India’s recent annual economic survey 2017-18 suggested that there were 21 million “unwanted” girls in India due to parents favouring having sons instead of daughters. Thus the news about improving sex ratio in few states this week (being attributed to government’s attention in form of several schemes and programs) caught my eye – pleasantly surprised but extremely happy to see improvement in girl child getting the opportunity to first of all survive and thereafter hopefully go on to make positive changes in this world. This same week, multiple women got us international medals in sports…all this makes me celebrate the fact that I too am a woman and working towards [hopefully] improving maternal and child health and nutrition across the life course.
However, if we assess whether all (or even majority) women get their fair share, the answer is NO. We still have a huge problem of gender preference (female foeticide, no or minimal education, early marriages, multiple pregnancies, security and safety issues, domestic abuse, etc. At all stages of her life, the girl child still struggles to get others or in fact even her own self to pay attention / priority to her health and nutrition. No doubt that the governments have been sensitive to this issue and have a lot of programs and schemes in place to ensure well-being of women (http://www.wcd.nic.in/schemes-listing/2404; http://www.wcd.nic.in/schemes-listing/2405; http://www.wcd.nic.in/schemes-listing/2419) especially during critical phases like under 5, adolescence, pregnancy and lactation.
I don’t mean to neglect the men but just that societal norms as well as the health statistics in our country currently still favour them. Both the ends of the malnutrition spectrum i.e. undernourishment and overweight-obesity are more among women than men. NFHS-4 shows 23% women (15-49y) are underweight (BMI<18.5 kg/m2) while 21% of them are overweight women (BMI>25 kg/m2). Additionally, 53% of 15-49 y old women are grappling with anaemia.
Often, because of competing priorities and limited resources, the question which decision makers ask researchers is which is the best time (when girl child is born, an infant, school goer, adolescent, young adult or married, pregnant and/or lactating or elderly) to intervene or make maximum impact on health and nutrition of women? Intervention here means offering any additional package of either food, nutrition items, monetary support or in-kind services, counselling or their combination. Most experienced people may prefer to choose pregnancy where you may impact two lives with single intervention. I don’t know the answer but there is definitely evidence of pros/benefits of intervention at any of the above mentioned ages and stages in the life of a girl child. We know if a pregnant woman is fed well and kept happy during her pregnancy, she gives birth to healthier babies. We also know that school-going adolescent girls when provided balanced meals rich in micronutrients, show an improvement in attention, cognition and overall health indicators. Under-fives if fed well go on to become more productive and healthier than their malnourished counterparts.
Several international bodies endorse investing in strategies to improve the future intergenerational health indicators by working towards improvement in women’s nutrition and health today. I have summarised some of these as ABCDE (explained ahead): a) Augment the quantity and quality (nutrient level) of food consumed; b) Boost women’s productivity by extending best support and flexibility for critical periods like adolescence, pregnancy, lactation etc.; c) Collect and collate high quality data/evidence on women’s access to nutrition and health services to provide better insights and direction for future priority-setting; d) Dedicate efforts to combat multiple micronutrient deficiencies; e) Empower women through education, employment and equity.
Even though we are aware of multiple odds against women, they still appear smiling and shining in all walks of life. So, let’s all collectively make Indian girls and women smile more frequently and shine much brighter by at least helping to improve their health and nourishment. More power to women!
Dr Shweta Khandelwal,
Public Health Foundation of India