India’s economic growth over the last 15 years, and the growing size of the middle class, have become a source of attraction for international investors, especially in the retail food industry. However, the gap between the rich and the poor has only widened: nearly 40 per cent of the population earns the equivalent of less than $1.25 a day. India has the world’s largest number of undernourished infants and children, approximately 61 million. It was quick to identify the problem, and introduced the Integrated Child Development Scheme (ICDS) in 1975. But it has had only limited and patchy success. Today, India has several programmes meant to overcome undernutrition. Yet, in the given situation, achieving the first Millennium Development Goal (MDG) of eradicating extreme hunger and poverty by 2015, remains unrealistic.
Under the 11th Five Year Plan, the budget for this is more than Rs.44,000 crore, employing several hundred workers and serving more than 8.2 million pregnant women and 40 million children under five. Yet, undernutrition in children contributes to 22 per cent of the disease burden. Micronutrient deficiencies cost about $2.5 billion a year. The ICDS, though well-intended, suffers from discrepancies and a lack of commitment to providing quality care for the vulnerable and the needy. Its focus has been mainly on quantitative coverage, food distribution to the three- to five-year age group and pre-school education. It needs to concentrate on pregnant women and children under two.
Critical period of development
The most critical period of a child’s development is from conception to the first two years. The nutritional needs of the pregnant mother and the young child have quantitative and qualitative aspects. Yet, the fund allocation is the least for this group. The ICDS spends Rs.4 a day for infants less than 72 months old, Rs.5 a day for pregnant mothers, and Rs.6 a day for three- to five-year olds. Failure to intervene in undernutrition and micronutrient deficiencies during this critical period has left generations of children stunted. Research has established that environmental factors determine the height, weight and intellect of an individual, and not genetic or hereditary factors. To break the intergenerational cycle of undernutrition, ICDS should enable anganwadi workers to concentrate on this high-risk group. Community participation in terms of creating focus groups for pregnant women and young mothers to educate them on healthy diets, proper antenatal care, universal breastfeeding promotion, and the importance of adequate nutrition during the weaning period, will improve outcomes. Failure to prevent undernutrition in this group will have a cascading effect from womb to tomb. An undernourished mother most often delivers a low-weight baby. This poor start will result in frequent infections, poor cognitive and motor skills, reduced IQ, and stunted growth. These lead to low economic productivity at the individual and community level.
The provision of supplementary nutrition, a key component of the ICDS, receives the major share of funding. In most anganwadi centres, food is in the form of cooked meals for pre-school children and macro/micronutrient powder for pregnant mothers and infants less than two years. Studies suggest that nutrient powder is ineffective in meeting nutritional needs. Alternative and more effective methods are needed to combat undernutrition. Provision of conditional food coupons instead of the nutritious powder can help combat undernutrition more effectively in this critical group. Such a model has been successful in the United States in the form of the WIC program.
The U.S. programme
The Special Supplemental Nutrition Program for Women, Infants, and Children — better known as the WIC Program — in the U.S., is a federal grant programme introduced in the same year as the ICDS. The focus is to safeguard the health of low-income group women, infants and children until the age of four. Interestingly, the maximum utilisation is by infants less than two years, and it decreases as the child gets older. Supplemental food package coupons are provided to pregnant, lactating mothers and low-income group families with children up to four. The food has to be purchased from government-authorised vendors within the local area. Apart from favourable health outcomes such as increased breast feeding, reduced infant mortality and prevention of undernutrition, this helps local farmers sell their produce and small traders to increase business.
Lack of access to or availability of food is just one of the determinants of undernutrition. Agricultural food production, access to safe water and sanitation, awareness about nutrition and availability of health-care services, are equally important. The ICDS has contained severe protein-energy malnutrition, but failed to alleviate mild to moderate undernutrition and micronutrient deficiencies. The ICDS needs to focus on empowering women and making them aware of the long-term benefits of healthy food and help beneficiaries access healthy, nutritious and palatable food of their choice. This would reduce pilferage and help achieve the objectives of the ICDS.
In recent times there has been some extraordinary interest to adapt and adopt models and practices from the U.S. economy. Today in the U.S., the functioning of Walmart, the Wall Street financial system, and the market-based health-care industrial policy are issues that are being debated. However, programmes like the WIC that strive to emancipate and empower the vulnerable and to create a self-reliant and healthy population, could form the foundation for positive economic growth. The ICDS can evolve strategies and methods similar to the WIC but that suit the Indian environment, to reduce the disease burden caused by preventable undernutrition. Otherwise, even the most well intentioned economic reforms will fail to make India a developed nation.
(Dr. Poongothai Aladi Aruna, a former Minister in Tamil Nadu, is currently a Humphrey Fellow under the auspices of the Fulbright Foundation, at Johns Hopkins University, Baltimore. Email: balajipoongothai@ymail.com )
