Special
Feature: National Nutrition Week – 1st
to 7th Sep 2017
Breaking
Inter-generational Cycle of Malnutrition &
Optimising the IYCF Practices
Santosh
Jain Passi*
Akanksha Jain**
Malnutrition
among populations – particularly the children, is an interplay of multiple
factors like illiteracy, ignorance, poverty, large families, lack of resources
including food/nutrition insecurity and poor access to health care services. Since
long, our government’s endeavour has been to reduce morbidity/mortality rates
by implementing multipronged strategies for breaking the intergenerational
cycle of under-nutrition. Events leading to malnutrition often predate child-birth;
maternal under-nutrition, teenage pregnancies, closely spaced child-births and
high parity are the major contributors to pre-term/low birth weight deliveries.
Escalating malnutrition among children aged below 2 years is indicative of
poor infant feeding practices. Therefore, appropriate infant feeding practices coupled
with adequate maternal nutrition are crucial for healthy growth/development of
the child; and for this a life cycle approach is imperative.
Appropriate/optimal Infant and Young
Child Feeding (IYCF) practices emphasise on early initiation of breastfeeding (within
the 1st hour of child-birth) without giving any pre-lacteals,
exclusive breastfeeding for the first six months of life (not even water,
only prescribed medicines/tonics, if any); and after 6 months, age-appropriate
complementary foods with continued breastfeeding up to two years and beyond. In
the light of this, theme for this year’s National Nutrition Week is ‘Optimal
IYCF Practices: Better child health’.
Every year, National Nutrition
Week is celebrated from 1st to 7th September for intensifying
nutrition/health related awareness among the masses. Launched by the Food &
Nutrition Board in 1982, it is envisaged that the nutrition education/training
programmes carried out by the governmental/non-governmental organizations will have
far reaching implications on productivity, economic growth and ultimately the
nation’s development.
Optimum
nutrition coupled with regular physical activity is the cornerstone of good
health/well-being. Importance of proper nutrition in survival, health and
development of the current as well as the succeeding generations cannot be
undermined. Healthy children learn better and adequately nourished individuals are
more productive. On the other hand, poor nutrition can result in lowered immunity,
impaired physical growth/mental development, increased morbidity and thereby, reduced
productivity.
WHO/UNICEF
have designated the first 1000 days of life (270 days in-utero + 2 years post-birth)
as the critical window for infant/young child nutrition interventions. This
period being vital for brain growth/development, any malnutrition can cause stunting
and suboptimal mental development. Breastfeeding – the gold standard feeding
option for babies needs to be promoted; therefore, mothers as well as the other
caregivers need to be made cognizant of its benefits, both for the baby and the
mother. During pregnancy itself, effective counselling (inter-personal/small
groups) should be carried out to highlight the advantages of breastfeeding vs.
the dangers of artificial feeding; and thus, prepare the expectant mothers for
successful breastfeeding.
When a child - particularly the
girl child - is not provided enough nourishment, an inter-generational cycle of
malnutrition may set in. Both the individual level and intergenerational (from
one generation to the next) cycles of under-nutrition and ill health operate
simultaneously posing grave consequences. A low-birth-weight baby-girl borne by
a malnourished mother becomes a stunted/malnourished girl child à
stunted/ malnourished adolescent à
malnourished woman; and in turn, gives birth to a second-generation low-birth-weight
baby. This clearly illustrates how poor in-utero nutrition from an under-nourished
mother (both during & prior to pregnancy/lactation) extends through the
life-course affecting nutrition/health status of generation-by-generation. This
is further heightened by teenage pregnancies where the adolescent girls have to
bear the dual-burden of their own growth and that of the developing foetuses leading
to still poorer pregnancy outcome. Further, closely spaced high parity
pregnancies often exacerbate nutritional deficits which get passed on to their
offspring/s too. Micro-nutrient (iron, zinc, iodine & vitamin A) deficiencies
in young girls too can catalyze the intergenerational malnutrition cycle. This
can mar the nation’s development due to physically/mentally affected workforce
with reduced work capacity.
In
the light of these adversaries, nutrition has become an integral component of
all the maternal and child health programmes such as:
·
Integrated Child Development Services
(ICDS), launched on 2nd Oct 1975
has been universalized in the country. The target group comprises children
(<6 years), pregnant/nursing mothers & women in reproductive ages (15-44
years) as well as adolescent girls for improving their nutrition/health status
by providing a package of services right at the grass-roots level.
