According to the latest data, more than 35 percent of young children in India are stunted. This marks a reduction from 2005-6, when one in two young children was stunted, to one in three children now in 2019-21. However, in absolute numbers, India still has the largest population of stunted children in the world. Childhood stunting affects children’s later developmental outcomes, including their ability to learn in school. Proper nutrition is essential for healthy brain development. For children to reach their potential, they must be provided with proper care and nutrition from their earliest years. We can and must do better for our children.
There is no silver bullet: child malnutrition is a complex problem. It requires multiple nutrition-specific and nutrition-sensitive interventions, such as adequate supply of protein and green leafy vegetables, clean drinking water, toilets, and informed parenting. Reducing malnutrition in children requires a life cycle approach.
The prevalence of child marriage is unacceptably high in our society: one in four or five girls is still forced to marry before the age of 18. Supporting girls to access secondary education, retaining them in school and preventing them from being married in childhood will not only reduce the risk of early pregnancy and the prevalence of low birth weight among newborns, but also give girls the opportunity to develop their potential as educated adults.
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Other important interventions to support children’s good nutrition include hot school meals and residential schools and shelters for children from disadvantaged homes.
To break the intergenerational cycle of malnutrition, we know that special attention must be paid to the first thousand days of a child’s life, which includes the months before birth. The Integrated Child Development Services (ICDS) programme, with its network of nearly 1.4 million Anganwadis across India, is therefore the main policy intervention to address malnutrition in young children under the age of 6, as well as in pregnant women and lactating mothers.
Nutrition and health interventions before and after the birth of a child are critical. Recognizing this, states such as Andhra Pradesh, Telangana and Karnataka have replaced the monthly dry rations provided to pregnant and lactating women with a substantial daily hot meal in the Anganwadi, including eggs and milk, supplementing ICDS cost norms with their own financial resources. The hot meal is not an end in itself, but the first step in a series of layered interventions that may include calcium, iron, and folic acid supplementation, deworming, and nutrition education. An independent evaluation has confirmed that the redesign of this policy has produced benefits in terms of improved birth weight of babies and improvements in hemoglobin, gestational weight gain and mental well-being among pregnant and lactating women. .
There is an additional weakness in the ICDS supplemental nutrition program in its current form. Results from the National Family Health Survey-5 (NFHS-5) show that only 11.3% of children under 2 years of age received an adequate diet. Babies and young children under 3 years of age do not come to Anganwadis for their supplementary nutrition; instead, their families receive take-home rations (THR) as a packaged mix. This packaged mix is often of uneven quality, unpalatable to children, and is therefore sometimes used as animal feed, rather than fed to children.
It is time to rethink this aspect of the ICDS supplemental nutrition program. We know that in low-income households, mothers of children under the age of three need to engage in paid work; these infants or toddlers are often left behind in informal care arrangements, usually with a grandmother or neighbor. However, even in rural areas, elderly women are also engaged in daily wage labor and therefore the need for child care is acute. Infant and toddler feeding practices are key to improving child nutrition, and these are the years when nutrition and care practices can have the greatest impact. So it’s time to think about setting up practical and profitable day care for these children, where they can be provided with early stimulation and supplementary nutrition while their mothers go out to earn a living.
This can be done through the gram panchayats. The MGRNEGS rural livelihoods program already envisages the creation of a daycare center in any workplace with five or more children under 6 years of age, and one of the workers will be designated as a caretaker.
Funds to run such a nursery can come from MGNREGS, as MGRNREGS workers would leave their children in their care; with a minor modification to the guidelines, even daycare construction can be included as an allowable asset-creating activity under MGNREGS; and the space for the building can be provided by the gram panchayat (GP).
The GP may involve a local women’s self-help group (SHG) to run the nursery, selecting the group through the panchayat-level federation of women’s SHGs. Daycare workers can be chosen by the SHG from among its members based on defined eligibility criteria. Nursery workers can receive adequate training in child care, early stimulation and nutrition. Supplemental nutrition can be provided by the ICDS program through a transfer from ICDS management to gram panchayats, who in turn will make payments to SHGs based on the number of children served. Cooking arrangements can be shared with the Anganwadi.
In urban areas, since MGREGS is not available, such crèches should be established in areas where significant construction activity is taking place, supported by the construction industry. It will be feasible to do it in a grouped way instead of a nursery in each workplace. Urban women’s SHGs can run these daycare centers, and ICDS can provide the nutrition component. Caregivers can be paid from funds raised at the Construction Workers and Other Construction Workers Welfare Board.
These practical details can be worked out locally. Daycare centers for young children under the age of 3 will serve many purposes: they will allow women to seek paid work outside the home; provide livelihoods to SHG daycare workers; will lead to greater participation of local rural and urban agencies in basic child care services; and above all, it will provide the opportunity for quality nutrition and adequate early stimulation for children under 3 years of age.
The net result would be the tremendous benefit that infants and toddlers would be able to receive proper care, participate in early stimulation activities, and be fed nutritious foods made from fresh, locally available ingredients during daycare hours; their mothers would be able to earn a living, which would allow them to better care for their children at home. This would really help India break the intergenerational chain of malnutrition, empower mothers and provide a bright future for all children.
(Uma Mahadevan-Dasgupta is Additional Chief Secretary, Panchayat Raj, Government of Karnataka; Ramani Venkatesan was former Director General, Rajmata Jijau Mother-Child Health & Nutrition Mission, Government of Maharashtra)
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