Community action, with a focus on women’s well-being, can fight malnutrition

With equal wages for women and men, and direct payments to workers’ bank accounts, MGNREGA helps to increase women’s incomes.

On an MGNREGA worksite in Kolar, Karnataka, a male worker came up to me and said that men ought to be paid more than women. I asked him why. “Adhu yaavaagalu hange,” he replied: That was how it always was. Not so in MGNREGA, I told him.

With equal wages for women and men, and direct payments to workers’ bank accounts, MGNREGA helps to increase women’s incomes. Another major programme which can improve women’s livelihood, their social empowerment and their lives is the National Rural Livelihood Mission (NRLM). Increased incomes give women more voice in family decisions, and the ability to care better for their families and themselves.

Data from the fifth round of the National Family Health Survey (NFHS-5) shows gains in some important areas. In most of the 22 states and Union territories surveyed, infant mortality rates and under-five mortality rates have fallen; and institutional births and child immunisation rates have increased. Access to improved drinking water and sanitation has increased in almost all areas surveyed.

On child malnutrition, the NFHS’s findings are worrying. Beyond behaviour change communication and regular monitoring, direct nutrition interventions are key, especially during pregnancy, breastfeeding and in the early years of a child’s life. Pregnant women, lactating mothers and young children need hot cooked meals with adequate protein, milk, and green leafy vegetables. States like Karnataka, Andhra Pradesh and Telangana have replaced take-home rations for mothers with daily hot cooked meals.

While providing hot cooked meals frontline health workers also have the opportunity to give pregnant women iron, folic acid and calcium tablets. They are also engaged in early childhood stimulation activities and parenting sessions. Instead of frontline workers going to each woman’s house, women coming to the anganwadi makes it easier to provide all women with appropriate services and counselling. Mothers’ lunch groups at the anganwadi can also function as informal social networks. A study by the Public Health Foundation of India (PHFI) of Karnataka’s Mathrupoorna programme for pregnant women and breastfeeding mothers found a reduction in anaemia, improved gestational weight gain, improved birth weight, and reduced depression among women participants.

Beyond the “first thousand days”, the intergenerational cycle of malnutrition and its social determinants call for a life cycle approach. Such an approach should address the complex social ill of child marriage. One of the best ways to prevent child marriage is by supporting girls to stay in high school. Grass roots social empowerment programmes should focus on increasing girls’ enrolment, access and retention in secondary education. The nutritional status of adolescent girls could be improved by extending the mid-day meal programme to secondary educational institutions, as some states have done.

Malnutrition should also be understood in the context of women’s work. Childcare enables women to earn a livelihood. Longer working hours for the anganwadi, such as in Karnataka where it runs from 9.30 am to 4 pm, will help women go out to do paid work, including on MGNREGA worksites. Mobile creches for younger children at these worksites and construction sites will help women to work without anxiety about their children’s safety and well-being.

The anganwadi system needs strengthening. Anganwadi supervisors can be supported with interest-free loans and fuel allowance for two-wheelers, enabling them to provide regular guidance to their cluster. Their skills should be upgraded with certificate courses on nutrition and early childhood stimulation. Online training at scale has been the discovery of the pandemic year. Anganwadi workers and supervisors can be supported for professional development through live online sessions on nutrition, growth monitoring and early childhood education.

Anganwadi infrastructure needs attention: Sturdy buildings, kitchens, stores, toilets, play areas and fenced compounds, functional water connections and arrangements for handwashing are urgent imperatives. To cater to multiple meal requirements, anganwadi kitchens need double-burner stoves, gas cylinders, pressure cookers and sufficient steel cooking vessels. Kitchen gardens should be planted with drought-resistant and highly nutritive plants like moringa.

The most effective platform for community action on the ground is the gram panchayat. We often talk of the “last mile” for communication services. The panchayat should be the first mile for social welfare services. There are around 2,50,000 gram panchayats in India, and nearly 14 lakh anganwadis, the majority in rural areas. The anganwadi committee, chaired by a stakeholder mother and including other parents, grandparents and the panchayat ward member, should be a subcommittee of the gram panchayat. It should meet every month on a fixed day, and its discussions should be presented to the gram panchayat for action.

Exclusion and convergence are two major challenges in social welfare programmes. Local governments are the best placed to address the problem of exclusion. They can ensure coverage of the poorest women and children, especially nomadic and semi-nomadic communities, and seasonal migrants such as brick workers and sugarcane harvesters. Panchayats are also the best forum to prevent child marriage and ensure that all girls stay in school.

Convergent action on the ground is one of the strengths of gram panchayats. Anganwadi workers, ASHAs, ANMs and anganwadi supervisors can work together with panchayat members to ensure that all children and mothers are covered with immunisation, antenatal care, maternity benefits and nutrition services. Gram panchayats can use their funds, converged with MGNREGA, to strengthen anganwadis. They can engage women’s collectives under NRLM for anganwadi and school needs, and provide panchayat services such as end-to-end solid waste management, water pump operations, surveys, bill collections and management of fair price shops. Such steps will increase women’s individual and group incomes in sustainable ways. They will also lead to greater social and economic empowerment of women, their participation in local governance, and, eventually, better nutrition for all.

The writer is in the Indian Administrative Service, and based in Bengaluru

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