2 School Feeding Programmes in India

Children's undernutrition is a hidden issue that weakens the power and potential of societies by preventing people from reaching their full potential. India is home to almost a quarter of the world's undernourished youngsters. 1 Stunting, wasting, and underweight are the three primary signs that are frequently used to measure undernutrition in children. However, 37% of children under the age of 5 in India continue to be stunted, according to NFHS IV statistics, despite some improvement in child nutrition status over the past ten years.

Girls, women, and children are the primary targets of nutrition interventions in India because they are at vulnerable ages. For children's future growth and development, appropriate nutrition throughout the first two years of life is considered crucial. Adolescence is a vulnerable time for girls in particular. Nutrition education and treatments can be used to treat low BMI and anaemia in teenage girls. The survival and well-being of the unborn children depend on the general health and nutritional state of pregnant and nursing women, the third significant group.

In India, the number of undernourished children has decreased during the past 30 years. A 50% decrease in severe undernourishment was seen from 1975–1979 to 2004–2005. Additionally, throughout this time, oedema and marasma, two clinical indicators of nutritional inadequacy, decreased. In absolute terms as well as in comparison to other nations, the overall levels of child undernutrition continue to be very high. The majority of the world's undernourished youngsters reside in India (less only than Nepal and Bangladesh). India has twice as many underweight children as sub-Saharan Africa, at about 60 million. India's 2010 child mortality rate was 63. 63 kids passed away before turning five. This resulted in a staggering number of child deaths in 2010—16, 96 000, or 22% of all child deaths worldwide. An alarming nutritional situation for children in India was exposed by the results of the third National Family Health Survey (NFHS). In the age group of 6 to 35 months, the percentage of anaemic children increased from 79.2% in 2005-2006 to 74.2% in 1998-99, whereas the percentage of underweight children slightly decreased to 45.9% in 2005-2006 from 47% in 1998-99. It was discovered that six states—Bihar, MP, Rajasthan, UP, Maharashtra, and Odisha—accounted for 80% of the malnourished children in India.

The maternal and child nutrition characteristics have improved recently, according to data from the National Family Health Survey 4 (NFHS-4). 37 percent of children under the age of five are stunted, according to NFHS-4 statistics for 15 states, a drop of barely five percentage points over ten years. The worst afflicted states are Bihar and Madhya Pradesh, where 48% and 42% of children are stunted, respectively. From 39 percent to 34 percent, the percentage of underweight children has decreased slowly, with Bihar and Madhya Pradesh once again suffering the most. Improvements have been made in the area of child wasting (low weight for height). The new data reveals that the percentage of wasted children in the states for which data are available has decreased by more than half in the past ten years, from 48% to 22%. The percentages of adult males and females with BMIs below normal have also decreased.

Selected state-level information from the 2013–14 Rapid Survey on Children (RSOC), which was carried out by the Ministry of Women and Child Development and UNICEF. Some states stand out for having much higher rates of stunting in children under the age of five. These states include Gujarat, Madhya Pradesh, Uttar Pradesh, Meghalaya, Odisha, Jharkhand, Madhya Pradesh, Chattisgarh, and Uttar Pradesh.

A paradigm created by UNICEF (see image below) suggests that a number of social, economic, political, and environmental variables contribute to the persistence of mother and child undernutrition in developing nations (Black et al 2008). While specific health and nutrition programmes obviously play a crucial impact, eliminating poverty and inequality would also reduce undernutrition (ibid).

The "Barker Hypothesis" is a widely accepted theory concerning the causes of adult diseases, including cardio vascular illness and diabetes, and it suggests that poor maternal nutrition status affects foetal development and results in "foetal programming"—permanent metabolic abnormalities.

"A baby's susceptibility to chronic diseases in later life depends on the nutrition it receives from its mother and how exposed it is to infection after birth." The developmental origin of health and diseases (DOHD) theory contends that the welfare neglect of mothers and infants is to blame for the poorer health of people in specific socioeconomic classes living in more underdeveloped regions of the world.

