Delivering Essential Nutrition

In India, despite provisions for tribal development, 32% of tribal women are chronically undernourished, as opposed to 23% among those not belonging to tribal households.Large-scale surveys and routine monitoring are currently deficient in measuring the nutrition status of women, especially tribal women. This study was undertaken to analyse the reach of various health-related schemes for tribal women in Chhattisgarh, Jharkhand, and Odisha. In the light of its findings, it is recommended that all national schemes should be reviewed through a tribal lens, as tribes remain outside the ambit of most nutrition safety nets. Proven measures like strengthening tribal development nodal agencies, motivational incentives to fieldworkers and organised community involvement, need to be scaled up.

The authors are grateful to the reviewer, whose comments were immensely useful in revising the manuscript.

Adequacy of women’s nutrition before conception, during pregnancy and post-pregnancy is critical for reduc- ing child stunting. Among chronically undernourished or stunted children, as high as 50% of impairment occurs before birth, in womb (Victora et al 2010; Sachdev 2012). In India, 42% of adolescent girls aged 15–19 years, who are or will soon be mothers, and 25% of women aged 20–29 years, who are most likely to be multiparous, are thin or have a body mass index (BMI) below 18.5 (IIPS 2016). Prevalence of thinness among tribal women at 32%, is 9% points higher than among non-tribal Indian women in 2015–16. The gap has just reduced by 2% points in a decade, that is, between 2005–06 and 2015–16 (IIPS and Macro International 2007; IIPS 2016).

There is global and national consensus on five essential nutrition interventions before, during and between pregnancies. These include interventions that address the immediate causes of undernutrition, pertaining to increasing nutrient intake and disease prevention (or nutrition-specific interventions), as well as the underlying and basic causes of undernutrition, such as household food insecurity and literacy (or nutrition-sensitive interventions). These interventions include: (i) improving the quantity of household food consumed and its nutrient quality, (ii) preventing and managing micronutrient deficiencies and anaemia, (iii) increasing women’s access to health services and special care for the “most vulnerable,” (iv) increasing women’s access to water and sanitation education and commodities, and (v) preventing extremely early, too many and very close pregnancies (Bhutta et al 2013; Nutrition Coalition 2010; Ruel et al 2013; Gillespie 1997).