An expected scourge
Among the problems posed by COVID-19 for Indian society, a surge of malnutrition and anaemia amongst its vulnerable sections is one that can and should be addressed presently
Governments across the world are presently working in emergency mode, concentrating all their energies in conquering the invisible, unknown, lethal virus which is heaping death, shutdowns and chaos everywhere.
No doubt, there have been pandemics before and viruses have wiped out millions of people across the globe. But never before has a virus invasion and its containment resulted in such a multi-pronged pincer attack on the entire life structure of populations. Apart from the virus' capacity to indiscriminately kill people, the inevitable preventive measures of social, economic, production, education shutdown are equally lethal in killing livelihoods and occupations across the economic spectrum, especially targeting the survival of the weakest. The virus and its containment has dislocated supply chains across agricultural, industrial and service sectors, made stock markets crash and halted economies, ranging from humble domestic economies to mighty global and national economies of scale.
As always, in any emergency, the hardest hit and most vulnerable are the poor. In the case of India, the migrant labourers suddenly find themselves homeless, wageless and starving. Their desire to reach their distant homes far outweighs any fear of death from invisible viruses, which have been a part of their lives for many years, coming from some of the poorest states of India. For them, the fear of dying of destitution and starvation is more powerful than the fear of dying from the Coronavirus.
Governments, district administrations and philanthropic organisations are putting in their best efforts through preventive, curative, regulatory, social and human interventions. A general strategy and emergency provisions are in place, and discussions regarding an exit strategy for the lockdown have also started.
At this point, it would also be important for policymakers and their think tanks to give some attention to the expected deterioration in the nutritional/health situation and the acute nutrition insecurity of the poorest 20-25 per cent of the population during the next 4-8 months, which is the likely duration for the gradual restoration of supply chains, livelihoods and production. The invisible virus will amplify the unseen scourge of malnutrition.
Even before the lockdown, the dietary intake of this group was far below the Recommended Dietary Allowance (RDA) prescribed by the Indian Council for Medical Research (ICMR). Though governments have taken steps to provide take-home rations under ICDS, food grains under PDS and emergency food handouts, the dietary gap between RDA and actual consumption among the poorest households is bound to widen due to present cash and food shortages and place vulnerable populations in a complete subsistence mode. Reports from the field inform us that poor rural families are presently subsisting on rice and wheat given under PDS and some dal which they have stored from their own fields or as wages. There is no milk or any other food for children.
Predictable outcomes of such a situation are incidences of wasting away among children which are already high and would increase immediately. Additionally, the occurrence of the phenomenon of stunting among children which was showing signs of improvement over the last few years but will now gradually deteriorate. The Body Mass Index (BMI) of adolescent girls and boys in this group, which is unacceptably low and remains an unaddressed issue, will worsen and severely impact the health and earning capacity of our youth, the demographic dividend that we so proudly boast about. Besides this, the already high rates of anaemia across all age groups and both sexes would increase.
Most worrisome would be the expected increase in the percentage of infants born with low birth weight (LBW) during the course of the next year on account of poor pregnancy weight gain/foetal nutrition. LBW would brand another generation of children with malnutrition, morbidity or mortality, producing another generation of adults with lesser physical and cognitive potential.
These projections have been discussed with other experts in the country and there is consensus that it is now time for preparing and putting in place the required steps to prevent a surge in malnutrition, anaemia, and low birth weight babies in the near future and its repercussions on our human resources and public health.
An essential and proven intervention recommended in addition to the ongoing government initiatives of providing basic foodgrains for preventing starvation among the most vulnerable is to provide additional calories, protein and micronutrients in the form of fortified nutritious food, made from low-cost mixtures of millets, soya, green gram, peanuts, jaggery, etc. It should be introduced as an essential food in the open market, or distributed free of cost to the neediest families. This is a simple, cost-effective and proven intervention to prevent macro and micronutrient deficiency among the most vulnerable, and is endorsed in the National Nutrition Policy 1993 and earlier Five Year Plans. There are several FSSAI approved compositions of such fortified blended foods for children, adolescents, women, adults already available. And presently, there is a complete absence of such low-cost foods in the market which the poor can afford, though all grocery stores are full of several new varieties of expensive energy food and drinks.
How can this be done in the immediate future? There are several energy food production units in the public and private sectors which can be requested to produce such low cost, high energy foods as essential foods. These could be made available to vulnerable families through the open market, or through free distribution, either by the government under the COVID Emergency funds or through philanthropic agencies. Interestingly, there are several private sector units operating in India that produce such low cost fortified blended foods but only for export and not for Indian markets!
This intervention will almost immediately contain and mitigate the imminent upsurge in low birth weight babies, malnutrition and anaemia, the repercussions of which the nation will have to face very soon. Since this is a complex inter-sectoral subject, it would be appropriate and timely for 'Niti Aayog' to start consultations on these lines and provide necessary advisories to the states, which are presently concentrated on containing and defeating the virus.
The writer is a former Secretary to the Government of India. Views expressed are strictly personal
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