Children and the pandemic
Disruption in health services, suspension of mid-day meals, use of ASHA workers for COVID-related activities could aggravate India’s malnutrition problem.
COVID-19 has changed the way we have been taking all that is precious to us for granted. It has not only made the world pause, reflect and rearrange priorities in life, but has made many of us aware of our privileges and shown us a mirror to how we react to human sufferings as a society. While we come to terms with the COVID-induced changes one cannot comprehend the damage that the pandemic will inflict on children, albeit indirectly. Since the outbreak, the world has focused its attention acutely on the higher fatality rate the virus has caused among the elderly and launched a scientific enquiry on why children have emerged relatively unaffected. But amidst decoding this mysterious eccentricity of the virus, what has escaped our attention is the long-term damage the cascading effect of COVID-19 is likely to cause in children — through inadequate health services, broken medical supplies, interrupted access to nutritious food and income loss in families.
The long-term impact of the pandemic on economic and social systems remains invisible, but experts have begun to caution with worrying forecasts. Drawing from a recent Lancet study, the UNICEF has warned that three lakh children could die in India over the next six months due to disrupted health services and surge in child-wasting, a form of malnutrition when the child is too thin for his/her height. India is expected to bear one of the heaviest tolls of this preventable devastation, partly because its record in managing malnutrition among children was grim even in pre-COVID-19 times. India is home to half of the “wasted children” globally, reckons the recently launched Global Nutrition Report 2020. More than a third (37.9 per cent) of our children under-five years are stunted, and over a fifth (20.8 per cent) are wasted, the report adds. These rates are significantly higher compared to average prevalence in developing countries, which stand at 25 per cent for stunting and 8.9 per cent for wasting. Furthermore, even the National Family Health Surveys (NFHS) data shows that in the decade up to 2015, children suffering from severe acute malnutrition grew to 7.5 per cent from 6.4 per cent. Separately, Observer Research Foundation reports that with 15 per cent of the total population in the “hungry” bracket, India is one of the most undernourished regions in the world.
This nutrition insecure backdrop of India makes it dangerous to live through an extreme adversity like the current pandemic without proper planning for protection of our vulnerable population. Past few weeks, the entire country has been in lockdown mode to contain the infection which has brought economic activities to a complete standstill and resulted in income losses. Mid-day meals, the main source of nutrition for millions of children had to be suspended with schools shut, and congregations banned. Some states are trying to substitute it with dry ration but sharing of food by other family members in such trying times cannot be ruled out.
Overall health outreach services have been disrupted amid the panic the virus has triggered. Services of our front-line workers, the ASHAs and Anganwadi workers, had to be diverted for COVID-19 surveillance activities. Considering that they have been the lifeline of government’s nutrition programmes, this is bound to result in neglect of children and their nutrition status.
The highly infectious nature of the virus has prompted decisions that have caused serious economic distress, particularly to those dependent on daily wages to survive. Vulnerable groups have been further pushed to poverty. Children belonging to poor households face the highest vulnerability in terms of physical growth and brain development at crucial stages of their life because of highly compromised, untimely, and unhealthy meals, poor dietary intake and weakened immune system. Hence, pregnant or lactating mothers, infants and young children need protection not just from the virus, but from a lack of healthcare facilities, inadequate diet and misinformed breastfeeding practices.
Even as lockdown regulations ease and essential healthcare including antenatal care services slowly start resuming, the pandemic has already led to severe adverse consequences for mothers and children, particularly those facing socio-economic disadvantages. To restore efficiency in the system, special rations, including nutrients like protein, good fats, vitamins, essential minerals with less sugar, need to be made readily available on an urgent basis for mothers and children, so that their weakened immunity is boosted to fight deadly infections.
Government silos are abundant with 71 million tonnes of rice and wheat, recently there were images of pulses rotting in godowns that went viral. It is important to mobilise resources to increase the access of people to a diversified diet. Nutrition programmes like the Integrated Child Development Services (ICDS), mid-day meals, and anganwadi centres should continue to work as essential services and provide rations and meals to beneficiaries’ homes. States need to innovate strategies to support marginalised workers and ensure access of food at people’s doorsteps. As the numbers of vulnerable are set to soar, the country needs to expand preventive coverage of access to food and pre-empt a hunger crisis.
Post the pandemic, new strategies will have to be planned out for strengthening community-based management of acute malnutrition. Structural reforms of the Nutritional Rehabilitation Centres (NRCs) will have to be considered along with a ready workforce that has to be trained to fulfil the needs of the population during and post-pandemic. This will ensure access to nutrition services for women and children, improving their health.
The battle ahead is full of grave challenges. Properly planned, sustainable, inclusive polices and relief measures need to be implemented with an efficient, skilled and motivated workforce on the ground with seamless coordination between the Centre and states. Post pandemic, we shouldn’t have to live with this one regret — that the preventable damage surpassed the damage that was unpreventable.
Source: Indian Express, 18/06/2020
