Tackling malnutrition in children, migrant families in a post-pandemic India

A UNICEF report says over 880,000 children could die in the next 12 months

malnutrition-hunger-children Representational Image | AFP

The pandemic-induced lockdown has left the migrant labour class in all Indian states unemployed and facing uncertainties. Even today, as India implements ‘Unlock 2.0’, many migrant families, especially women and children, face starvation that expose their immune-compromised systems to deadly infections like COVID-19.

While government schemes like POSHAN Abhiyaan (Nutrition Mission), Pradhan Mantri Garib Kalyan Yojana, Garib Kalyan Rojgar Abhiyan Yojana, Garib Kalyan Anna Yojna ensure looking after the vulnerable sections of society and their livelihoods, successful gains are yet to be visible.

Under the Centre’s Atma Nirbhar Bharat Abhiyan, the government has planned to take significant measures to mitigate hardships faced by the poor. This includes distribution of free food grains and pulses to 80 crore people (five kilos per person per month for May and June 2020). However, the mechanism to deliver these rations was not only ill-equipped, but also bound by administrative norms of proportionate state-wise allotment and delivery. In a crisis, the mechanisms need to be more responsive to changing scenarios in different states.

Redesigning the Public Distribution System (PDS) supply chain is, therefore, essential for successful delivery of food under all schemes. In Prime Minister Narendra Modi’s address on June 30, 2020, he had highlighted the government’s efforts on providing free ration to the poor, a scheme which will be extended till November 2020. But all these efforts to mitigate food shortage is an uphill task in the long-run.

As health systems are focused on COVID-19 response, other essential public services must not get disrupted. These include essential maternal and child health services like immunization and ANC check-ups, and supplies of safe and nutritious take-home food packets that will significantly affect the growth and development of vulnerable women and children.

A recent UNICEF report, quoting a study by Johns Hopkins Bloomberg School of Public Health, states that over 880,000 children could die over the next 12 months, the bulk being from India and Pakistan succumbing to infections like measles and pneumonia. Public health systems in these countries are poorly equipped to deal with such a global pandemic.

Lack of access to health facilities, non-availability of public toilets, unsafe food are problems faced by most migrants workers. This may cause an increase in infections like diarrhoea, typhoid and upper respiratory tract infections. Crowding in shelters, inadequate housing and unhygienic living conditions could further transmit these infections, including COVID-19, to a wider group.

The economic crisis related to COVID-19 could also push India back on all its developmental targets for health and nutrition in the Sustainable Development Goals (SDG) 2030 Agenda. The SDGs address that nutrition has a multidirectional relationship with many developmental goals, and thus, makes it important for countries to achieve Target 2.2 of the SDGs which is: “By 2030 end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons”.

This target is based on the goals outlined by the 65th World Health Assembly (WHA) in May 2012 for fighting all forms of malnutrition globally. The growing food insecurity because of disrupted food and essential health outreach services could crumple the public health infrastructure and disrupt essential health services that facilitate achievement of these goals.  

According to the Global Nutrition Report 2020, 37.9 per cent of India’s children under five years are stunted, and 20.8 per cent are wasted, a form of malnutrition where children are too thin for their height. These numbers are much higher than in other developing countries, where on an average 25 per cent of children suffer stunting and 8.9 per cent are victims of wasting.

Most state governments have arranged to deliver Take Home Rations (THR) through home visits by frontline workers—ASHAs and Anganwadi ‘Sewikas’. These grassroot-level functionaries are engaged in COVID-19 related surveillance activities, with very little time or motivation to devote to their usual health and nutrition related duties in the community. Entrusting them the additional responsibility to ensure proper distribution of THR to children and pregnant women should be substantially supported by the community itself apart from local government officials and village gram panchayats.

Special efforts need to be made to include the marginalized for access to all the government subsidies. Also, in times of such food shortage, it is imperative to ensure that the THR is consumed by those for whom it is meant and not by other members of the family. Children already suffering from “Moderate or Severe Acute Malnutrition” (MAM or SAM) living in their homes without any medical care and adequate supplementary nutrition need the most attention.

This is where the Community-based Management of Acute Malnutrition (CMAM) guidelines assume a high priority. A call for launching these guidelines with updated protocols for infection control, basic hygiene and physical distancing is the need of the hour.

In fact, in post COVID-19 times, if families become reluctant to visit Nutrition Rehabilitation Centres (NRCs) for fear of contracting infection, these home visit protocols for frontline workers will be hugely beneficial in ensuring access to health and nutrition services and supplies. Strengthening the implementation of the community-based management strategy for addressing severe acute malnutrition as well as ensuring adequate protection at the NRCs should be accorded priority.

UNICEF has warned in its recent report that 1.2 million additional children under five could die in just six months in low and middle-income countries due to reduction in routine health services coverage and increase in child wasting; of this, nearly three lakhs would be in India.

The way forward after the pandemic will be full of challenges. Well-planned, sustainable, inclusive polices and relief measures need to be implemented efficiently. The aftershocks of this dual battle India faces against Malnutrition and COVID-19 will be felt on a large scale if it is not handled on time. We need to act fast to save our vulnerable children from this never-ending cycle of poverty, infection and deprivation. 

Dr Seema Puri is an Associate Professor, Institute of Home Economics, University of Delhi