Nutrition more than filling the stomach with food: Arjan de Wagt, Chief of Nutrition, UNICEF India
In a conversation with Rashmi Mabiyan, Chief of UNICEF India (Nutrition), Arjan de Wagt, lays strong emphasis on the importance of nutrition and role of the public and private sector in fighting malnutrition.
Malnourishment is 100 per cent preventable yet an estimated 26 million children aged under five years are wasted in South Asia, which is over half of the global burden of wasting. In India, the prevalence of wasting is witnessed highest at birth (37%) which reflects the number of malnourished children and anaemic mothers. In order to reduce this burden, Poshan Abhiyaan and IMPAct4Nutrition have been working towards bringing awareness and improving the nutritional status of children, lactating mothers.
Q. How is Poshan Abhiyaan working towards the fight against malnutrition in India?
I am very happy that Poshan Abhiyaan is a major agenda and the Prime Minister has pushed that. From a technical point of view, the strategies to policies to guidelines, India is doing good. There are very few countries in the world that have got such a comprehensive package of multi-stakeholders, multi-departmental, multi-ministerial policies and strategies that are generally quite sound.
Many countries don’t have any community inclusive strategies, the fundamentals are really there but the challenge is in the benefits reaching the last mile. You are only going to get the results of Poshan Abhiyaan if you have got 100% coverage and 100% continuity.
The quality of the interventions, the counselling that the front-line workers give needs to be good quality counselling. As national and state-level governments, you have to write programmes, strategies which you need to implement 100% C2IQ (Coverage, Continuity, Intensity and Quality).
It has recognised that government can provide services, but in the end, the meal and the food is eaten in the house, so we need communities to be aware of why malnutrition is so important and what they can do about it.
Q. What are the challenges that need to be recognised to fight malnutrition?
The biggest problems in malnutrition are two: one is the nutritional status of pregnant women, we see that a lot of children are born with poor nutrition because the mother had poor nutrition and another part is the tremendous increase in malnutrition from 4 months onwards. It is said that till 6 months you should only have exclusive breastfeeding and only after that you can introduce other foods but many mothers are not practising these.
Important days like the first week of August marks as breastfeeding week however, we need 52 breastfeeding weeks for promotion of breast-feeding. To achieve behaviour change you need to have very intensive communication.
Last year in January, I went on a road trip from Delhi to MP (Madhya Pradesh) where I saw hundreds of ads on fast foods. I saw one public space for breast-feeding which was the only one focussing on good nutrition.
If we can increase the importance of fruits and vegetables then we can create demands but if we don’t have them available then we cannot even create the demand. The stomach of a baby is very small, you may just fill the stomach but miss the nutrients.
It’s all about the intensity of the interventions, people need to be reminded about the importance of nutrition and they need to know that nutrition is more than filling the stomach with food.
Q. Could you elaborate on lack of nutrition causing irreversible damage?
There is not much awareness on the importance of nutrition but in order to grow to your full potential you need the right nutrients. During pregnancy and the first 2 years of an infant, a major part of the brain develops in the first 1000 days of a baby. We know from evidence that if you don’t have the right nutrition or suffer from malnutrition, even your IQ is irreversibly lower. So it is not just stunted length but also stunted immune system and stunted brain development.
According to the Comprehensive National Nutrition Survey 2016-2018 report, children in the poorest wealth quintile were more likely to be stunted (49%), as compared to 19% in the richest quintile.
So, that is really why the education needs to come in so that families and communities know the importance of nutritious food and for behaviour change to happen.
Q. What are the measures that need to be taken towards tackling malnutrition in India?
Under Poshan Abhiyan, the governments are significantly investing in strengthening the system. As per the Comprehensive National Nutrition Survey (CNNS), malnutrition in under-five children states that 35% were stunted, 17% were wasted, 33% were underweight and 2% were overweight.
If we can improve the diet of pregnant women and the feeding of children between 4 to 12 months, it can make a tremendous change. We need to zoom in around these groups around complementary feeding, demonstrate how to prepare the food, how do you mix the different foods that are available to you.
In order to do the service to the children you need to have capacity strengthening and proper monitoring and we are trying to do both at the same time. We need a combination of different behaviour change approaches.
If you combine mass media with community-based events, home visits, asha workers, Anganwadi workers and ANMs, it can help promote the production of household kitchen garden of these nutritious vegetables and fruits.
Mass media doesn’t change behaviour but it reminds the mind and creates awareness. Government can deliver services but the government cannot stop malnutrition, communities need to do that. They have to use the services and improve their diet as there is no alternative.
Q. As nutrition is the best public health investment, how is IMPAct4Nutrition working towards this?
IMPAct4Nutrition is a platform to Mobilise Private Action for Nutrition. The idea is that IMPAct4Nutrition becomes a private sector movement for POSHAN. UNICEF, Tata Trusts, CII, Sight and Life, CSR Box, IPE Global and NASSCOM Foundation came up with this idea. What we are trying to do now is to mobilise companies in three strategic areas, which is referred to as the ACE card:
- Assets and Core Business for Nutrition
- Cash/ CSR for Nutrition
- Employee Engagement for Nutrition
The IMPAct4Nutrition along with the pledged partners (companies), co-develops robust knowledge base for nutrition literacy that companies can use in their ongoing CSR initiatives and employee engagement programmes.
By taking the pledge with IMPAct4Nutrition, companies are committing to make POSHAN Abhiyan a Jan Andolan, a social movement to address nutritional issues in their company ecosystem. With this commitment, the private sector will reach out to employees, their families and customers to spread awareness and improve their knowledge on the importance of nutrition and healthy eating. If we have the companies taking this responsibility it could have a tremendous impact on the nutritional status of the country.