Food fundamentals….Coomi Kapoor
Fortification with micronutrients is crucial in fighting anaemia
Fortification with micronutrients is crucial in fighting anaemia
It will be a mistake to assume that the food security bill, in its present form, will necessarily and sharply reduce Indias embarrassingly high rates of child malnutrition. Satiating hunger and providing nutrients that are essential for healthy growth and fitness are not quite the same thing, a fact highlighted by the leading medical journal Lancet in a recent research paper. The article says the prevalence of anaemia in India is higher than that in Bangladesh, Nepal, Sri Lanka, Pakistan and Southeast Asian countries. It cites the National Family Health Survey figures that 55 per cent of Indian women in the reproductive age, and 70 per cent of children under five, are anaemic.
While the budgetary allocation on Indias nutrition programmes is substantial, a major flaw is a lack of focus. The most vulnerable sections of the population often fall between the cracks. The crucial window of opportunity to counter the adverse effects of undernourishment and malnourishment is in pregnant and lactating mothers and children under the age of two in middle- and lower-middle-income groups. It is a vicious cycle: anaemic mothers produce anaemic babies. Fifty per cent of Indian children under three are underweight, 38.4 per cent are stunted and 19.1 per cent are wasted. These unfortunate statistics have not cropped up simply because of lack of food, but a failure to introduce the right nutrients in the diet at the right age. Apart from iron deficiency, which results in anaemia, an estimated 50 per cent of children receive less than half their daily requirement of vitamin A, zinc and folic acid.
Most of these deficiencies in diet could be addressed fairly easily by reaching out to vulnerable sections through the Integrated Child Development Scheme (ICDS). Unfortunately, for years nutritionists and NGOs have quarrelled over the right strategy to adopt. In the bargain, anaemia rates have not declined for over a decade. While half-a-dozen high-powered nutrition committees have in general terms endorsed the importance of a cost-effective, easily doable nutritional intervention like fortification and providing fortified supplementary food to children under three, the Central government has failed to push for such measures.
Towards the end of UPA 1, the ministry of women and child development sent out an excellent set of guidelines to state governments, laying down nutrition norms for the ICDS. It recommended take-home rations of blended fortified mixes for children under three and fortified, cooked hot meals for older children. The guidelines took into account the crucial fact that children between the ages of six months and two years have a much smaller stomach capacity and require nutrient-dense meals rich in energy several times daily, whereas older children have different needs.
The message seems to be slowly percolating down. Fortified take-home rations for under-three children in the ICDS are finally being implemented to some degree in states like Tamil Nadu, Karnataka, Punjab, Uttar Pradesh, Uttarakhand, Gujarat, Rajasthan and Andhra Pradesh. On the other hand, there are states like Kerala, Bihar, Himachal Pradesh, Jharkhand and Assam which stick to the old system of simply providing take-home grain rations for infants. The grain generally ends up as part of the family pot.
One reason why our ICDS policies are not uniform is that court commissioners in the Right to Food case argue that fortified mixes should be supplied only by small self-help groups, which would make introduction of fortification interventions on a nationwide scale impossible. Rajasthan, for instance, is actually contemplating pulling back on some of its pre-mix distribution schemes in the ICDS which are not run by NGOs.
The conventional method of treating anaemia through iron tablets has not proved effective, and hardly 30 per cent of the population has been covered because of distribution problems. It makes sound sense, therefore, to opt for the route of fortifying our staple foods, by adding micronutrients. The costs of fortifying are minimal, the risk negligible and the returns enormous. Wheat, for example, is commonly fortified with iron and zinc. Oil is the vehicle for vitamin A. In fact, 35 countries have made flour fortification mandatory.
In India, Gujarat has been a trend-setter, introducing legislation to make it compulsory to fortify wheat with iron and folic acid and oil with vitamin A. But even enforcing such laws is problematic. Despite a government decree making it compulsory to fortify salt with iodine, around 29 per cent of salt eaten in the country either has no iodine at all or is inadequately iodised.
URL: http://www.indianexpress.com/news/food-fundamentals/834008/0