In India, undernutrition among children is significantly influenced by gender. Due to their unique needs during adolescence, pregnancy, and nursing, women are particularly affected by undernutrition. The cycle of poverty is perpetuated when undernourished mothers give birth to undernourished children. Women's lack of autonomy creates obstacles in the way of their being able to properly care for themselves and their children. 4 Therefore, one of the top development priorities in underdeveloped nations is the health and nutrition of adolescent girls, pregnant women, and infants.

A better diet for women and girls could avoid impaired foetal growth. Improved child survival and development, lower maternal mortality, and a reduction in the occurrence of chronic diseases in adults are all benefits of better nutrition for girls and women. Therefore, moms are the primary audience for public health programmes that use food- and energy-based supplements.

Undernutrition in mothers is a problem around the world. Less than 18.5 Kg/m2 on the Body Mass Index (or BMI) scale denotes maternal undernutrition. Due to the high prevalence (40%) of mothers with low BMI, countries like India, Bangladesh, and Eritrea have been classified as crucial (Black et al 2009). To assess a child's nutritional status, anthropometric indices based on age, height, and weight are used. The following three universally accepted indicators are used:

• 1) Height for Age, where low scores indicate stunting; 
• 2) Weight for Age, where low scores indicate wasting; and 
• 3) Height for Weight, where low scores indicate underweight. 

Stunting is thought to be a cumulative sign of malnutrition starting at birth (or conception). Wasting is a sign of inadequate nutrition in the near term. A more complete indicator that includes both stunting and wasting is underweight. Childhood stunting or wasting is linked to poor health, reduced cognitive function, and increased mortality. Populations with high rates of stunting or underweight individuals are indicative of long-term nutritional malnutrition.

There are two sources of anthropometric information for kids in India. The National Nutrition Monitoring Board (NNMB) in Hyderabad has weight for age statistics broken down by state going back to the 1970s. In 120 villages, 20 homes are included in the NNMB survey (operational in only 9 states). The other source of child anthropometric data is the National Family Health Survey (NFHS), which has been done in four rounds to far (1992-1993, 1998-1999, 2005-06, and 2014-15).

High levels of vitamin and mineral deficiencies still exist in the majority of poor countries. Children who are frequently anaemic may experience delays in cognitive and motor coordination, increased susceptibility to illnesses, and problems in their academic performance. Low amounts of vitamin A lead to weakened immunity and shorter life spans.

If implemented on a national level, the following interventions are thought to be highly effective in addressing maternal and child nutrition: "timely initiation of breastfeeding, exclusive breastfeeding for the first six months of life, introduction of complementary food at the proper time, age-appropriate food for children from six months to two years, full immunisation, vitamin A supplementation, de-worming, therapeutic feeding for children with severe acute malnutrition."

The program's overarching objectives include enhancing the nutritional and physical well-being of young children under the age of six, as well as pregnant and nursing mothers. ensuring the child's social, physical, and psychological growth. lowering the prevalence of death, disease, hunger, and dropout rates. Along with educating mothers about how to meet their children's nutritional and health needs, ICDS also organises the implementation of policies across pertinent ministries and agencies. The programme is coordinated by the Ministry of Women and Child Development (WCD). To assess and track the effectiveness of the programme, the Ministry collaborates with the state governments. Panchayats have been actively involved in implementing and overseeing the plan since 1992 (when the 73rd amendment was passed).

The ICDS is co-funded by the federal and state governments. The programme integrates health, education, and nutrition intervention as part of its multi-sectoral approach to children's wellness. At the local level, it is carried out by a network of "anganwadi centres" (AWCs). According to the ICDS, there must be one Anganwadi centre for every 1000 people and one for every 700 persons in tribal areas. The AWWs and AW personnel are under the supervision of the Child Development Project Officers (CDPO) at the block level, while the CDPOs are under the supervision of the District Program Officers. In recent years, a number of issues with the plan and execution of the programme have been brought up. The ICDS continues to be a top-down programme with little community ownership or effort. With inadequate coverage in more underdeveloped states, it receives low marks on the equity and efficiency scale. The youngest children are not given enough attention when providing services (0-3 year olds).

