The Intergenerational Cycle Of Malnutrition In India

Now, having a better understanding of ensuring food and nutrition security, it is very much important to understand the influence of the intergenerational cycle on the nutritional status of the community. We had been all the while stressing the importance of nutritional care to be given to pregnant women, but the bearing of it on the entire generation has not been discussed. This chain lays the foundation for a healthy community and claims to be an important intervention strategy to break the cycle of malnutrition.

Further, a life-course standpoint suggests that nutritional changes are most likely to be continued when they occur during times of developmental transition or milestones such as pregnancy or adolescence. Adolescence is an exclusive period, as the growth spurt is high and also in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women's education. Hence, an intergenerational cycle is nothing but passing on the nutritional stature from one generation to another.

When a girl child is not provided with enough nourishment, at any stage of the life cycle, an inter-generational cycle of malnutrition may set in. The individual level and intergenerational cycles of under-nutrition and ill health together pose serious consequences.

A low-birth-weight baby-girl born for a malnourished mother becomes a stunted/malnourished girl child, à stunted/ malnourished adolescent, à malnourished woman; and in turn, gives birth to a second-generation low-birth-weight baby. This sequence depicts how poor in-utero nutrition from an under-nourished mother extends through the life cycle affecting nutritional status generation-by-generation. Teenage pregnancies where the adolescent girls have to bear the dual-burden of their own growth and that of the developing foetus leading to still poorer pregnancy outcomes that heighten the severity of the cycle. Also, closely spaced high parity pregnancies often intensify nutritional deficits which get passed on to their offspring too. Micro-nutrient (iron, zinc, folate, iodine & vitamin A) deficiencies in young girls can aggravate the intergenerational malnutrition cycle. All these magnitudes put together, an intergenerational malnutrition cycle leads to the impaired workforce with reduced work capacity .which will mask the nation’s development.

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In the light of these adversaries, nutrition has become an integral component of all the maternal and child health programmes such as:

• Integrated Child Development Services (ICDS), launched on 2nd Oct 1975 has been universalized in the country. The target group comprises children (Reproductive, Maternal, Newborn, Child and Adolescent Health Programme (RMCH+A, launched in 2013) addresses the major causes of mortality among women, children & adolescents along with the reasons for delayed access/utilization of health care services. This strategic approach highlights the importance of a ‘continuum of care during various stages of life;
• Janani Shishu Suraksha Karyakaram (JSSK) – launched on 1st June 2011 aims to provide better women/child health services such as cost-free/cashless facilities for pregnant women (normal deliveries/cesarean section operations) and sick new-borns (• Pradhan Mantri Matritva Vandana Yojana (PMMVY) is a maternity benefit program implemented by Ministry of Women & Child Development, Government of India. It is a conditional cash transfer scheme for pregnant/nursing mothers (aged >19 years) for the first two live births to partially compensate the childbirth/childcare-linked wage loss. In addition, it provides adequate facilities for safe delivery and breastfeeding/infant feeding;
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aims to reduce maternal and infant mortality rates in the country through safe pregnancies and safe deliveries. It provides quality comprehensive antenatal care to pregnant women on a designated day - the 9th of every month;
• The Mother and Child Tracking System – Monitors the health care system to ensure all mothers & their children have easy access to various healthcare services like care during pregnancy/child-birth and complete maternal & child immunization;
• MAA (Mothers’ Absolute Affection) – an intensified flagship program of the MoHFW was launched in 2016. It aims to enhance optimal breastfeeding practices in the country through a set of comprehensive activities for protecting, promoting, and supporting breastfeeding/child feeding, both at the community & the facility level. The programme emphasises generating community awareness, strengthening inter-personal communication skills of the functionaries, and providing necessary support for breastfeeding at delivery points/public health facilities along with the need for adequate family support to the nursing mother;
• The recent amendment of the Maternity Benefit Act (April 2017) enshrines paid maternity leave for 26 weeks even in private sector; however, for the pregnant women already having 2 living children, it remains unchanged (12 weeks) and the same is for adoptive/commissioning mothers too. Crèche facility and the option for work from home are other features of this amended Act;
• India Newborn Action Plan (INAP), launched in September 2014, aims to end preventable new-born deaths and stillbirths so as to achieve single-digit neonatal mortality/stillbirth rates by 2030;
• Adolescent Reproductive and Sexual Health (ARSH) program comprises the package of preventive, promotive, curative, and counseling services for addressing their reproductive and sexual issues.

Other programs/schemes targeting adolescent girls include Kishori Shakti Yojana, Balika Samridhi Yojana, Scheme for Adolescent Girls (SABLA), Weekly Iron and Folic Acid Supplementation (WIFS) program, Menstrual Hygiene Scheme, and many more. These programs aim at empowering the adolescents with improved nutrition/health-related awareness as well as better nutritional status so that they enter matrimony and motherhood with better nutrient stores.

Under UIP, Mission Indradhanush is cost-free expanded immunization coverage for children against 7 vaccine-preventable diseases (Diphtheria, Pertussis, Tetanus, Childhood-Tuberculosis, Polio, Hepatitis B, and Measles) by 2020. Further, Swachh Bharat, ‘Beti Bachao Beti Padao’ Abhiyan, adolescent-friendly clinics also address critical nutrition-sensitive issues.

It is thus, possible that through concerted efforts, the intergenerational cycle of malnutrition can be turned virtuous and improvements in maternal nutritional status and pregnancy outcome can be achieved. Better diet quantity/quality, micronutrient supplementation and improved health services can be the catalytic strategies for bringing about the desired change. As per the continuum of care approach, focusing on girl child to women along the lifecycle is imperative for achieving the Sustainable Development Goals (SDGs) and overcoming poverty, malnutrition and ill-health.