Malnutrition still exists as undernutrition, but it has morphed in recent decades, with the emergence of ‘over-nutrition’ and widespread micro-nutrient deficiency too – like anaemia among women and children.
A key factor at the heart of the issue is nutritional literacy. Over the past decade, the importance of nutrition has come to the fore, enabled by the widespread uptake of the internet. However, this awareness and knowledge has not percolated down to the bottom of the pyramid. Here is another role for grassroots, village functionaries to play – Asha and Anganwadi workers, as also community health volunteers – in increasing the nutritional literacy of villagers, in particular women.
Malnutrition in rural India: Insufficient dietary intake and illnesses are the most common causes of malnutrition; however, other key factors include lifestyle, nutritional practices, unsafe water, food insecurity, lack of sanitation or basic hygiene, unhealthy feeding and caring practices, inadequate health infrastructure and sub-optimal implementation of nutrition schemes.
According to the World Health Organization (WHO), in 2022, as many as 390 million adults were underweight, while 2.5 billion adults were overweight and/or obese. In children under five years of age, 149 million were stunted, 45 million were wasted and 37 million were overweight and/or obese. According to the National Family Health Survey 5, in India, national obesity rates were 41.16 per cent for women and 44.02 per cent for men, while the prevalence of micronutrient deficiency such as anaemia was 67 per cent among children aged 6-59 months and 57 per cent of women of reproductive age.
Proper nutrition plays an important role in all these issues, but is often impacted at the grassroots level by local beliefs. In rural India, when a baby is born, there is a belief that the first breastmilk – the vital colostrum, which is power-packed with nutrients and acts as a natural boost to a baby’s immune system – may be indigestible or may harm the baby. Challenging these beliefs requires a home-grown approach and the village health workers are the best source to provide that.
Literacy on-ground: Health and nutrition are dependent on cultural, socio-economic, equity, access to services and information. And, trained functionaries at the village-level have a role to play in helping bridge the gap in rural communities. By providing training and relevant IEC materials, village functionaries can be the catalysts for change across the many faces of malnutrition. But these women already carry a heavy load and adding more work to their shoulders requires support and motivation.
Infant feeding – the first 1,000 days: Health workers initiate early registration and providing nutrition counselling to mothers on balanced foods that provide for healthy growth and development of both foetus and baby. They also advocate multi-vitamin, folic acid, iron supplementation. They promote early initiation and exclusive breast-feeding and create awareness during the ANC and last trimester about nipple care and feeding.
Antenatal & post-natal support: These workers provide monthly antenatal care and post-natal check-ups, which help in monitoring the growth of children, along with specific nutrition sensitisation for mother and family, as the baby is getting all nutrition through the mother.
Advocating for nutritional diversity: Consumption of locally grown food has value and creating awareness of this among the community helps in fostering a balanced diet.
Protein variants & supplementation: Awareness is also being generated about food practices and how to make nutritional recipes, via village events.
Promotion of kitchen gardening: Village functionaries provide local demonstrations and awareness activities on creating kitchen gardens.
Nutrition hubs & centres: Nutrition resource centres are platforms where information is made available and displayed about diversified food, healthy recipes, homemade nutrition supplements, kitchen gardening and information on the role of macro- and micro-nutrients in human development is promoted. It creates awareness among stakeholder groups like farmers (growing earlier food crops like millets), women groups, adolescents and children. Recipe demonstration are also co-ordinated to engage a variety of groups.
Local IEC materials: Locally tested and validated IEC material help to achieve effective impact being in local context and using local languages. Also, local names to the food products is required.
Role, crucial:Undernourishment and micro-nutrient deficiency still continue to prevail across the country. The impacts of these across the lifecycle of a human are immense. As grassroots workers continue their work in tackling malnutrition as we know it, they have an all-new load of work on their shoulders, as they confront the ‘new face of malnutrition’. Women health workers require recognition for the crucial and important role they are playing in tackling complex national health problems, at the last mile.