Malnutrition In Northeast And How This Can Be Addressed
Between the National Family Health Survey (NFHS)-4 (2015–16) and the fifth round (2019–2020), there has been a considerable increase in the number of malnourished children in India, and the progress made during the first half of the decade appears to have been undone. For a child's motor, sensory, cognitive, social, and emotional development, malnutrition has substantial long-term effects. It impedes productivity and academic progress, both of which have a negative impact on future earnings.
Malnutrition in the northeastern states of India is worse than the country average. Four states in the Northeast — Meghalaya, Mizoram, Nagaland and Tripura — have seen an upsurge in stunting among children under the age of five. Stunting, or low height for age, is a recognised risk factor for children's delayed development. According to a study funded by the World Bank, a 1% reduction in adult height as a result of childhood stunting is linked to a 1.4% reduction in economic productivity. Children who are stunted, earn 20% less as adults. Stunting is highest in Meghalaya at 46.8 %, followed by Nagaland (32.7%), Tripura (32.3 %), and Mizoram (28.9%). In Mizoram, Nagaland, and Tripura, the percentage of kids who are stunted, wasting, underweight, or overweight has increased.
The NFHS-5 shows Assam, Manipur and Sikkim have shown a drop in stunting levels. In Assam, stunting has decreased by almost one percentage point, although rates of overweight (2.3% to 4.9%), underweight (29.8% to 32.8%), and stunting (17% to 21.7%) have all increased, whereas that of wasting and underweight have decreased by more than 2% in each instance. As the number of stunted, wasting, and underweight children has dropped, Sikkim has done considerably better than other NE states — so has Manipur, with a decrease in wasting from 6.8% to 9.9% in under-five children. Every state in the Northeast saw an increase in the number of overweight people, which amplifies the growing double burden of malnutrition in the states.
Children's higher immunity is greatly influenced by appropriate foods and feeding practices. The percentages of breastfeeding children receiving adequate complementary foods have improved only in Meghalaya and Tripura. Early initiation of breastfeeding is on the decline in six out of the eight northeastern states, with highest levels in Sikkim (33.5%) and Assam (15.3%). Sikkim, Tripura, and Manipur all exhibit a notable reduction in exclusive breastfeeding (EBF) rates, with Sikkim losing nearly 26 percentage points. EBF in Sikkim is the lowest at 28.3 percent, far lower than the national average of 63.7 percent. Tripura demonstrated a gain of 39.5 percentage points in the practice of timely introduction of semi-solid food, whereas Meghalaya, Mizoram, Nagaland, Sikkim, and Arunachal Pradesh showed a slight fall. Minimum Adequate Diet (or diet adequacy) is a combined indicator of feeding frequency and diet variety. From 8% to 29.8%, there is a significant range throughout the northeastern states. All states, with the exception of Assam, have performed better on this measure than the nation as a whole.
It is heartening to see a declining trend in underweight women (BMI < 18.5) in all eight northeastern states. The situation with obesity is more complicated: only Meghalaya and Nagaland have seen decreases, while the other six states have seen increases. In six of the eight northeastern states, anaemia among women of reproductive age has increased, with Tripura worst at 67.2%, and Assam at 65.9%.
How Malnutrition Can Be Tackled In NE
Stunting among children in the Northeast is caused by a number of factors, including poor maternal health, a lack of antenatal care, inadequate infrastructure and healthcare facilities, inadequate feeding and nutrition for women, and limited access to education, clean drinking water, and sanitary facilities. Lack of toilets, drinking water and cooking fuels in the home environment have an impact on child malnutrition, according to a 2015 study on indigenous peoples in the Northeast.
Sikkim has the lowest rate of childhood stunting and the highest levels of women's empowerment and health determinants. Manipur, Mizoram, and Sikkim fare better than the national average in most measures. Newborns' chances of being stunted are decreased by better maternal nutrition prior to conception, throughout pregnancy, and after delivery. According to data for Sikkim, Manipur, and Mizoram, the risk of stunting decreases as the number of underweight mothers decreases.
In the northeastern states, the use of supplementary food at the anganwadi centres varies greatly, from about 35% in Arunachal Pradesh to 70% in Tripura. A low of 20.7% in Nagaland and a high of 79.4% in Manipur is the ANC coverage across the Northeast. All states have lower percentages of iron and folic acid (IFA) intake than the national average of 26%, with the exception of Manipur where 30.3% of pregnant women completed the full 180-day course of IFA tablets. Nagaland has the lowest rate, at just 4.1%. Overall, the NE states show a wide variation in service availability and uptake.
Several programmes and best practices across the Northeast have been initiated to enhance mother and child health. For example, the Assam government encouraged women in rural communities to develop "nutrition gardens" where they could grow vegetables, "Kan Sikul, Kan Huan (My School, My Farm)” programme in the most impoverished and disaster-prone area in Mizoram-Lawngtlai, and the “dibbi adaan pradaan (lunchbox exchange)” initiative in Hailakandi district of Assam for promoting better nutrition and variety in menu.
Malnutrition in the Northeast has to be addressed holistically through the scaling up of direct nutrition interventions and the coupling of them with nutrition-sensitive measures to close the nutrition gap. In the long run, it could be beneficial to improve the monitoring and evaluation of current interventions by building on the POSHAN Abhiyaan and health projects.
The author is Senior Fellow, Health Initiative, Observer Research Foundation, New Delhi.
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