Diet is misunderstood, hunger is palpable and India has a long way to go to ensure no one goes to sleep hungry. When the Global Hunger Index (GHI) was published for 2019, India was ranked 102nd out of 117 countries. India – the government, civil society are very aware of this problem, the problem is staring at us and it is not invisible.
India tries hard, but 15% of Indians are hungry. From lunchtime meals to nutrition programs to expensive but much-needed rehabilitation centers. From reforms and programs of the public sector (iodination of salt, fortification of wheat, lunches, loans for vegetable gardens, etc.) to civil society programs such as mother-child nutrition, awareness-raising, demand generation, etc. to start-up programs of the private sector such as ironfish, iron lead, apps, etc. Progress has been made and yet more than half of women of childbearing age are anemic and either die in childbirth or cannot lead a fully productive quality life.
In order for India to make progress in combating malnutrition, one must be aware of the fact that the problem is profound, multifaceted, and that every actor has a role to play.
In 2014 I studied the role of nutritional rehabilitation centers (NRC) and an interview stayed with me. A young mother, Sunita (name changed), left the center shortly after two days of care instead of the mandatory fourteen days. I was very curious as the NRC had looked after them well, they were respectful and empathetic, and fed them and their child for free. She was very matter-of-fact that her 3 year old son was home and he needed care. I kept my emotions in check when I was stunned – she was at the NRC with her newborn daughter – whose chances of survival depended on the care of the NRC. In further discussions with the NRC nurses and carers, I learned that Sunita’s decision was not isolated. It was common for mothers to stop rehabilitation center services when a boy needed home care. Most of the mothers who use and stay all the time are malnourished sons. There appears to be a clear, conscious trend of decision making that exposes the gender bias in nursing.
The causes of malnutrition are structural violence. In this case, patriarchal social norms. Because of our resource constraints, we are often unable to develop systems that take into account the larger social norms that make decision-making critical to combating stunts, waste, and anemia. Combined with the scarcity that drives decision-making among those who need our systems most, we find ourselves in a swamp.
When we look at the efforts India should be making to meet nutritional needs to reduce stunting, waste and anemia by 2022, we are staring at a complicated conundrum with many small parts and much lost translation in the path between policy and implementation . Cross-sector partnerships and mainstreaming efforts like POSHAN Abhiyaan are the direction that offers a lot of hope. However, we must ask ourselves whether this alone can achieve our goals. And what it really takes as a country, as a community, as a family and as an individual to address a problem that is preventing us from not only achieving our own economic goals but also killing many of our children, and which is affecting entire generations.
However, it is at the grassroots level, in the kitchens and in the family structures, where the change has to take place – and that is only possible if women like Sunita find safe spaces in which they not only take care of themselves but also make smart decisions can improve the long-term health and wellbeing of the people in their care. And this requires a cross-sector partnership that brings nutrition narration hand-in-hand with all interventions – be it in health, social protection, livelihood, urban planning, education, business, agriculture and more.
Understanding of health and nutrition cannot be limited to the hands of health professionals. The democratization of the understanding of nutrition through a variety of media-controlled interventions, combined with a well thought-out system redesign at every point of contact – be it at shopping points, educational institutions, workplaces, community institutions, clubs and more – is of crucial importance at this point.
To break it down further, we stare at an abyss of deficits – knowledge deficits, skill deficits, food insecurity – that mark the beginning of a generation cycle and repeat itself repeatedly, arising entirely from an often normative view of inequality and stratification and distorted burden of responsibility.
This is an everyday problem for everyone and needs to be addressed by everyone and for those around them. And sometimes we as communities need to figure out what it takes to prepare a high nutritional meal at an affordable cost. The answers are diverse – from urban planning, which enables hyperlocal vegetable gardens, to determining the core costs and expenditure investments, water, sanitation and hygiene measures, to spaces that channel empathy in order to give women and children the opportunity to do better Foods to choose and more.
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