OPINION: How to tackle India’s adolescent malnutrition in a holistic way

A holistic approach is needed to meet the National Nutrition Mission’s goals

India Pollution Representational image | PTI

India is a young nation and our ongoing demographic dividend promise is expected to continue over the next few decades. As per the Census Population Projection 2016, children and youth comprise 45 per cent of the total population.

Today, India is home to the largest number of adolescents (10-19 years) in the world with the Census Population Projection estimating 230 million.

Adolescence is considered to be the second-most critical phase for the physical growth of a person’s life, with substantial demands for both nutrients and energy. This is also the last chance to rectify growth lag and nutritional deficiencies that may have occurred during early childhood.

A failure to receive adequate nutrition in this period can lead to conditions such as anaemia, which is among the top 15 causes of global morbidity and mortality according to the New York Academy of Science. In India, one of the most under-served needs during this vital period is adequate nutrition. 

The recently released Comprehensive National Nutritional Survey (CNNS) 2019 indicated that 28 per cent of adolescents in the country suffer from some form of anaemia, and adolescent girls had a higher prevalence of anaemia (40%), compared to boys (18%). Anaemia was also identified to be a moderate to severe public health problem for adolescents in 20 states in the country.

Anaemia has adverse consequences on physical and cognitive development and also poses a severe threat to future safe motherhood in girls. Earlier studies had also indicated that there is a direct link between anaemia and diet pattern and food intake. The CNNS also highlighted that a low percentage of adolescents consumed dairy products (61%), fruits (41.4%), eggs (35%), and fish (24%), chicken or meat (30%). Thus, this could lead to nutritional deficiency among adolescents and hinder their development.

Goal 2 of the Sustainable Development Goals (SDGs) identifies hunger and malnutrition as a huge barrier for development and aims to end all forms of hunger and malnutrition by 2030, making sure all people—especially children—have sufficient and nutritious food all year.

Issues surrounding adolescent health have been receiving increasing government attention over the last few years. The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in 2014 to meet the comprehensive healthcare needs of adolescents with an objective to improve nutritional status among adolescents. RKSK has several interventions to reduce the prevalence of malnutrition and Iron Deficiency Anaemia (IDA) among adolescent girls and boys, including counselling on a balanced diet, the inclusion of nutritional education at the school level, management of low BMI, and counselling at Adolescent Friendly Health Clinics (AFHC).

CNNS also revealed that 22 per cent of adolescents had an iron deficiency which is one of the most common nutritional deficiencies worldwide. Iron deficiency has a significant impact on physical and cognitive growth of adolescents. The extent of iron deficiencies ranges from 45 per cent to 10 per cent among Indian states.

A point of concern is also that a gender and social class differential in the prevalence of iron deficiency was observed among adolescents, with girls having almost three times higher prevalence compared to boys (31% vs. 12%) and adolescents from scheduled castes, as compared to other castes (27% vs. 21%).

The issues of iron deficiency and anaemia should not be viewed in isolation but in tandem with their critical drivers of poverty, accessibility to education and health services, socio-economic constructs etc. The prevalence of anaemia varied significantly by the schooling status of adolescents; 36 per cent of adolescents who were out of school were anaemic, while anaemia was lower by 10 percentage points at 26 per cent among those who attended school.

Additionally, the prevalence of anaemia decreased with a higher level of mother’s schooling among both school-age children and adolescents and was more prevalent in households of the poorest wealth quintiles. Ironically, the RKSK targets for Weekly Iron and Folic Acid supplements seem to be higher for girls who are in school as opposed to out of school. Educational indicators also reflect that there is an increasing trend in drop-outs among girls from primary to higher secondary levels. Therefore, increasing girls’ access to education would have a bearing on their learning as well as on their health. They would be able to receive services provisioned under the RKSK as well as the Mid-Day Meal programme.

'Peer Educators' under RKSK can play a crucial role to provide information to adolescents. As of September 2018, the Ministry of Health reported that 2.19 lakh Peer Educators across 214 districts were being trained under RKSK. This component of the programme has tremendous potential and should be strengthened and expanded to all remaining districts of India. 

The more recently launched National Nutrition Mission (2017-18) is committed to ensuring that every child, adolescent girl and woman attains optimal nutritional status, with a special focus on those from the most vulnerable communities. One of its goals is to reduce the prevalence of anaemia among young children, adolescent girls and women in the reproductive age group (15- 49 years) by one-third of NFHS-4 levels by 2022. The National Nutrition Strategy envisions the convergence of all key departments that impact adolescent health and well-being. Its interventions related to anaemia include ensuring access of all adolescent girls to IFA tablets, dietary diversification and Improving intake of iron and folate-rich dark green leafy vegetables and vegetables and also those that promote iron absorption (rich in Vitamin C), and the introduction of iron and iodine-fortified salt, especially in Mid-Day Meals.

If these goals under the National Nutrition Mission are to be realized, interventions would have to be accelerated and designed taking into account the empirical evidence generated through nationally representative surveys and more investments should be made on adolescent health and nutritional needs.

The 2019-20 Budget allocations saw a 14 per cent increase under the National Nutrition Mission, however, the Scheme for Adolescent Girls saw a sharp decline from 500 crores to 300 crores. Thus, there is a need to prioritise financial allocations and commitments for the schemes that directly benefit girls across sectors of health and education so that the overall welfare of adolescents in general and girl child, in particular, can be ensured.

Priti Mahara is the Director of Policy Research and Advocacy at CRY—Child Rights and You.

The opinions expressed in this article are those of the author's and do not purport to reflect the opinions or views of THE WEEK.