Serving up a better alternative for mother and child

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.

The Integrated Child Development Services (ICDS) Scheme was launched in 1975 with the following objectives:

1. to improve the nutritional and health status of children in the age-group 0-6 years;
2. to lay the foundation for proper psychological, physical and social development of the child;
3. to reduce the incidence of mortality, morbidity, malnutrition and school dropout;
4. to achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and
5. to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

 

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.

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. 

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.

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.

 

                                                                                                               

WHO admits that India has been effectively reducing its infant and maternal mortality figures, thanks largely to National Rural Health Mission (NRHM). But experts say the pace hasn't been satisfactory enough, especially when it comes to infant and maternal deaths.

One of the MDG goals is to reduce under-five mortality rate to 42 per 1,000 live births by 2015. India will reach 52 by that year missing the target by 10 percentage points.

The national level estimate of infant mortality rate is likely to be 44 against the MDG target of 27 in 2015. Some of the largest states like Madhya Pradesh (62), Odisha (61), Uttar Pradesh (61), Assam (58), Meghalaya (55), Rajasthan (55), Chhattisgarh (51), Bihar (48) and Haryana (48) still have IMR above the national estimates.

The national level measure of the proportion of one-year old (12-23 months) children immunized against measles has registered an increase from 42.2% (1992-93) to 74.1% (2009).

India is, however, expected to cover about 89% children in the age group 12-23 months for immunization against measles by 2015 — short of universal immunization of one-year olds against measles by about 11 percentage points.

India will reach maternal mortality rate (MMR) of 139 per 100,000 live births by 2015, falling short by 30 percentage points.