Addressing malnutrition is critical to laying a strong foundation for human development. Optimal maternal nutrition and infant and young child feeding are the most effective set of interventions in reducing child deaths and disease, preventing malnutrition, in determining cognitive development, and in eventually enabling adult life productivity. Specifically, the first 1,000 days of life, i.e., from conception to the first two years of a child’s life, are key as this phase presents a critical window of opportunity in ensuring optimal growth, development, child survival and lifelong health and nutrition. In fact, 80% of brain development takes place in the first 1,000 days of life.
To address the persistent high burden of malnutrition, India has been undertaking several policy and programmatic efforts which include the flagship programme, the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan (launched in April 2018) under the Ministry of Women and Child Development (MWCD). Its overarching goal is to improve nutritional outcomes by focusing on capacity building, improvement of service delivery, community mobilisation and participation, use of technology, and inter-ministerial/inter-departmental convergent planning and review. Additionally, there has been an enhanced focus on documentation of interventions coverage in the first 1,000 days, such as registration of pregnancies, antenatal checkup, and exclusive breastfeeding, as compared to the situation in 2015-16.
Evidence-based interventions are key
Evidence tells us that for bringing about change in nutrition outcomes, evidence-based interventions need to be delivered with high coverage, continuity (over the first 1,000 days of life and across delivery channels), intensity (multiple interactions), quality and equity. The health and nutrition status of women, including the weight and haemoglobin level, age at conception, and levels of multiple micronutrients during periconception period, are critical determinants for the child’s health.
The criticality of preconception care, i.e., care before pregnancy, is acknowledged. In 2018, the Ministry of Health and Family Welfare worked with Maharashtra and UNICEF to introduce the first ever primary health-care innovation programme to promote the health of women during the preconception period, in the Peth and Sinnar blocks of Nashik district, Maharashtra. During the programme, which was completed in 27 months, it was seen that promoting the health of adolescent girls and women not only promotes the health of the newborn but also prevents low birth weight, preterm birth, and newborn deaths. Its success led to it being scaled across several districts in the State.
All such interventions are delivered to the last mile by the network of the frontline work force: Accredited Social Health Activists (ASHAs), Auxiliary Nurse-Midwives (ANMs) and Anganwadi Workers (AWWs), who play a key role in empowering the community on health planning and action. In many geographies, they are the only access point to basic nutrition and other health services. They are critical in promoting healthy practices, providing on-ground support, and improving awareness.
In Uttar Pradesh
For example, during the Poshan Pakhwdaa in March 2022, in a remote village in Uttar Pradesh, all families with children below two were able to overcome age-old fears and misconceptions and get their children weighed at the anganwadi centre after multiple and continuous efforts by the AWWs, supported by the lady supervisor. Mothers and other relatives such as grandmothers and also fathers were enlightened about the benefits of regular weight measurement. Men, especially fathers, also play a very important role in ensuring maternal and newborn health (MNH). They can influence behaviours and good practices around MNH within their households and communities. Studies show that mothers are 1.5 times more likely to receive prenatal care in the first trimester when fathers are involved during pregnancy.
Back to the story. The AWW and the lady supervisor found support in the panchayat pradhan who had organised a community-level meeting a day before the start of the Poshan Pakhwada. All the men, women, AWWs, ASHAs, schoolteachers and community elders were involved to generate awareness on the benefits of weight measurement, early detection of undernourished children and ensure the weighing of all eligible young children.
Also read: The way to tackle malnutrition
Similarly, lady supervisors of a block in Unnao district (Uttar Pradesh) have ensured that AWWs have not only received growth monitoring devices but also been trained to measure and record body weight accurately. Community mobilisation meetings to ensure coverage of all eligible children were also organised.
These stories of change from Uttar Pradesh that have been driven by frontline workers and their supervisors resonate with the joint efforts of AWWs and ASHA workers in a remote village bordering Nepal, who ensure the regular weighing of each child every month to detect deficiencies in early growth.
The momentum for strengthening the nutrition system focuses on regular skilling, supportive supervision and motivation of frontline workers to deliver contextualised, focused and quality nutrition and health services. These along with data-driven reviews must be prioritised and sustained at the programme level. Because of their deeper understanding on the issues and needs at the grassroots level, their contribution to community health is much more. It is crucial to empower our frontline workers who are driving change at the last mile.
Dr. Dinesh Baswal is Lead MNCH and Chief of Party Saksham MNCH Accelerator supported by USAID (South Asia Hub). He is also former Deputy Commissioner Maternal Health, Ministry of Health and Family Welfare
