India: Count Infants the Food Security Law

5 July 2009

President of India, Shrimati Pratibha Devisingh Patil, while delivering her address to the Parliament on 4th June, committed to introduction of new flagship programmes for food security. Further, to improve nutrition situation in India, she said, “. . .Malnutrition has emerged as a major health challenge needing urgent response. Hence the nutrition delivery programme will be comprehensively revamped to bring it under the watch of panchayat institutions and move to provision of hot cooked meals in anganwadis. . .†. The debate over hot cooked meals for children in government run nutrition programme ICDS seems to be settled. However, the challenge is to revamp the ‘nutrition delivery programme’ to make inclusive and reach the infants. It is the period when human life is at its most vulnerable. A notable development milestone is that 70% of brain develops during infancy. In a proposed food security law for the nation, the right of infants’ to adequate food needs to be viewed within the context of existing human rights principles. In many dialogues and debates about food or nutritional security and human rights, the rights of infants are usually forgotten. It is often presumed that infant feeding is a natural process, in the private domain between the infant and its mother, an area that rarely needs interventions from outside. Food for infants includes timely initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the fist six months, and continued breastfeeding thereafter along with adequate complementary feeding for two years or beyond. Prime Minister of India said it rightly 2 years ago, that to wipe out child malnutrition, India needs to do three additional actions; infants need to be breastfed, good health care and access to safe water supply. These components can make a difference not just between life and death, but also in terms of physical, mental, emotional, and intellectual development.

Achieving universal coverage of exclusive breastfeeding during 0-6 months would be the real challenge in the new revamped nutrition delivery programme. It is meaningful as it can cut under-five child deaths by nearly one-sixth. Ensuring start of breastfeeding within one hour of birth in all mothers could cut newborn deaths by more than one-fifth. This nutrition input could be critical to bring down infant and neonatal mortality rates , which have remained relatively unchanged since past five years. Nearly 1.4 million infants die annually and so much depends on how and what they are fed. Research has overwhelmingly shown time and again that exclusive breastfeeding during fist six months cuts down diarrhea disease and lower respiratory tract infections by more than half. The World Health Statistics Report 2009 has highlighted and recognised that ‘not exclusive breastfeeding’ is a ‘risk factor’ for infant and young child mortality. 

India is faced with several challenges on several fronts, but the most overwhelming challenge, and one that bodes ill for the future of the country, is that almost half the children in the country are malnourished in spite of the awesome economic growth that is taking place. The steepest rise in malnutrition occurs from birth to two years of age. Even a single short episode of diarrhea can plunge the child into malnutrition. In a situation where both potable water and sanitation are at a premium, exclusive breastfeeding during first six months, with its transference of immunity to several diseases from the mother to the child, is the one intervention that is cost effective and sustainable. Unfortunately, in India only 40% babies begin breastfeeding within one hour according to the latest District level health survey 2007-08. And only about 20% are able to practice exclusive breastfeeding till six months. In numbers it means 20 million infants out of 26 million born are not able to secure their right to food during first six months. It is thus critical to first recognize and secondly initiate widespread action to ensure food security for infants.

The current thinking at the policy level must understand the difference of tackling hunger and malnutrition in infants than that of older children. Both need to be tackled on a war footing. While balanced hot cooked meals is a strategy for older children , infant malnutrition can only be tackled by ensuring that women stay in close proximity with their babies for at least six months.

What do women need to provide food security to infants? ALL women need accurate , unbiased information and skilled counseling for good infant feeding practices, maternity entitlements , support systems at work sites like crèches, and supporting health system. Aggressive promotion of baby food industry must end in health sector or otherwise. This should be a Minimum Essential Programme (MEP) of services in the revamped programme and part of food security law. Maternity benefits means leave for organised sector, and cash benefit for unorganised sector. It should also include food assistance during lactation. It would be ideal if all women could be financially compensated for devoting six months to exclusive breastfeeding. However, this may not be possible, or may not be needed in different situations. While some elements of the package could be provided for all women, other components like cash benefits and nutrition support could be provided only to women of low socioeconomic status.

This action on protection, promotion and support of breastfeeding during first six months of life requires a strategy and an action plan with a budget. On top of this it needs to be coordinated.

In fact, communities need to relieve ALL women who are at work at home during this crucial period of human development. Successive governments have made several commitments in the past to improve infant nutrition and survival, so has the new government also. These commitments now need to be translated from rhetoric into action.

Fulfilling infants’ right to adequate food obliges Government of India to acknowledge women’s rights to adequate nutrition, as well as their rights to other forms of support to enable them to exclusively breastfeed their infants without endangering either their own health or their economic status. Continued breastfeeding along with adequate complementary feeding fulfils the need for food after six months.

Can we afford not to take such an action? Especially Government of India has already granted six months maternity leave for central government women employees, now is the turn of others to receive similar benefit.

Government of India should keep a budget line for this purpose. A reasonable calculation for maternity benefits, thousand rupees a month for six months for about 67 lakh BPL women each year it should be about 4000 Crores. According more recent estimates it would double approximately to 8000 Crores. Further, for a block level promotion, protection, support and coordination, the Planning commission did an exercise in 2007 to arrive at a gross budgetary expenditure of about

Rs. 300 Crores per annum. Such a provision could be a roadmap to realize infant’s food security. India is said to be big economy , doing well, this cannot be left out because lack of resources.

This comes as reminder to the policy and lawmakers to count infants-citizens under 12 months of age, in making of the food security law and in its financial memorandums.

Dr. Arun Gupta is a pediatrician and works as regional coordinator of International Baby Food Action Network (IBFAN) Asia, and is a member of the Prime ministers council on India’s Nutrition Challenges.

Dr. Arun Gupta, MD, FIAP,
 Regional Coordinator
 International Baby Food Action Network(IBFAN) Asia.
 Member, Prime Minister’s Council on India’s Nutrition Challenges.

BP-33 Pitampura, Delhi 110088 INDIA