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Anganwadis of India - Tackling Malnutrition in a Pandemic

Juhi Mandal - Visiting Assistant, Inequalities Program

Picture Credit: The Hindu


‘I have the audacity to believe that people everywhere can have three meals a day for their bodies, education and culture for their minds and dignity, equality and freedom for their spirits.’

- Martin Luther King Jr.


Since the 1970s, India has developed an extensive structure of the Anganwadi system which later proved to be the backbone of the country’s fight against undernutrition. Launched with 5000 anganwadis, this largest mother and child nutrition, and care programme is one of its kind in the world. Today, India has more than 1.3 million Anganwadi centres across the country, which are solely dedicated to ensuring the delivery of early education, health and nutrition services as part of the Integrated Child Development Services (ICDS) scheme. One-third of the world’s stunted children live in India, which is the highest in the world. The ICDS was established with a vision to cater to supplementary nutrition, non-formal early education, immunisation, health check-up, and referral services in a cost-effective way to tackle inequality and raise a generation of healthier adults. Since its inception in 1975, the Anganwadi system in India has impressively expanded its reach. Today, the programme is operational in almost every block of the country, according to the Ministry of Women and Child Development, every community, rural or urban, of 400 to 800 people has at least one Anganwadi center. However, its efficiency and effectiveness remain quite limited; years of analysis on the implementation of the Anganwadi system has revealed the institutional weakness it suffers.


Tackling malnutrition requires a multi-sectoral approach and convergent interventions from the government as well as the civil society. The Integrated Child Development Services began as a small-scale initiative with a goal to feed, educate, and help vulnerable children and their mothers, later turning into the world’s largest integrated child services programs. A year later, after India launched its National Policy for Children, in 1975 with the financial help from United Nations International Children’s Emergency Fund (UNICEF), India launched ICDS intending to improve the nutrition, health, and development of children from birth to age six, monitoring and educating pregnant and lactating mothers, and helping vulnerable adolescent girls and women between 15 and 44. As a matter of fact, India was way ahead of its contemporaries and had already started a cross-sectoral child development programme and made it a piece of primary machinery to eliminate hunger and malnutrition.


As Amartya Sen’s entitlement theory argued hunger from an ‘entitlement approach’ and concluded- “hunger is a case of people not having enough food to eat, but not necessarily of there not being enough food to go around; modern world hunger is a structural problem, it is neither a natural phenomenon nor the product of an unbalanced Malthusian equation”. Undernutrition and malnourishment are conditions perpetuated by structural violence. This condition is inflicted systematically and indirectly by the already prevailing social orders or social inequalities. In the case of India, this particular structural violence is perpetuated along the lines of caste, gender, class, religion and tribal identity. Therefore, addressing undernutrition and malnourishment cannot be viewed from the lens of ‘emergency crisis’ rather the issue requires to be addressed from a structural and systemic point of view.

Picture by the Author

Picture by the Author


Disruptions due to COVID-19 crisis


While the states must recognize that the new Coronavirus outbreak is a serious public health emergency, COVID-19 related food insecurity is an alarming trend. Since 2019, the pandemic has proven to exacerbate the socio-economic inequalities across the world compelling the reassignment of the priorities of the welfare schemes, the already ambitious but institutionally weak programme of fighting undernourishment in India is dealing with various disturbances as well. There is a plausible link between immune health and nutrition health making malnourished children and women prone to the virus and suggesting a higher mortality risk along with the elderly.


The Anganwadi Centers across the country are bound to provide hot cooked meals with eggs to the children of age 3 to 6 and take-home-ration (THR) to pregnant and lactating women under the Supplementary Nutrition Programme of the ICDS. However, the prolonged lockdown is causing a continuous shortage of the food supply. The decentralisation of the ICDS in various states has encouraged the Self-Help groups to take responsibility for the THR, although the lockdown amidst the pandemic has made it impossible for these small SHGs to produce and distribute the THR to the Anganwadi Centers. This has resulted in almost total discontinuation of the THR along with the loss of wages and livelihoods of women entrepreneurs engaged in the SHGs. The disruptions of supply chains due to the lockdowns have resulted in the blockage of hot cooked meals (mid-day meals).


Due to the unprecedented scenarios presented by the coronavirus outbreak, the poultry sector is severely hit in India, affecting the distribution of the primary source of nutrition provided under the Supplementary Nutrition Programme through the Anganwadis. Hence, depriving India of nutritional support has mounted the risk of an increase in the number of severe acute malnourishment in children. The adverse impact on children of constrained access to clinics, social workers, water, and sanitisation can push borderline cases into severe cases of malnutrition, possibly resulting in many malnourished children to experience near-death situations and those experiencing moderate malnutrition could slip into severe malnutrition.

