A child at the malnutrition ward at the Community Health Centre in Baran District, Rajasthan.
A child at the malnutrition ward at the Community Health Centre in Baran District, Rajasthan. Sanjay Rawat/Outlook

India Must Brace For A Massive Spike In Malnutrition Post Covid

The already high incidence of wasting and stunting among children will see a dramatic increase unless we can ensure proper nutrition.

Veena S Rao | Nov 19, 2020

Governments across the world are presently working in emergency mode, concentrating all their energies in conquering the invisible, unknown, lethal virus which is heaping death, shutdowns and chaos everywhere.

No doubt, there have been pandemics before, and viruses have wiped out millions of people across the globe. But never before has a virus invasion and its containment resulted in such a multi-pronged pincer attack on the entire life structure of populations. Apart from the virus’ capacity to indiscriminately kill people, the inevitable preventive measures of social, economic, production, education shutdown, are equally lethal in killing livelihoods and occupations across the economic spectrum, more especially targeting the survival of the weakest. The virus and its containment has dislocated supply chains across agricultural, industrial and service sectors, made stock markets crash, and halted economies, ranging from humble domestic economies to mighty global and national economies of scale.

As always in any emergency, the hardest hit are the poor and most vulnerable – in the case of India, they include first and foremost the migrant labourers, who suddenly find themselves homeless, wage-less and starving. Their desire to reach their distant homes far outweighs any fear of death from invisible viruses, which have been a part of their lives for many years, coming from some of the poorest states of India. For them, the fear of dying of destitution and starvation is more powerful than the fear of dying from the corona virus.

Governments, district administrations and philanthropic organizations are putting in their best efforts through preventive, curative, regulatory, social and human interventions. A general strategy and emergency provisions are in place, and discussions regarding lockdown exit strategy have also started.

At this point it would also be important for policy makers and their think tanks to give some attention to the expected deterioration in the nutritional/health situation, and acute food and nutrition insecurity of the poorest 20-25% of the population during the next 4-8 months, which is the likely lockdown duration and for gradual restoration of supply chains, livelihoods, and production. The invisible virus will worsen the invisible scourge of malnutrition.

Even before the lockdown, the dietary intake of this group was far below the Recommended Dietary Allowance (RDA) prescribed by the Indian Council for Medical Research. (ICMR) Though governments have taken steps to provide Take Home Rations under ICDS, Food Grains under PDS, and emergency food handouts, the dietary gap between RDA and actual consumption among the poorest households is bound to widen due to the present livelihoods, cash and food trauma, and place vulnerable populations in a complete subsistence mode. Reports from the field inform that poor rural families are presently subsisting on rice and wheat given under PDS, and some dal which they have stored from their own fields or as wages. There is no milk or any other food for children.

Predictable outcomes of such a situation are that the incidence of wasting among children which is already high would increase immediately; stunting among children which was showing signs of improvement over the last few years will gradually deteriorate; Body Mass Index (BMI) of adolescent girls and boys, which is unacceptably low and remains an unaddressed issue, will worsen and severely impact the health and earning capacity of our youth, the demographic dividend that we so proudly boast about; the already high rates of anaemia across all age groups and both sexes would increase, and the general health of the adult population, the elderly and sick will also deteriorate.

Most worrisome would be the expected increase in the percentage of infants born with low birth weight (LBW) during the course of the next year on account of poor pregnancy weight gain/foetal nutrition. LBW would brand another generation of children with malnutrition, morbidity or mortality, producing another generation of adults with lesser physical and cognitive potential.

These projections have been discussed with other experts in the country, and there is consensus that it is now time for preparing and putting in place the required steps to prevent a surge in malnutrition, anaemia, and low birth weight babies in the near future, and its repercussions on our human resources and public health.

An essential and proven intervention recommended in addition to the ongoing government initiatives of providing basic foodgrains for preventing starvation among the most vulnerable, is to provide additional calories, protein and micronutrients in the form of fortified nutritious food, made from low cost mixtures of millets, soya, green gram, peanuts, jaggery etc. It should be introduced as an essential food in the open market, or distributed free of cost, to the neediest families. This is a simple, cost effective and proven intervention to prevent macro and micronutrient deficiency among the most vulnerable, and is endorsed in the National Nutrition Policy 1993 and earlier 5 Year Plans. There are several FSSAI approved compositions of such fortified blended foods for children, adolescents, women, adults already available. And presently, there is a complete absence of such low cost foods in the market which the poor can afford, though all grocery stores are full of several new varieties of expensive energy food and drinks.

How can this be done in the immediate future? There are several energy food production units in the public and private sectors, or run by women’s groups, which can be requested to produce such low cost, high energy foods as Essential Foods. These could be made available to vulnerable families through the open market, or through free distribution, either by government under the COVID Emergency funds or through philanthropic agencies. Interestingly, there are several private sector units operating in India that produce such low cost fortified blended foods, but only for export and not for Indian markets!

This intervention will almost immediately contain and mitigate the imminent upsurge in low birth weight babies, malnutrition and anaemia, the repercussions of which the nation will have to face very soon. Since this is a complex inter-sectoral subject, it would be appropriate and timely for Niti Aayog to start consultations on these lines and provide necessary advisories to the States, whose energies are presently concentrated on containing and defeating the virus.

(Veena S Rao, IAS (Retd) former Secretary to Govt of India, is one of India's foremost experts on malnutrition)