The spectre of malnutrition

While we fight COVID-19…

Governments across the world are presently working in emergency mode, concentrating all their energies on the coronavirus pandemic. 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 comprehensive attack on the life of populations. Apart from the virus’ capacity to cause deaths, the inevitable preventive measures of social, economic, production, education shutdowns are equally lethal in killing livelihoods and occupations across the economic spectrum, especially the survival of the weakest. The virus and its containment have dislocated supply chains across agricultural, industrial and service sectors, made stock markets crash and brought entire economies to halt.

As always in any crisis, the hardest hit are the poor and the 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 desperation 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 as they do 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 coronavirus.

Governments, district administrations and NGOs 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 started.

At this point, it would also be important for policymakers and their think-tanks to give 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 to the 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 food grain rations 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 say 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.

The predictable outcomes of such a situation are that the incidence of wasting among children, which is already high, will increase immediately; stunting among children, which was showing signs of improvement over the last few years, will gradually deteriorate; the 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 will increase, and the general health of the adult population, the elderly and the sick will also deteriorate.

Most worrisome is 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 will curse another generation of children with malnutrition, morbidity or mortality, producing another generation of adults with lesser physical and cognitive potential.

There is consensus among experts on these projections and that it is now time to prepare and put in place 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 food grains to prevent 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 Five-Year Plans. There are several FSSAI-approved compositions of such fortified, blended foods for children, adolescents, women and 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 foods 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 LBW babies, malnutrition and anaemia, the repercussions of which the nation will have to face soon. Since this is a complex inter-sectoral subject, it would be appropriate and timely for Niti Aayog to start consultations and provide advisories to the states, whose energies are presently focused on containing COVID-19.

(The writer, a retired IAS officer, is an expert on development issues)