The First 1000 Days Of Nutrition Of A Child: Breaking An Intergenerational Cycle Of Malnutrition

The period of the first 1000 days of an infant’s life (measured from the mother’s pregnancy to the child’s second birthday) is the most critical window to shape a child’s development. Within this timeframe, a child not only undergoes rapid physical growth, but also experiences fundamental brain development that influences their lifelong wellbeing. Much of this development begins even before the child’s birth. This makes adequate nutrition an essential priority in the first 1000 days, as this is the time when nutrition has the greatest impact on growth and future health, the absence of which can stunt aspects of mental and physical development, with lifelong effects.

Malnutrition: A mammoth challenge in India

Unfortunately, the reality for thousands of Indian children and women of reproductive age is that they are struggling with the problem of malnutrition. As one of the worst forms of non-communicable diseases, malnutrition has taken the magnitude of a silent emergency. Looking at children in India under 5 years of age as of 2021, 35.5 per cent suffered from stunted growth, while 32.1 per cent were underweight, according to the Ministry of Women and Child Development. By amplifying the risk of contracting chronic diseases later in life, these forms of malnutrition have created a huge health care challenge for the country.

Causes of malnutrition in India

Malnutrition in India has a variety of causes, with maternal malnutrition being a widespread and multigenerational problem in the country.

Cultural and societal factors are responsible for a significant part of this, disproportionately impacting women. For instance, in many cultures it is common for women to eat last and least, after the men and boys have been fed.
Further, a significant percentage of girls in India marry at young ages, and subsequently give birth relatively early in life. This reignites the cycle of malnutrition as the young, malnourished mothers give birth to infants with lower birth weights, putting the children at a higher risk of developmental problems.

Initiatives to break this vicious cycle

India has undertaken a variety of initiatives to break this cycle of prenatal and infant malnutrition. By assisting young mothers in gaining access to proper nutrition, care, and education, we can enable them to understand and ensure adequate nutrition for themselves and their families, effectively combating the problem at its root. While this solution is simple in theory, it faces a variety of challenges in a country as complex and diverse as India.  In the face of these obstacles, India is expanding the scope of its efforts, as well as partnering with a wide range of stakeholders, to combat malnutrition on the ground. In an effort to make a real and sustainable impact on the lives of people, malnutrition needs to be tackled on three different levels:

Food consumption

Deficiency of essential micronutrients such as iron, iodine, and vitamins (A, B12, D), also known as ‘hidden hunger’ is a key challenge in India. According to the NFHS 4 report, India has the largest burden of iron-deficiency anemia globally, with nearly 59 per cent of children and 50 per cent of pregnant women being anemic. Another major public health concern is the deficiency of iodine, which affects 5 per cent of the population, causing 337 districts across the country to become endemic. In addition to micronutrient deficiencies, access to hygienic, wholesome and nutritious food remains a challenge for various populations and socio-economic groups, especially for children in certain tribal belts of the country.

Programmes and processes

Improper neurodevelopment of children during infancy is a widespread challenge across the country, and it is important to combat the same through educational and assistance programmes. In a country that has a massive 66 per cent rural populace, the implementation of nutrition schemes can be an uphill task, but it is vital to have systems in place that aptly review cases of malnutrition and identify optimized outcomes to encounter the same. Earlier this year, India recorded a major breakthrough in the fight against malnutrition. As a result of the ongoing programmes and improvements in the coverage of health and nutrition interventions, the Global Hunger Index recorded that developmental stunting among children in India has substantially dropped. This is a testament to the positive impact of a multi-sectoral approach, that not only educates the mother but also teaches caregivers, family members, communities and service providers how they can make a difference by maintaining a healthy nutritional balance.

Policy

India has both a societal and a national stake in ensuring that children get a strong start to life. Policymakers in such a vast country can struggle to develop uniform data-driven nutrition policies for the entire state. Thus, dedicated action towards improvement of nutrition during the first 1,000 days must come from a concerted, multi-stakeholder approach, enabling children to reach their full developmental potential and securing a brighter future.

Healthcare professionals across the globe believe that good nutrition for the first 1,000 days is crucial during three particular stages – pregnancy, infancy and toddlerhood. In this period, it is important for the child to receive stable nutrition, a responsive relationship with caregivers and a safe and nurturing environment. In India, this can be achieved by strengthening existing nutrition programmes and schemes. The Indian Government, along with several independent organizations, are working to address the issue of poor nutrition, improving access to and education about optimal nutrition across 500 plus districts in the country.

(This article is authored by Dr Sujeet Ranjan, Associate Director – Nutrition, Tata Trusts)