourage females to seek regular health care. Teaching girls to use their knowledge of nutrition when preparing and handling food can also improve their health and that of their families. Schools can be a key part of helping adolescent girls become healthy adults.
Author works with Odisha Khadya Adhikaar Abhiyan.