PCI India

Impact of Lockdown on Malnutrition among Children: A view from Anganwadi Centres in Delhi

Srishti Mehta

Early Child Development has been recognized as an essential tool for ensuring the healthy growth of the child. It involves the physical, cognitive and motor development during the early years, which is paramount for extracting the full potential of a child as the maximum development of the brain occurs in these years only. Inappropriate nutritional intake leads to dire consequences like hampering the physical and cognitive development process, affecting health, etc. Many diseases and morbid conditions have been described to result from nutritional deficiencies. Nutritional deficiency in childhood leads to increased risk of impoverished health status in adulthood. Not only this, lack of nutrients in childhood creates a vicious cycle. The hampered growth process in undernourished children adversely affects their learning abilities in childhood which impacts their earning opportunities in adulthood that further deteriorates the nutrient intake status of them and their families. According to NFHS4, there were around 32.3% stunted, 17.1% wasted and 27% underweight children in Delhi in 2015-16. The prevalence of anaemia among children under 5 years was alarmingly high at 62.6%.

To cope with the issue, the Ministry of Women and Child Development launched ICDS in 1975 intending to improve the nutritional status of children below the age of 6 years and provide them with primary healthcare. The scheme led to the establishment of Anganwadis that cater pregnant women, lactating mothers and the children in the age group of 0-6 years with supplementary nutrition. The primary aim of the scheme is to ensure comprehensive development of the children. Several services are provided under the scheme- immunization, preschool in formal education, health checkup, supplementary nutrition, referral services and nutrition and health education.

There are around 10,897 Anganwadi centres in Delhi that serve approximately 6 lakh children and over 1lakh women across the nine districts. The Anganwadi centres (AWCs) are established to provide a cooked meal to children to pregnant women and lactating mothers. A major proportion of the beneficiaries of this scheme are from the low socio-economic background. Thus the supplementary nutrition provided by AWC is the only source of nutrition they have. This intervention by AWCs helps in bridging the gap of calorific value between their average daily intake and the recommended dietary allowances. Establishment of AWCs is one of the crucial initiatives that have been tackling the problem of malnutrition in India for the past 45 years.

In the past few months, the outbreak of Covid-19 has led to severe public health concerns across the globe. The spread of the Virus and the corresponding consequences has created a storm of terror throughout the world. As a precautionary measure, the Government of India has decided to impose a nation-wide lockdown, that led to even closing down of all the AWCs. The national capital territory of Delhi also decided to suspend the activities of 10,897 Anganwadi centres. As a result of this, lakhs of children, especially belonging to low-income communities, are now more prone to malnutrition and thus have more chances of getting infected by communicable diseases. The Coronavirus pandemic has adversely affected the functioning of regular health services.

The Anganwadi Workers (AWWs) are supposed to register all the pregnancies and birth in the given area. Along with this, the responsibility of preparing immunization schedules and ensuring timely vaccination of every child of the area lies with the AWWs. But, the pandemic induced lockdown of AWCs has completely disrupted these schedules for over many months, not only in Delhi but in all states. This has led to delayed immunization of many children while some are entirely left. Moreover, it has been seen that the AWCs have been used as quarantine centres, and the AWWs are involved in Covid-19 related works. Because of this, many parents have refused to take their children there for vaccinations, and thus they have been overlooked from getting an immunization.

Not only immunization, but the pandemic also triggered lockdown has obstructed the nutritional services of AWCs as well. Since AWCs are closed down; the supply of nutritional supplements to the beneficiaries under the ICDS has come to a stop. Because of this, the AWWs are also worried about an increase in child malnutrition in the wake of no supply of rations from AWCs. As a response to this, the Department of Women and Child Development has decided to provide dry ration to the beneficiaries, called Take Home Ration (THR). Under this, each child beneficiary is entitled to 1,300gm of Dalia, 260gm of black gram (raw), 130gm of jaggery and 130gm of roasted black gram. Each pregnant woman gets 1,690gm of Dalia, 260gm of black gram (raw), 130gm of jaggery and 130gm of roasted black gram (a report by Hindustan Times, published on 11th).

