Internship Report by Aniket Lakhpati (M.A Society and Culture, Class of 2023)
December 2022
Introduction
According to the GHI (Global Hunger Index) report of 2022, India ranks 107th out of 121 countries worldwide. With a score of 29.1, India falls under the 'serious' level of hunger within five different stages-low, moderate, serious, alarming, and extremely alarming. The report says although many countries, including India, secured favorable GHI scores, they have wide disparities in nutritional status, with areas of serious child nutrition (Von Grebmer et al., 2022). Apart from the GHI report, the Global Nutrition Report (GNI) states that “India is 'on course' to meet three global nutrition targets for which there was sufficient data to assess progress” (Country Nutrition Profiles, n.d.). These global nutrition targets include childhood stunting, childhood overweight and exclusive breastfeeding. India is a prominent example where the programmes and policies on nutrition and health change following the state and targeted areas.
In response to the GHI report 2022, the ministry of women and child development criticized it, saying that "three of the four indicators used for the calculation of the index are related to children's health (child stunting, child wasting and child mortality) and cannot be representative of the entire population. The fourth and most important indicator estimate of the Proportion of the Undernourished (PoU) population is based on an opinion poll conducted on a diminutive sample size of 3000``(Global Hunger Report 2022- The Index Is an Erroneous Measure of Hunger and Suffers From Serious Methodological Issues, n.d.). Nevertheless, the argument cannot help to alter ground reality. UNICEF alerted that India has the highest cases of child wasting in the world (Global Hunger Index 2023: India reports highest child wasting rate; slips 4 notches on ranking, 2023). Despite the government's efforts to improve health and provide nutrition to women and children in the last few years (including covid times), the situation has mostly stayed the same (Sinha, 2021). The GHI score from 2014 to 2022 fluctuates between 28.2 and 29.1 (The Hindu, 2022).
The improvements in health, nutrition interventions, and household conditions contributed to the decline in stunting in four Indian states between 2006 to 2016. These four states include Chhattisgarh, Gujarat, Odisha, and Tamil Nadu (Von Grebmer et al., 2022). WCD department, Gujrat, reported in its report on 'malnutrition among children' that "As per the recent report of NFHS-5 (National Family Health Survey 2019-21), the nutrition indicators for children under five years have improved as compared with NFHS-4 (2015-16)" (Malnutrition Among Children, n.d.). Despite that, Gujrat, being a basket of various food safety programmes such as Mid-day Meal (MDM), Integrated Child Development Services (ICDS) Scheme and Public Distribution System (PDS), still there has been an increase in the percentage of children under the age of five, who are facing undernutrition, overweight and severely wasted (Muhammed, 2022).
The aim of this report is to recognise the gap between government policies/schemes regarding health and nutrition for women and children and their implementation at the ground level, at Palaj, near Gandhinagar.
Objectives
To study the socio-economic factors responsible for the health of pregnant and lactating women and child stunting and wasting
How the socio-economic factors affect the acceptance of the benefits of government policies.
To highlight the role and contribution of local government institutions such as Anganwadis and health centers.
Methodology
In December 2022, fieldwork for this research was conducted in Palaj, a tiny village close to Gandhinagar. I visited three Anganwadi centres and a health centre, where I spoke with Anganwadi workers, helpers, and hospital physicians, in addition to doing a few informal interviews with women and Asha workers. The selection of interviews and data collection were conducted using the Snowball Sampling method. In addition to my research, I read several reports from governments and international organisations on women's and children's development, hunger, malnutrition, and health, including the health and nutrition-related policies and schemes that the Indian government and the Gujarat WCD department have announced and put into effect.
Findings
The government provides supplementary nutrition to children (six months to six years old) and pregnant and lactating women through Anganwadi workers and helpers. Normal children get 500 kcal and 12-15 grams of protein; underweight children get 800 kcal and 20-25 grams of protein, which covers their one-third requirement of daily food. Anganwadi workers said that they measure the weight and height of each child every month and fix their diet according to that. The weekly diet chart is fixed and changes with the areas and states. Anganwadi workers and helpers provide the take-home ration for pregnant and lactating women. It includes 600 kcal and 18-20 grams of protein. Even when the covid was at its peak, it was obligatory for Anganwadi workers to provide this ration to pregnant and lactating women.
"The people were hesitant to accept the food packets from us during covid times. Sometimes they asked us to leave food packets at the gate or the window. Some people refused to take the food packets from us." said, an Anganwadi worker.
The upper middle class, or those who are economically well off, are more ignorant of government schemes compared to the economically disadvantaged and lower middle class people. They refuse to accept assistance from Anganwadi centres and start enrolling their children to private schools when they are about three years old. This is not only a sign of their lack of faith in the food's quality, but it also emphasises their social class distinctions between caste and religious groups. So, they are unwilling to lower their class by accepting government facilities.