·
Reproductive, Maternal, Newborn, Child
and Adolescent Health Programme (RMCH+A, launched
in 2013) addresses the major causes of mortality among women, children &
adolescents along with the reasons for delayed access/utilization of health
care services. This strategic approach highlights the importance of ‘continuum
of care’ during various stages of life.
·
Janani Shishu Suraksha Karyakaram (JSSK)
– launched on 1st June, 2011 aims to provide better women/child
health services such as cost-free/cashless facilities for pregnant women (normal
deliveries/caesarean section operations) and sick new-borns (<30 days
post-partum) through government health institutions in rural/urban areas.
·
Pradhan Mantri Matritva Vandana Yojana
(PMMVY) is a maternity benefit program
implemented by Ministry of Women & Child Development, Government of India.
It is a conditional cash transfer scheme for pregnant/nursing mothers (aged >19
years) for first two live births to partially compensate the childbirth/childcare
linked wage-loss. In addition, it provides adequate facilities for safe
delivery and breastfeeding/infant feeding.
·
Pradhan Mantri Surakshit Matritva
Abhiyan (PMSMA) aims to
reduce maternal and infant mortality rates in the country through safe
pregnancies and safe deliveries. It provides quality comprehensive antenatal
care to pregnant women on a designated day - 9th of every month.
·
The Mother and Child Tracking System
– Monitors the health care system to ensure all mothers & their children to
have an easy access to various health-care services like care during pregnancy/child-birth
and complete maternal & child immunization.
·
MAA (Mothers’ Absolute Affection) –
an intensified
flagship programme of the MoHFW was launched in 2016.
It aims to enhance optimal breastfeeding practices in the country through a set
of comprehensive activities for protecting, promoting and supporting
breastfeeding/child feeding, both at community & the facility level. The
programme emphasises on generating community awareness, strengthening inter-personal communication
skills of the functionaries and providing necessary support for breastfeeding
at delivery points/public health facilities along with the need for adequate family
support to the nursing mother.
·
Recent amendment of the Maternity
Benefit Act (April 2017) enshrines paid maternity leave for 26 weeks even in
private sector; however, for the pregnant women already having 2 living
children, it remains unchanged (12 weeks) and the same is for
adoptive/commissioning mothers too. Crèche facility and the option for work
from home are other features of this amended Act.
·
India Newborn Action Plan (INAP), launched
in September 2014, aims to end preventable new-born deaths and stillbirths so
as to achieve single digit neonatal mortality/stillbirth rates by 2030.
·
Adolescent Reproductive and Sexual
Health (ARSH) programme comprises the package
of preventive, promotive, curative and counselling services for addressing
their reproductive and sexual issues.
Other
programmes/schemes targeting adolescent girls include Kishori Shakti
Yojana, Balika Samridhi Yojana, Scheme for Adolescent
Girls (SABLA), Weekly Iron and Folic Acid Supplementation (WIFS)
programme, Menstural Hygiene Scheme and many more. These programmes aim at
empowering the adolescents with improved nutrition/health related awareness as
well as better nutritional status so that they enter matrimony and motherhood
with better nutrient stores.
Under
UIP, Mission Indradhanush is cost-free expanded immunization
coverage for children against 7 vaccine preventable diseases (Diphtheria,
Pertussis, Tetanus, Childhood-Tuberculosis, Polio, Hepatitis B and Measles) by
2020. Further, Swachh Bharat, ‘Beti Bachao Beti Padao’ abhiyan,
adolescent friendly clinics also address critical nutrition-sensitive
issues.
It is thus, possible that through concerted efforts,
the intergenerational cycle of malnutrition can be turned virtuous and improvements
in maternal nutritional status and pregnancy outcome can be achieved. Better diet
quantity/quality, micronutrient supplementation and improved health services
can be the catalytic strategies for bringing about the desired change. As per
the continuum of care approach, focusing on girl child to women along the
lifecycle is imperative for achieving the Sustainable Development Goals (SDGs)
and overcoming poverty, malnutrition and ill-health.
“Optimum IYCF practices coupled with good nutrition along
lifecycle can retain the individuals’ health…..break the inter-generational cycle
of malnutrition….and eventually make India a healthy & productive nation”!!
_________________________________________________________
*Dr Santosh Jain
Passi - Public Health Nutrition Consultant; Former Director, Institute of
Home Economics, University of Delhi
** Ms Akanksha
Jain - Ph D Scholar, Amity University, Noida, Uttar Pradesh;
Research Officer - Public Health Nutrition Division, LSTech Ventures Ltd,
Gurgaon, Haryana, India
Views expressed in the
article are author’s personal.