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Union Government is celebrating Rashtriya Poshan Maah (National Nutrition Month) in the month of September. It is a part of POSHAN Abhiyaan (National Nutrition Mission), which was launched early this year with the aim of reducing undernutrition and anaemia among children, women and adolescent girls at an accelerated pace. The levels of undernutrition in India are unacceptably high. NFHS-4 data shows that in India almost 38.4% children under 5-years of age are stunted (low height-for-age) and 21% wasted (low weight-for-height). There is thus an urgent need to scale-up interventions and programmes relevant for improving nutrition.

Poshan Maah tries to bring focus on nutrition with the tag line of har ghar, poshan tyohar. The initiative is about spreading behavioural change and communication (BCC) messages related to maternal, infant and young child care and feeding practices. It also includes other related interventions such as growth monitoring, anaemia management, hygiene and sanitation and so on.

BCC has remained one of the most neglected areas of nutrition improvement. It has been observed during field visits that while the budgets for Information, Education and Communication (IEC) and BCC are low, even the procured materials remain largely unutilised. Poshan Maah by focusing completely on BCC activities helps to bring these issues to the forefront, which have often been side-lined in the routine delivery of schemes / programmes. It also makes nutrition a common topic of discussion in families. Despite all this, the larger question that remains is whether behaviour change alone, with limited outreach of other requisite measures will achieve its objective of reducing undernutrition in India?

Undernutrition, as is well-know, is a result of complex interplay of factors related to diet, disease, household food security, hygiene and sanitation facilities, access to health facilities and other socio-economic factors. A range of interventions across sectors are thus required for addressing undernutrition. However, convergence across sectors has remained one of the weakest links in addressing under nutrition in the country. Even for Poshan Maah, almost 18 Union Ministries and departments are listed as participants in the initiative spearheaded by Ministry of Women and Child Development (MWCD). However, the role and action plans of most of the Ministries other than some directly relevant ministries such as MWCD, Health, and Information and Broadcasting are not clearly spelt out. In fact this has been the trend in the last few years, where the policies do acknowledge nutrition as multisectoral, but no effort is made on ground to converge actions across departments. For instance, Food and Civil Supplies department plays a vital role in ensuring availability and access to food for people living below poverty line, yet, the department doesn’t find a mention beyond the list of participating departments in the event. Similarly, intake of unsafe drinking water is a leading cause of disease, and hence undernutrition in India; yet we do not see convergent action plans with Ministry of Drinking Water and Sanitation in the month long programme. Thus, inter-sectoral nutrition actions remain an unaddressed issue.

Moreover, the vision governing the activities undertaken in the event remains narrow. The BCC is understood as hand washing, breastfeeding, and care, regardless of the socio-economic view of the problem. While all these are necessary, an important part of IEC is to make people aware of their entitlements (such as those mentioned in National Food Security Act 2013), creating awareness about relevant schemes (such as National Rural Drinking Water Programme, MGNREGA, and others) to propagate the packages these scheme’s offer for child development and maternal health, and to inform them about the linkages nutrition has with factors other than food (such as poverty, safe drinking water, open defecation, etc.). The platform could have become larger and more transformative if it could have done that. In addition, this way the onus for good nutrition wouldn’t have been solely on family and women specifically, but also on the government to ensure adequate and effective delivery of essential services for all. We have observed in our work on nutrition that outreach of nutrition services is often constrained by gaps in service delivery. For instance, the uptake of the health-related interventions are affected adversely by factors such as shortage in supply of nutrition supplements (IFA and calcium), poor quality of testing kits used by ANMs during Village Health and Nutrition Day (VHND), non-functioning weighing machines for monitoring weight, lack of water for hand washing and so on. These factors, along with shortage of staff and infrastructure, further constrain the reach out of the system to the people. Unless the inherent gaps in the public service delivery system, which restrict access of people to services critical for improving nutrition, are addressed, the impact of BCC would be limited.

In conclusion it may be said that while there is a lot of focus on building momentum around nutrition, the exercise remains limited in scope. Although it is important to create a discussion around nutrition and to inculcate habits that will improve nutrition, the issues pertaining to food security, potable water and access to health services need greater attention. The exercise could have been more meaningful if it had been accompanied by regular and quality provision of food through PDS, ICDS, and MDM, drinking water facilities through NRDWP, and so on. But in the absence of simultaneous focus on these, the event seems superficial.

The views expressed in this piece are those of the author, and don’t necessarily reflect the position of CBGA. You can reach Chandrika Singh at chandrika@cbgaindia.org.