The Anganwadi staff members face some major challenges in their line of work. Their wages are quite meagre as compared to the work they put in. Some Anganwadi centers are yet to appoint a helper after the position gets vacant. It creates huge pressure on the worker, and it impacts their efficiency.
"We cannot protest for raising our salaries against the government because, as a woman, we have limitations. Domestic responsibilities also bound us. Even if we protest, we cannot continue it for long. Sometimes we need to spend extra money from our pocket to bring all the ration from the PDS shop to Anganwadi. The government does not give that money to us." said, one of the Anganwadi workers.
Asha workers' appointments helped a great deal in spreading awareness about government schemes on health and nutrition for children and women.
"They are connected with almost every family in the village. They provide information on whether women or children are suffering from disease or weakness issues. They also helped us register a newborn child in Anganwadi." said, one of the Anganwadi workers.
There are more registered girls than registered boys at the three Anganwadi facilities visited.
Analysis
As mentioned above, India has a wide disparity in nutritional status and health facilities. These schemes do not only change with states but also within the state. Some schemes, such as supplementary nutrition through Anganwadis, are implemented throughout the state. However, some nutrition schemes for example, Doodh Sanjivani Yojna, Poshan Sudha Yojna, etc. are particularly implemented in comparatively backward areas (including some tribal blocks) of the state. Schemes such as Poshan Sudha Yojna provide daily hot-cooked nutritious meals and iron and calcium tablets in tribal or backward areas. The scheme also ensures education for tribal women on health and nutrition (WCD, n.d.). The fieldwork was primarily conducted in Palaj, which does not fall under such backward areas and thus, do not seek benefit from these schemes.
Gandhinagar and Ahmedabad are not too far from the village of Palaj. A vast array of medical facilities and technology are available to people. The villagers' livelihoods are not only based on farming, despite the fact that some of them do. As people grow increasingly connected to nearby towns for jobs, they become more cognizant of education, health, and a variety of other issues. IIT Gandhinagar, a technical university located a short distance from the village, may provide a means of employment for those in need, which could be a vital first step towards achieving financial and economic stability.
Conclusion
This report sought to identify the disparity between government plans and policies pertaining to women's and children's health and nutrition and their actual execution at Palaj. The findings and analysis of this gap, however, brought to light the difficulties that Anganwadi employees confront and how their inadequate compensation and lack of resources contribute to their stress.
On the other hand, The study draws attention to the regional variations in India's nutrition and health policies, some of which are created with impoverished and tribal populations in mind. Because Palaj is the study's focal point, a place that these focused programmes do not serve, it emphasises the need for a broad and inclusive strategy to ensure full nutrition and health coverage in a variety of socioeconomic and geographic contexts.
In conclusion, the difference that has been discovered highlights both of which have a major influence on the overall efficacy of health and nutrition programmes. Closing the gap between the intended policy and the actual reality on the ground requires addressing these problems in order to create a more equitable and effective approach to promote the well-being of women and children in the region.
References
Country Nutrition Profiles. (n.d.). Global Nutrition Report | Country Nutrition Profiles - Global Nutrition Report. https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india/#:~:text=The%20specific%20targets%20set%20are,to%20at%20least%2050%25%3B
Global Hunger Report 2022- The index is an erroneous measure of hunger and suffers from serious methodological issues. (n.d.). https://pib.gov.in/Pressreleaseshare.aspx?PRID=1868103
“Malnutrition among Children.” (n.d.). https://pib.gov.in/Pressreleaseshare.aspx?PRID=1806601
Muhammed, S. (2022, April 24). Gujarat’s Malnourished And Anaemic Children Need Urgent Government Attention. Vibes of India. https://www.vibesofindia.com/39-per-cent-of-children-in-gujarat-under-the-age-of-five-years-are-stunted/
von Grebmer, K., Bernstein, J., Wiemers, M., Reiner, L., Bachmeier, M., Hanano, A., Towey, O., Chéilleachair, R. N., Foley, C., Gitter, S., Larocque, G., Fritschel, H., Author, G., & Resnick, D. (2022). GLOBAL HUNGER INDEX FOOD SYSTEMS TRANSFORMATION AND LOCAL GOVERNANCE A Peer-Reviewed Publication.
India ranks 107th out of 121 countries on Global Hunger Index. (2022, October 2). . - YouTube. https://www.thehindu.com/news/national/india-ranks-107-out-of-121-countries-on-global-hunger-index/article66010797.ece
Global Hunger Index 2023: India reports highest child wasting rate; slips 4 notches on ranking. (2023, October 13). https://www.downtoearth.org.in/news/health/global-hunger-index-2023-india-reports-highest-child-wasting-rate-slips-4-notches-on-ranking-92282
Sinha D. (2021). Hunger and food security in the times of Covid-19. Journal of social and economic development, 23( Suppl 2), 320–331. https://pubmed.ncbi.nlm.nih.gov/34720482/
WCD. (n.d.). WCD. https://wcd.gujarat.gov.in/posts?id=346
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