India is a land of paradoxes when it comes to nutrition. On the one hand, there is malnourishment, especially in children and women in rural areas, on the other obesity is fast emerging as a major lifestyle issue in urban areas.
The Global Hunger Index (GHI) report of 2021 has ranked India at 101 out of 116 countries, with the hunger situation in the country categorised as ‘serious’. While the media focuses on GHI, there is a little serious discussion on the nutritional challenges that India faces. GHI is a composite measure that uses three interlinked dimensions of hunger, including the proportion of the population consuming inadequate calorie intake, the proportion of undernourished children, which includes two indicators of ‘stunted’ and ‘wasted’ children below the age of 5 years,, and under-5 mortality rates.
According to the latest estimates by the Ministry of Women and Child Development (WCD), over 33 lakh children in India are malnourished and more than half of them fall in the severely malnourished category with Maharashtra, Bihar and Gujarat topping the list. Anaemia is also a big issue, especially among women and children.
The Covid-19 pandemic seems to have further exacerbated the health and nutrition crisis among the poorest of the poor. The WCD ministry estimates that there are 17.76 lakh or 1.7 million severely acute malnourished (SAM) children and 15.46 lakh or 1.5 million moderately acute malnourished (MAM) children as of October 14, 2021.
Both MAM and SAM have severe health repercussions on the health of women and children and other vulnerable sections of the population. With the problem being diverse and the geographical spread wide, there is a need to address the issue through provision of adequate and nutritious diets.
A good start has been made of late. Under the PM-POSHAN Flexi Funds component, a supplementary nutrition programme has been rolled out in backward districts, which have a high prevalence of malnutrition and anaemia among children.
Provision of adequate and nutritious diets would serve its purpose better if popularised among intended beneficiaries through matching communication. There is no one-size-fits-all. The communication would have to be well-crafted and well-thought-out for the right groups.
The communication campaigns should be divided into three categories for the vulnerable rural masses in languages they can understand; for rural pockets in urban areas; and specific campaigns for women.
The starting point is to allay the fears of Covid-19 and bring back children to schools in rural areas. Then services under the Integrated Child Development Scheme (ICDS) and midday meals in schools have to be urgently regularised after the prolonged closure of schools. The prolonged closures severely affected children living in multi-dimensional poverty disproportionately since they have been largely dependent on these services to fulfil their educational and nutritional needs.
Alongside, nutrition counselling will have to be redesigned, keeping the Covid-19 fear factor in mind and used as an approach to MAM management in situations where caregivers may be constrained due to lack of appropriate care practices. Caregivers could do better with sufficient awareness on how to combine foods into appropriate diets for malnourished or at-risk children. This is where proper communication has a role to play. And to reiterate, the campaigns have to be sustained and focused.
For rural areas, communication on nutrition should be multi-pronged, simple and in dialects that can be assimilated by communities. The use of folk art, popular skits and dramas should form the communication bouquet. To make it more attractive and to draw their attention, rewards should be given and a process to identify leaders among the groups should form part of the communication strategy. This is because leaders among communities would have better connectivity and communication skills. Communication should be oriented more towards mothers so that they can address their nutritional needs and that of their children.
As emphasised earlier, the communication should be multipronged through visual, audio, print and performing arts like folk music, dance dramas, popular songs and competition-based programmes. And all this would have to be backed up with door-to-door campaigns with the help of ASHA and Anganwadi workers. They are the touch-points when it comes to driving communication home.
When it comes to urban areas, the campaigns would have to be tweaked to address the special needs, especially since access to nutritional foods may not be an issue.
While developing communication strategies, there is a need to first distinguish between the earlier food consumption habits of India and the way these have changed now. India’s dietary patterns have shown that the food used to be connected to the local ecosystem. It was ecologically rich and diverse. Every part of India celebrated its biodiversity through its food culture. The indigenous Indian diet understood that food, built into our day-to-today lives, is one of the most powerful forms of medicine we have. This fact should be better emphasised to underline the fact that nutrition need not be rocket science, if focused communication is used as a key driving force.
(Dr Swadeep Srivastava is Founder & CEO of HEAL Health and HEAL Foundation.)