Food leakage and erratic supplies are widespread. Poor infrastructure, such as a lack of restrooms, a staffing shortfall, and insufficient supplies of textbooks and immunizations, plague the AWC. Other design-related issues include the ICDS program's increased focus on food security, which results in less attention being paid to other interventions that can improve child nutritional outcomes, like improving childcare practises (practises around breastfeeding, weaning, and diets) and household food budgeting. The nutritional status of children can also be improved by other non-food treatments such disease prevention and control, micronutrient supplementation, and child growth monitoring. The causes of malnutrition are multifaceted. However, the current emphasis on improving food security through supplemental nutrition programmes is excessive.

The provision of a daily meal at schools is widely recognised as an excellent method for encouraging low-income students to attend class, pay attention, and perform better. In addition to promoting better nutrition and access to education, school lunches also help students focus better, which improves academic performance. 8 The largest school feeding programme in the world is called the MDM plan. It is in use in every state in the union and reaches 120 million kids in 1.2 million schools. The school feeding programme, started in the 1980s by various states (Gujarat, Kerala, Tamil Nadu, and Pondicherry), is where the programme got its start. The National Program of Nutritional Support to Primary Education (NP-NSPE), a federally funded programme that will serve 2408 blocks, was introduced in 1995. All students in classes I through V attending public, government-aided, local body, and EGS and AIE centres were included in the scope of MDM beginning in 2002. The programme has been updated since 2007 to include students in upper primary classes (VIVIII). New food standards have been implemented over time, and funds have been allocated more generously for things like paying the cook's wage, delivering grain, paying for cooking fuel, and building a clearly defined cooking area inside the schools.

The MDM programme is justified by three arguments. The MDM teaches kids to eat together and break down caste barriers, which is the first aspect of equity. The second is nutrition, and the third is education because MDM encourages increased school enrollment, improved academic performance, and consistent attendance at the classroom. Numerous experts have emphasised the MDM's multifaceted potential benefits (see Dreze and Goyal 2003). These include putting an end to classroom hunger, promoting schoolchildren's healthy growth, increasing the amount of calories and protein they consume, giving them access to essential nutritional supplements like iron and iodine, and providing opportunity to start mass deworming. In addition to providing nutritional advantages, the MDM can promote greater social fairness by encouraging children from various caste groups to eat together, eliminating gender differences in consumption, and providing financial assistance to lower-income families. An improvement in disadvantaged children's and girls' school attendance is one good effect that has been noted. In Rajasthan, empirical studies likewise discovered a large rise in enrollment rates in disadvantaged areas soon following the implementation of mid-day meals. Additionally, there is mounting evidence that the programme improves younger kids' attendance at school. MDM offers jobs to women from disadvantaged sectors in certain states. The program's implementation is impacted by the fact that state budgetary allocations vary from state to state.

The MDM scheme has undergone numerous adjustments since 2006, and there is uncertainty regarding the program's objectives. The universalization of primary education is a stated goal of MDM. Lack of connections with the Ministry of Health and Family Welfare, a lack of data on the effectiveness (e.g., whether MDM has decreased chronic hunger or malnutrition among school-aged children), and widespread inconsistencies in the distribution and consumption of food grains are further issues. The primary areas of concern continue to be a lack of funding to pay cooking expenses, delays in budget distribution, and inconsistent food quality delivered in different states that deviates from established guidelines. If sanitation is not upheld and the quality of the components is not guaranteed, midday meals could constitute a health threat. Dreze (2004) contends that an institutional foundation is necessary to guarantee the protection of children's fundamental rights to nourishment, health, and education. As a result, the mid-day meal is a crucial social protection tool that may uphold these rights by ensuring that kids attend school or anganwadi centres.