Picture by the Author


The compromised health infrastructure has disrupted the Immunisation Universal Programme, immunization activities have been an important component of National Reproductive and Child Health Programme and is currently one of the key areas under National Rural Health Mission (NRHM) since 2005. The pandemic has caused a kind of ‘vaccination dilemma’, with a high infection rate in the medical professionals, parents of the children are refusing to visit the public clinics, and children are missing out on vaccines and nutrition. There are places where the immunisation activities did not fully stop due to the novel coronavirus crisis, but since many Anganwadi workers are involved with the Covid relief work and Anganwadi Centers are being used as quarantine centers, many children have been left out. However, the migrant exodus from cities to the villages has made it difficult for the Anganwadi workers to track the vaccination records, further jeopardising the health of the already nutrition-deficient newborns and new mothers. The public resources for antenatal and postnatal care, immunisation, treatment of acute malnutrition, among others have been diverted towards the COVID relief work until the time the government exponentially increases its public health capacity.


The Anganwadi workers who were in charge of monitoring and enhancing nutrition among children and women in India are now working as Covid frontliners with the duty of the local level surveillance in the different parts of the country. Many states such as Odisha, Chhattisgarh, Kerala and others have initiated a door-to-door cooked meal service as a supplementary nutrition move since the first month of the nationwide lockdown, and as a result the entire responsibility of the initiative has fallen on the Anganwadis of the nation. The Anganwadi workers and helpers have always been overburdened and underpaid, the added liabilities of the pandemic responses have only increased the concerns for these working women with a mere ‘honorarium’ of 6,500 (lesser in many states) which is even under the minimum wage set by most states (around 300/day).


Conclusion


A significant section of the Indian population, from the low socio-economic backgrounds, depends largely on the mid-day meals for nutrition and dietary support since the adoption of the Integrated Child Development Services, which aids in reducing the protein and calories deficiency in them. Mid-day meals and eggs were the primary source of nutrition for India's 120 million children, just over half of whom get it from the Anganwadis. Amidst the pandemic none of which is reaching the concerned. This food insecurity puts India in a dangerous situation as the chances are whatever slow and steady achievements of ICDS were witnessed in the pre-COVID world, the pandemic has the potential to nullify most (or all) of them. The Ministry of Child and Women Development, in March 2020, initiated a series of interactive awareness sessions/ digital workshops for the Anganwadi workers to update information on antenatal and postnatal care, but the present digital divide in the country has highlighted a hindrance in the process. According to the Telecom Regulatory Authority of India 2018, total internet density in the country stood at about 49 percent, with more than half of the country without internet, the digitalisation of Anganwadis could prove to be counterproductive.


The pandemic and the resultant lockdown has brought higher risks of increased malnourishment and morbidity among the children and pregnant and lactating women. There is a dire need of governments to recognise the vital contribution of the Anganwadi workers and helpers, furthermore when the responses of the pandemic have highly relied upon them making them the frontline workers. There is a need to build upon the existing capacities of the Anganwadi workers as the “new normal” presented by the pandemic requires them to integrate their knowledge, experience and expertise and enhance their technical abilities. However, undermining the existing digital divide while implementing this will only add on to the vulnerabilities and defeat the whole purpose of the initiative.

The ICDS in the ongoing pandemic needs to be resourced better, for which a ‘rights approach can help put the children’s and women’s issue on the political agenda, and to forge new social norms on these issues. A wider acknowledgement of the children’s and maternity issues as a fundamental right can reverse the long standing neglect to the crisis of undernourishment in public policy. The primary role of the rights perspective is to change the public perception of what is due to India’s children. The rights approach while dealing with undernourishment in India can further help in increasing the capacity of women to prosecute malnutrition, abnormal pregnancies and ill health. It is high time that both the central and the state governments give recognition to the Anganwadi workers as healthcare employees with proper training; especially when they are already overburdened as frontline workers and when the country could use additional 1.3 million anganwadi workers in the healthcare workforce during an ongoing healthcare crisis.

Juhi is currently in the final year of Master's in Political Science with International Relations, Jadavpur University and is pursuing a PG Diploma Course on Human Rights and Duties Education. Her work experience largely has been in the human development sector and developmental studies. The extensive educational background she has on Politics and International Relations has inspired her to develop her skills on the areas of Rural Development, Identity Politics and South-Asian Studies.


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