The Government of India has recently released the data of National Family Health Survey-5, 2019-20. According to the released data, the rate of malnutrition in the country has increased as compared to the National Family Health Survey-4, 2015-16, which is a matter of great concern especially in those States that have had a history of being placed in the bottom of the table in many key socio-economic indicator rankings. Over 33 lakh children in India are malnourished and 17.7 lakh of them are severely malnourished.
According to the National Family Health Survey (NFHS)-5, India has unacceptably high levels of stunting, despite marginal improvement over the years. The number of children under 5 years who are stunted (less height-for-age) in India has come down from 38.4% to 35.5% and the number of children who are underweight (less weight-for-age) has come down from 35.8% to 32.1%. The NFHS-5 reported wasting (weight-for-height) in 19.3% children under five years as compared to 21 per cent in NFHS-4.
So far as Odisha is concerned, there is noticeable improvement in figures relating to child malnutrition as compared to the national averages. Stunting in Odisha has come down significantly from 38.2% in NFHS-4 to 31% in NFHS-5. The percentage of underweight children has gone down from 34.4% to 29.7% and there has been a marginal improvement of 0.2% in the figures concerned with wasting. Though there is a long way to go to achieve top performing status, it seems that there is a good momentum on key essential nutrition actions.
Taking a closer look across the length and breadth of the State we see that there has been a significant increase in the total number of children aged 6-23 months that received an adequate diet in all the districts. However, the improvement in the percentage of children under 5 years who are underweight has not been uniform. While there has been an overall improvement in all districts in NFHS-5 as compared to NFHS-4 the districts of Khordha, Kendrapada, Cuttack, Nayagarh , Jharsuguda, Bargarh, Bhadrak, Mayurbhanj, Malkangiri and Nabrangpur have seen only a marginal improvement unlike the significant improvement seen in Kandhamal and Sundargarh.
However, comparing the district figures with the State average , we find that the percentage of children under the age of five who are underweight in the coastal areas is less than that in the entire State. The figures of the percentage of children stunted have improved in almost all parts of Odisha barring the southern belt consisting of the districts like Malkangiri, Koraput, Nuapada, Nabarangpur, Gajapati and Raygada and the northern most districts of Mayurbhanj, Bhadrak and Kendujhar. When compared with the State’s average of the percentage of children who are stunted, we find that districts along the coastal belt and Subarnapur, Jharsuguda and Debgarh are peforming better than the State as a whole.
The most alarming indications however comes from the figures of severe wasting. Barring a few coastal districts like Puri, Ganjam, Kendrapara and Nayagarh, all districts are performing below par. The percentage of children under the age of five who are severely wasted has increased in Mayurbhanj, Baleswar, Dhenkanal, Nabarangpur, Malkangiri, Subarnapur, Debgarh, Kandhamal and Balangir. The few better performing districts in this category are Jharsuguda, Rayagada, Nuapada, Dhenkanal, Malkangiri, Bargarh and Kalahandi.
These geospatial variations of child malnutrition may be linked to the variation in terms of socio-demographic and economic indicators in the districts of Odisha.
The high prevalence of all three parameters of malnutrition in the southern belt and the region in and around Mayurbhanj, home to a major portion of the tribal population of the State indicates that while a lot is being done to improve the availability and access of basic amenities and healthcare all over the State, these measures are yet to penetrate into the ground and reach those who have been historically left out and are in dire need of it.
To address the issue of malnutrition, especially in women and children, the Government of Odisha has been implementing the flagship centrally sponsored schemes such as the Integrated Child Development Services (ICDS), the Mid-Day Meals (MDM) scheme and the Central Government’s food subsidy scheme called the Targeted Public Distribution System (TPDS). It has also seen good results in its schemes MAMATA and Janani Suraksha Yojana targeting the overall well-being of pregnant, lactating women and their infants (including their nutritional needs). It aims to promote the thought of healthcare seeking behaviour amongst all echelons of the society.
The Government has been implementing Mid-Day Meals programme at schools with multiple objectives of providing wholesome food having requisite energy and protein to enhance the nutritional status of children and at the same time, attract students to school enhancing their enrolment and retention. It also subsumes the secondary objectives of reducing caste prejudices, class inequalities, gender gaps, etc. To enhance the efficiency and effectiveness of the scheme, Odisha is the first State to provide “Food Security Allowance” and in order to optimise the nutritional outcomes of the MDM scheme, the Government has implemented the concept of multi-cap and multi-tap facilities. It has also taken steps to address the issue of micro-nutrient deficiency among the children and has distributed iron tablets to reduce the prevalence of anaemia.
Odisha has also been an active participant in the Poshan Abhiyaan , also known as the National Nutrition Mission. It was launched in 2018 with the aim to improve nutritional status of children (0-6 years), adolescent girls, pregnant women and lactating mothers. It is a three-year programme to ensure a holistic approach, covering all 36 States and UTs. The essential components for making implementation of POSHAN Abhiyaan successful are Jan Andolan and Community mobilisation. The Panchayati Raj Institutions play a key role at the grassroot level in garnering support for successful implementation of various activities. They are participating actively in community mobilisation, creating awareness in various activities.
It is important to integrate the ground level ASHA and Anganwadi workers into the mainstream primary healthcare system and give them more responsibility and incentive to deal with real everyday nutrition problems of children under the age of five. These workers happen to be the first direct instance of connect between the State and the public. Hence it is important to train them and equip them with knowledge and tools to alleviate the stress of the people and reduce the burden on our healthcare sector.
Also, regular surveys and periodic checks must be conducted to assess the gravity with which the enchanting policies made in our legislatures are being implemented on the ground.
No compromise and no oversight can be allowed when it comes to the rights, well-being, good health and ultimately the happiness of our children.