However, this initiative of THR is also falling short in tackling the challenges of the health of nutrition among children. Many beneficiaries are not able to receive the THR because of migration and reverse-migration. Even if some beneficiaries are getting the THR, it is being divided/shared among all the family members, as many people lost their jobs due to the lockdown. As a result, inadequate nutrition is available for the targeted sector, i.e. children, lactating mothers and pregnant women. All these together are putting a terrible impact on the health of infants and in-womb babies as they are not getting the required nutrition.  

It has been observed and also reported by many AWWs that the supply and the quality of the THR packets have been erratic and grossly inadequate. Taking an instance of an AWC in southeast Delhi, which is entitled to receive 40 packets of each item given in THR, only 15 packets reached. The AWWs are thus left with no other option than to distribute them randomly. Also, the frequency of receiving packets is very disturbed. As per a report by The Indian Express, the pandemic triggered lockdown has led to approximately 4 lakh additional cases of wasting (low weight for height) and over 4.1 lakh cases of underweight (low weight for age) children among the poorest households of the country.

The pandemic has not only created problems for beneficiaries but also for the AWWs. They have been employed in the work of Covid-19 surveillance and door-to-door visits to beneficiaries at the same time. However, they are not provided with adequate safety measures in terms of masks, gloves, sanitizers, etc. They have pay for these on their own. Not only this, the underpayment of these workers is adding to their misery. They are paid minimal wages with no or minimal incentives in terms of honorariums. This further reduces their motivation to visit fields for providing ration and immunization to the beneficiaries in these challenging times.

The most significant impact of this disruption would fall on the health and future prospects of children. The lack of sufficient diet will make children highly vulnerable and more prone to different childhood diseases. Moreover, the pandemic has made previously routine vaccination a daunting challenge. The delayed vaccination would reduce the effectiveness of the dose and also place the children at greater risk of being infected with various communicable diseases. According to an executive of UNICEF, the deterioration in vaccine coverage is threatening the lives of children, and this trade-off of one health crisis for another should be stopped urgently. As a consequence of inadequate nutrition and delayed immunization, there would be a surprisingly large increase in the number of malnourished cases in Delhi, leading to high child mortality rates.  Many AWWs have already reported that the lockdown has started worsening the situation of malnutrition among children in the state.

In view of this, the Chief Minister of Delhi and other ministries and departments are formulating policies and interventions to curb the loss of nutrition among children due to lockdown. One such initiative is taken by the Delhi Commission for Protection of Child Rights, under which a Child Protection Committee has been constituted and also a helpline named as ‘Sehat Evam Poshan Saathi’ has been launched. The helpline was launched with the view to handle the grievances of beneficiaries under the ICDS and PMMVY schemes. Since the primary aim of the Commission is to protect the rights of every child in Delhi, the helpline is the first-ever initiative taken in the country, having the objective of providing health and nutrition to the infants, lactating mothers and pregnant women. Along with this, the committee members are trained for supporting the work undertaken in AWCs and thus will act as a bridge between the AWWs, the beneficiaries and the concerned authorities. This will make sure that all prospective beneficiaries get their due nutrition and vaccination on time.

There is an increasing need for the concerned departments to look into the matter and undertake the required initiatives. In the absence of immediate actions, the rising numbers of malnourishment among children would put Delhi and thus India many years behind. The need of the hour is to give equal priority to the nutrition of children during the Covid-19 outbreak; otherwise, the already made efforts for reducing child morbidity and mortality would suffer a major setback. Furthermore, there is an urgent need to recognize the efforts made by AWWs for fighting against malnutrition and Covid-19 and therefore, more attention should be given to their safety and working conditions by the state and central governments at the same time.

The exact impact of the lockdown on the health and nutritional status of children in Delhi could only be measured once the AWCs reopen and become functional again to record and analyze the weight and height changes of children during this period.

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