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As per India’s 2015-16 health survey, one in every three children in the country is stunted, more than 50% of adolescent girls and pregnant women are anaemic, and almost 80% mothers do not receive full antenatal care during their pregnancy. Data from phase one of the National Family Health Survey-5, 2019-20 also points to a gloomy reality. If this was the scenario when all government-run health and nutrition programmes were fully functional and easily accessible, imagine the situation since 2020, when India was hit by covid.

After over a year of full and partial lockdowns and a devastating second wave of covid infections in April 2021, the situation remains bleak. There has been a decline in the uptake of health services like antenatal check-ups, counselling and consumption of micronutrient supplements among pregnant women. Dietary diversity has decreased significantly due to the food insecurity triggered by the pandemic, resulting in adverse consequences on maternal and child nutrition. Studies show that an alarming 90% of households reported suffering a reduction in food intake and 66% had less to eat than before the pandemic. Schools continue to remain shut, disrupting access to mid-day meals for the underprivileged and weekly iron and folic acid supplementation. The availability of nutritious food and micronutrient supplements supplied through India’s social safety net programmes have become erratic as a result of disrupted supply chains. The deadly second wave, which took away earning members of many families, has left many households vulnerable and struggling for basic food.

Undoubtedly, covid has brought with it a malnutrition storm, which is unwinding all the development gains that the country has made so far.

Food and nutrition security: While policymakers are adapting food security programmes to current needs, it is also crucial to consider the ‘hidden hunger’ among populations, especially among those with special dietary and nutritional requirements like pregnant and lactating women, adolescent girls and children.

Tackling this malnutrition crisis requires a far-sighted dual approach of providing food that fills stomachs as well as nourishes the body and spirit with nutrients to survive and thrive.

The disruptions caused by the pandemic have further emphasized the need for local nutritious foods and community-based initiatives to tackle food and nutrition insecurity. The Poshan Matka initiative in Madhya Pradesh and the promotion of nutrition gardens in Uttar Pradesh, for example, help promote dietary diversity and the inclusion of nutrient-rich local and affordable food items.

Providing necessary nutrition through diversified food sources is a safe and universally-accepted method of addressing a nutrition crisis. However, with changes in cropping patterns, lifestyles, food habits and economic pursuits, ensuring adequate quantities of diversified food still seems to be a challenge.

Micronutrient supplementation: One of the crucial steps towards nutrition security is the provision of micronutrient supplementation, which can help fulfil nutrition requirements and boost immunity. Many state governments have made commendable moves to re-energize micronutrient supplementation initiatives like the distribution of iron and folic acid and calcium tablets to pregnant women and adolescent girls through home visits, and the continuation of bi-annual vitamin A supplementation to children during calendar-marked Village Health & Nutrition Days.

Food fortification: In the context of the pandemic, food fortification becomes even more important, given its ability to improve the health of large segments of the population without direct contact. Fortified staples can provide populations the basic micronutrients needed by them.

India has led its food fortification sprint with mandatory universal salt iodization. Many Indian states like Madhya Pradesh, Kerala and Odisha have introduced fortified staples like double-fortified salt and fortified rice in their social safety net programmes to the benefit of millions of people in marginalized communities. However, maintaining smooth production and a strong supply chain is critical to ensure their availability without disruption. The pandemic also provides an opportunity to the government to adopt fortified staples nationwide in its safety-net programmes, the impact of which could multiply with the ‘One Nation, One Card’ initiative.

The path ahead: While the country prepares for future waves of covid and mutations of the virus, it must be recognized that nutrition cannot wait. Good nutrition is of foundational importance for children’s cognitive development, in addition to a reduced burden of non-communicable diseases, positive birth outcomes, a reduction in stunting, improved immunity and lifelong protection against infections and illnesses.

The Supreme Court’s recent directive to register migrant workers under the public distribution system and distribute dry rations to them will be critical in providing food security. However, to help resolve India’s malnutrition crisis, it is critical that policymakers look beyond empty calorie intake and shift their focus to the provision of nutritious food. Without urgent and significant consideration given to nutrition as part of our national covid response, the malnutrition crisis will only deepen.

Mini Varghese & Tomoko Nishimoto are, respectively, country director (India) and regional director (Asia), Nutrition International

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