One of the key indicators of a nation’s health status is how healthy are the pregnant mothers and their new born babies. Here, ‘malnutrition’, which implies both over-nutrition and under-nutrition, is a key parameter. Poor nutrition among pregnant and nursing women is one of the key reasons for the unacceptably high rate of maternal mortality (deaths related to pregnancy and childbirth) in India.
Our primary challenge is to address the nutritional needs of pregnant and nursing women so that they can deliver healthier babies and not deplete their own nutritional reserves to such an extent that their health suffers for a lifetime.
Currently, about four out of 10 women in India are underweight when they become pregnant. Not enough information is given to them on how much weight they need to gain and maintain during pregnancy. Most women in India, which includes those who live in both rural and urban areas, do not gain more than 7 kg during pregnancy, which is just not enough for the integral growth and overall development of the foetus and health of the mother.
Identifying the need: Our government has begun to take steps to improve this situation but we have a long way to go. The gove-rnment has now acknowledged that inexpensive, cost effective maternal nutrition programmes such as supplementation and community education, can be a good solution to the problem of maternal malnutrition and its impact on foetal health.
The Economic Survey of India 2015-16 has pointed out that foliate supplementation and salt iodisation before pregnancy, and calcium and protein supplementation during pregnancy can help improve maternal nutrition, reduce neonatal mortality and stunting in childhood.
Current nutrition interventi-ons for maternal health: The Integrated Child Development Services (ICDS) Scheme by the Ministry of Women and Child Development offers pregnant women nutrition counselling along with pre-mixes or ready-to-eat food that contains 600 calories and 18-20 grams of protein. The National Health Miss-ion organises Village Health Nutrition Days where trained community health workers deliver antenatal care for pregnant wo-men, including nutrition counselling and anaemia diagnosis.
The National Iron Plus Initiative provides iron and folic acid supplementation to pregnant women for a fixed time period during pregnancy. For future interventions, Ministry of Health and Family Welfare is also working on developing guidelines for calcium supplementation during antenatal care and intravenous iron sucrose if anaemia is severe. All these are excellent measures but diligent implementation of these by states is a necessary requirement.
Despite all the interventions currently in place, the 2016 Global Nutrition Report points out that India has amongst the lowest coverage of iron and folic acid supplementation for pregnant women and every second woman in the age group of 18-45 years is anaemic.
Step up national effortsOrganisations like UNICEF and WHO are providing technical assistance to the government to strengthen systems, improve programme implementation, monitoring, research and advocate for high impact best practices. These are welcome measures but there is no denying that we need to ramp up our on national efforts quickly, effectively yet efficiently.
Identifying the gaps: India needs to bridge the current fiscal gaps to strengthen interventions to improve maternal nutrition. In 2016, the government at the Centre allocated about $5.3 billion to nutrition-specific programmes such as the ICDS and the National Health Mission.
An additional $31.6 billion was spent to improve the underlying determinants of nutrition (poverty, sanitation and empowerment) through the Public Distribution System (PDS), the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), and the Swachh Bharat Mission.
India has made considerable improvements in maternal hea-lth in the last two decades. Good, balanced nutrition rem-ain key to our ongoing efforts to further reduce maternal mortality. We need more rigorous implementation of our current practices and introduction of new global guidelines and initiatives that can address existing gaps.
State governments need to take a strong stand to put an end to malnutrition and allocate the appropriate resources to do this. I am certain that if all stakeholders, from government ministries to other organisations and from businesses to individuals join hands, we will be well on track to consistently and sustainably improve the health of our women and children across the country to the extent required.
(The writer is Head of the Department, Clinical Nutritionist, Cloudnine Group of Hospitals, Bengaluru)