On a warm summer day, I met Surekha at an Anganwadi Centre in Chhindwara district, Madhya Pradesh. Surekha had recently given birth to her third baby. After resting for a week, she was back in the cotton fields, working as a daily wage labourer. The cracks of her palms and feet were filled with mud as she entered the Anganwadi Centre during her lunch break. While talking to her, I learned that all her three children were falling into different stages of malnutrition, including her newborn who was only 2 kilos, weak and malnourished.
The Anganwadi Worker (AWW) had identified Surekha’s older two children as Severely Acute Malnourished (SAM) and the third child as Moderately Acute Malnourished (MAM) after weighing them. I saw the confusion Surekha felt while listening to these words. She was trying hard to make sense of the phrases SAM and MAM, but to this mother who struggles every day to make ends meet, correcting an invisible illness seemed like a futile effort.
Surekha’s story mirrors the fact that the burden of malnutrition in India is unevenly distributed, and is directly associated with gender, caste, and class inequalities in this country. However, in tribal areas of rural Madhya Pradesh where The Antara Foundation (TAF) mainly works, issues like early pregnancy, severe anaemia, home delivery, and malnutrition coexist. The houses in these areas are often dispersed and located far away on hilltops, with limited access to healthcare services. Consequently, the vulnerable sections of society, especially women and children, bear a greater risk of being malnourished.
Many studies have shown that undernutrition during childhood deprives the body of essential nutrients. It also leads to low immunity, which could significantly reduce the capacity of the body to fight various infections, making them more susceptible to diseases. This becomes an intergenerational cycle. When an undernourished girl reaches reproductive age (still undernourished), she inevitably gives birth to an undernourished baby. The risk also expands to child and maternal mortality.
Madhya Pradesh (MP), is one of the states with a high prevalence of anaemia, wasting, and stunting in children (NFHS-5). The marking of Poshan Maah (Nutrition Month) in September every year, tries to address such nutritional challenges. The MP government recently issued guidelines on the effective implementation of ‘Poshan Abhiyaan’, an initiative by the central government to increase the nutritional outcomes of India’s mothers and children. A diverse set of activities are conducted during this month by the local functionaries at the village level (typically in an Anganwadi Centre). The topics of discussion include all the aspects of antenatal and postnatal care, anaemia, malnutrition, complementary feeding, marriage at the appropriate age for women, locally sourced nutritious food items, etc. Generally, the women from the community, especially the pregnant and the lactating ones, come to the AWC to attend discussions around nutrition. These gatherings are held by healthcare workers to mainly raise awareness on nutrition and the importance of locally grown foods.
A few days ago, Sukhwanti, an anaemic mother, delivered a baby boy. Her family was filled with joy at the arrival of a newborn. They performed all the rituals and made janam ghutti (a concoction of cow’s milk and herbs), an age-old practice to protect the newborn. During the post-natal period, it is common practice for the woman’s diet to be restricted to one meal a day. It is believed that if a woman eats more, the child will not be able to digest the milk, which will cause bloating in the child. I visited Sukhwanti with the ‘AAA’ (ASHA, AWW, ANM) when she told us that she had been advised to exclusively breastfeed the baby after birth. But for her family, this was a first. Sukhwanti’s mother-in-law was against this and believed that the baby must be fed cow’s milk and honey. We sat with the family and counselled them on the importance of exclusive breastfeeding.
We at TAF, prioritize home visits to such households, along with the healthcare workers and their supervisors. We also monitor and analyse data available on pregnant women, births, and malnourished children, to identify all the high-risk cases and ensure end-to-end follow-ups. As malnutrition is a multi-dimensional issue, Poshan Abhiyaan encompasses both community participation and community ownership, to solve the nutritional challenges in a village where the involvement of all stakeholders is necessary to achieve a meaningful impact. The healthcare workers at the village level, – both the AWW and ASHA, reach out to various age groups of the village. They also try and get male participation during such awareness activities.
To build ownership within the communities, public awareness rallies are held in the village with various slogans being chanted by the people. While the healthcare workers organise different nutrition-related activities at the Anganwadi Centre, the most innovative element is the poshan matkas (pots) that are prepared at the AWC, having a collection of various locally available items. Each day, women from the community bring a handful of nutritious grain/ vegetables/fruits from their homes to the AWC. The Anganwadi workers, one by one, place the different food items in beautifully decorated pots, while discussing the nutritional value of each of these items. These pots are then given to the women for their own use. This activity helps the community realise the importance of dietary diversity which can be achieved at the village level itself. Such community-based initiatives are budget-friendly and involves using locally available resources, making the practice sustainable in the long run.
This month, the Anganwadi Workers also arrange and decorate the AWCs with flowers and colourful rangolis. Such occasions give the workers an opportunity to stand out and present their work to the community, and any supervisor or local government health officials. The enthusiasm and zeal with which some of them work is unparalleled. During field visits, our team actively participates in the daily planned activities at the Anganwadi Centre by bringing in innovative games like spinner wheel games, card games, jigsaw puzzles, and pocket charts, on topics like micronutrient deficiency, benefits of breastfeeding, child danger signs, etc. These games help build rapport with the communities and communicate important information, while also having fun. Another important component of this Abhiyaan is organising screening camps for the identification of SAM and MAM children and increasing the participation of such families in the day-to-day activities.
Overall, ‘Poshan Abhiyaan’ plays a pivotal role in connecting with the communities and increasing their participation at Anganwadi Centres. It also increases awareness of the social determinants of health through participatory learning. The family as a unit, (including the male members) are encouraged to maintain good nutrition. Not only does this Abhiyaan create awareness at the grassroots level, but embraces the locally available resources in India’s rural areas to tackle the most pressing issue of malnutrition.