India’s nutrition crisis needs urgent remedies

The pandemic has hit the vulnerables in India quite hard, leading to a decline in incomes, rising unemployment and nutrition also.

India’s nutrition crisis needs urgent remedies

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• The story: The Covid pandemic has hit the vulerables in India quite hard, leading to a decline in incomes, rising unemployment and the nutritional shortfalls affecting children and women the most. These are problems with potentially long-term implications.
• The fat and the rest: India’s paradoxical nutritional landscape is one where obesity ails India’s ultra-rich upper-class residents and malnutrition makes those at the bottom of the pyramid suffer.
• NFHS: The fourth National Family Health Survey (NFHS) indicated how 53.1% of all women age 15-49 were anaemic. A high rate of undernourished mothers results in low-weight, poorly nourished babies and infants, whose in-utero lack of nutrition can have lifelong consequences. Twenty one percent of all children under 5 years remain unproductive or wasted (with low weight-to-height), as per India’s child wasting statistics.
• PMMVY: In 2017, having recognised this problem, the government launched the Pradhan Mantri Matru Vandana Yojana, a centrally sponsored (CSS) conditional cash transfer scheme. Under it, pregnant women and lactating mothers are entitled to Rs 5,000 for their first live birth subject to fulfilling certain conditions.

1. The cash incentive is paid in three instalments with the first Rs 1,000 being awarded on early registration of the pregnancy at an anganwadi centre (often with the help of an Accredited Social Health Activist or ASHA worker). Once the beneficiary receives at least one ante-natal check-up, they become eligible for the second instalment (of Rs 2,000).
2. The Union government further complements this scheme with the Pradhan Mantri Surakshit Matritva Abhiyan that offers free, universal antenatal care to all pregnant women. The final instalment (Rs 2,000) is paid after the birth and immunisation of the child. Between the fiscal years of 2018 and 2020, almost 1.75 core eligible beneficiaries were paid Rs 5,931.95 crores.
3. By tying the cash-transfer to conditions, the government hoped to incentivise mothers to engage in undertaking basic (self) maternal and childcare. Meanwhile, the money provided offers financial support for the soon-to-be-mothers to meet their nutritional requirements.

• Implementation troubles: The grassroot implementation of schemes is riddled with flaws. The efficiency of conditional cash transfers is hit by high administrative cost due to factors like identifying eligible beneficiaries, targeting and monitoring the disbursements made to them, and ensuring that intended goals are met with a given scheme’s actual implementation.  Complaints about delayed payments of “assigned transfers” have risen since 2020.
• Foodgrain but not nutrition: The focus since March 2020's pandemic has been only on providing public distribution system-supported food grains to the very poor and not supporting that with more funding for existing nutrition-focused welfare programmes. Similarly, due to fiscal constraints, some schemes are getting merged, leading to effectively low layouts (e.g. the Pradhan Mantri Surakshit Matritva Abhiyan clubbed with other programmes under Mission Shakti for women’s protection and empowerment).
• Deterioration of regular services: During the pandemic, many maternal child health and nutrition progammes were suspended, with regular health services like antenatal check-ups, immunisation, and child-growth monitoring being terminated for respondents across the state (much like the situation across the nation). ASHA workers, anganwadi workers, and nurse midwives conducted counselling sessions online and provided supplementary tablets and contraceptive devices during house visits, but their services too were constrained due to administrative delays and shortage of tech-abled resources (most workers didn’t even have a smart phone for use).
• Summary: Conditional cash transfers have limited effectiveness during times of crisis. Schemes like the Pradhan Mantri Surakshit Matritva Abhiyan are already troubled with bureaucratic overload and over-centralisation in processing of claims. A renewed focus on improving community healthcare access is now needed.

 

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