A third of women of reproductive age in India are undernourished , with a body mass index (BMI) of less than 18.5 kg/m2 . It is well known that an undernourished mother inevitably gives birth to an undernourished baby, perpetuating an intergenerational cycle of undernutrition.
Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low birth weight babies , perpetuating an intergenerational cycle.
This cycle can be compounded further in young mothers, especially adolescent girls who begin childbearing before they have grown and developed enough. When mothers take only short intervals between pregnancies and have many children, this can exacerbate nutrition deficits, which are then passed on to their children.
Accelerating efforts to improve maternal nutrition
While it is globally acknowledged that focusing on the first 1000 days of a child’s life – from conception to two years of age – is a critical window of opportunity to address child stunting.
However, to date, the focus of nutrition programmes for Indian children has largely been post-birth, with child and feeding-centred interventions. It is known that 50 per cent of the growth failure that gets accrued by two years of age occurs in the womb owing to poor nutrition its mother both during pregnancy and before pregnancy..
There is sufficient knowledge base that foetal stunting is largely caused by inadequate nutrition of the mother before conception and in the first trimester.
The major reason for stagnant levels of undernutrition among Indian children is because of a failure so far to adequately prevent undernutrition when it happens the maximum i.e., in the womb - caused by poor nutrition of women before and during pregnancy.
Given this, women’s nutrition – before, during and after pregnancy – has now been included as a special focus area in UNICEF India’s nutrition programming. The organization now aims to give added focus to universalize the coverage of five essential nutrition interventions for women which have been arrived at based on global and national consensus.
The 5 Essential Nutrition Interventions for Mothers
Arrived at through national and global consensus
1.Improving the quantity and nutrient level of food consumed in the household
•Access to generalized household food ration through public distribution system(PDS)
•Access to f supplementary foods under the integrated child development services scheme
•Access to knowledge to improve the local diet, production and household ehaviours through nutrition and health education.
2.Preventing micronutrient deficiencies and anaemia.
•WIron Folic Acid Supplementation deworming
•Pre and peri-conceptual folic acid supplementation
• Universal access to iodized salt
•Malaria prevention and treatment in malaria-endemic areas
•Access to knowledge and support to stop use of tobacco products during pregnancy
•Maternal calcium supplementation.
•Maternla vitamin A supplementation
3.Increasing women’s access to basic nutrition and health services.
•Early registration of pregnancy
•Quality of antental natal check up, with emphasis on pregnancy weight gain monitoringScreening and special care of at-risk mothers
4.Improving access to water and sanitation education and facilities:
•Sanitation and hygiene education, including menstrual hygiene.
5.Empowering women to prevent pregnancies too early, too often and too close together:
• Ensuring marriage at/after legal age of 18 through awareness and ensuring a girl completes secondary education
• Prevent maternal depletion by delaying first pregnancy and repeated pregnancies through family planning, reproductive health information, incentives and services
• Promoting community support system for women, skill development, economic empowerment
•Ensuring marriage at/after legal age of 18 through awareness and ensuring a girl completes secondary education and cash transfer
•Methods to prevent maternal depletion through family planning, reproductive health information, cash tranfers, and services
•Communitsupport system for women to support decision making, confidence building, skill development and economic empowerment.
UNICEF In Action
UNICEF India has also been at the forefront of strengthening coverage of existing nutrition interventions for women in flagships through policy, advocacy and system strengthening strategies.
More recently, it has also generatedingresearch evidenceon the barriers and opportunities that exist to universalizing the coverage and quality of the five interventions. Importantly, given the linkages of women’s nutrition with poverty alleviation, women’s empowerment and food security, two innovations are underway.
Firstly, a partnership has been established with the “Aaajevika” programme of the India government’s National Rural Livelihood Mission to test whether women’s nutrition initiatives can be mainstreamed through women’s empowerment platforms under “Aaajevika”.
Secondly, UNICEF in Andhra Pradesh and Telengana is technically supporting the state government to implement the One Full Meal Scheme . The programme aims to improve the nutrient intake of pregnant women and breastfeeding mothers, and reduce the prevalence and severity of maternal anaemia.
In Andhra Pradesh and Telangana, 5100 women federations, supported by Aajeevika and UNICEF, partner with State Governments to provide 895,000 pregnant and lactating mothers nutritious meals daily through 'ONE FULL MEAL' scheme, located in villages where undernutrition rates are high.
One Full Meal entitles pregnant women and breastfeeding mothers to receive a free nutritious meal every day between 11am and 2pm at the village Anganwadi centre, 25 days a month. More than 5,100 federations of women’s self-help groups have been engaged to support the implementation of the scheme. Each ICDS project gives a quarterly grant to the federations that are involved in the implementation of the programme.
At the policy level, UNICEF has been the lead agency supporting the Ministry of Health and Family Welfare to develop the country’s maternal calcium and deworming guidelines.