An EPW article titled “What can we infer from Maharashtra’s Nutrition Data?” lays emphasis upon the relatively new policy focus upon the issue of malnutrition in the last few years, given that several states have undertaken large-scale initiatives to address this. The launch of the National Nutrition Mission reiterates the government’s priority accorded to malnutrition.
Within this context, Maharashtra is cited as a success story for its State Nutrition Mission and reduction in stunting by 15% points between 2006 and 2012 (Haddad et al 2014). However, Maharashtra’s nutritional story is replete with paradoxes and has been in the news for the high prevalence of severely and moderately malnourished children (SAM and MAM) in several regions.
The question that warrants attention here is whether or not, the drastic reduction brought within a short period of six years, will be long-lasting and sustainable. This becomes even more pertinent given the fact that there has been a rise in the incidences of wasting. Wasting is a short-term measure of malnutrition and reflects interruptions in access to food and increased risk of death.
| PERIOD | STUNTING % | UNDERWEIGHT% | WASTING% | SEVERE WASTING% |
|---|---|---|---|---|
| 2005-06 | 46.3 | 37 | 16.5 | 5.2 |
| 2015-16 | 34.4 | 36 | 25.6 | 9.4 |
| Decline in % points | 11.9 | 1 | -9.1 | -4.2 |
Source: National Family Health Surveys 3 and 4
Lack of focus on long-term structural change
This divergence in data related to the multiple indicators of malnutrition is underscored by the rigidity of the structural barriers, systemic constraints and institutional barriers in Maharashtra, which have been bypassed by the ongoing nutrition interventions. Technical capacity and expertise are found lacking and local institutions remain alienated from programme design and government actions. In such a context, the dependence on donor agencies is rather high.
The interventions targeted towards child malnutrition in Maharashtra have been grounded in a quick-fix approach that ignores the critical sustainability criterion. These are short-term and target-oriented, focused on meeting numbers and have sidelined the development of nutrition infrastructure. This focus on measurable change entails an absence of consideration of the deeply embedded structural requirements and involvement of the local government institutions.
Thus, the credibility of the data claiming 40% decline in child stunting has been questioned, given that other indicators have remained stagnant or their prevalence has in fact increased. Even if the data is true, beyond this, any reduction will strictly hinge upon holistically addressing the issue of development in overall infrastructure.
Nelson Mandela’s reflection upon health interventions in Africa resonates with Maharashtra’s nutrition scenario. The targeting of reductions in rates of maternal mortality lead to an acceleration of the trend towards narrow and vertical interventions, which are calculated to move the Millennial Development Goals (MDG) targets, without providing sufficient attention to effective systems that could provide healthcare critical for maternal health.
Neglect of urban and equity dimensions
The incidences of hunger and malnutrition become matters of great concern in urban areas, due to the substantial difference in population. Despite being higher in these regions as compared to their rural counterparts, nutrition interventions remain disproportionately focused on rural areas. Moreover, the indicators for malnutrition in urban areas are more resistant to change i.e. show downward rigidity (IFPRI 2017, FAO 2012, Crush and Frayne 2011, Haddad et al 1999). This trend is especially problematic for an urbanized state like Maharashtra.
Impact of “identity” on access to nutrition
The EPW article uses Mumbai as an example to discuss this factor. The city’s slums and other informal settlements, at the periphery of the city’s prosperity, face chronic malnutrition and starvation (Yadavar 2017, Barnagarwala 2016, Bhavsar et al 2012). This is a result of institutional alienation, as local nutritional institutions and the municipality (implementation actors) reluctantly claim responsibility over them. This exclusion is not exogenous but is rather a product of local sentiments, biases and informal influences that work against specific communities.
Formal institution designs have ignored these and have contributes to selective programme failures, thereby leading to a further accentuation of the divide in access (Choudhary 2015, 2017). For instance, the ICDS centres set up to cater these groups, after reportage of hunger deaths, partially track child malnutrition indicators and the quality of nutrition provided remains questionable. Thus, identity mediates the way institutional structures function and contribute to nutrition outcomes.
In a nutshell
In Maharashtra and other states in India, rather than use a top-down approach, the local governments must be involved in the processes of nutrition planning and interventions, in order to integrate them better within ground-level institutions. The challenges of equity and sustainability must be systematically accounted for. Unless the structural issues outlined above are accommodated in the functioning of the National Nutrition Mission, it will fail to meet its mandate. This calls for a reformulation of the hunger problem in India with the aim of invoking transformative change to improve the nutrition scenario in the country.
India Outbound
February 25, 2019
source https://indiaoutbound.org/deconstructing-maharashtras-nutrition-story/
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