A Silver Lining for Child Nutrition amidst the COVID-19 Storm?

- By Jennifer Spencer, Nikhat Shaikh, Rijuta Sawant, Sushmita Das, Anuja Jayaraman (Research and Monitoring and Evaluation team, SNEHA)

March 2020, when a highly infectious virus spread in India and led to a nation-wide lockdown, will be remembered as a month after which the lives of many, changed forever. After almost 30 months since the lockdown, as we celebrate the Rashtriya Poshan Maah 2022 under the Rashtriya Poshan Abhiyan  of the Ministry of Women and Child Development of India, it is pertinent to look back at the effects of the COVID-19 pandemic on child nutrition, particularly for urban communities living in vulnerable settlements.

When the pandemic hit, several predictions about its adverse impacts on child health and nutrition surfaced. A Lancet study published in July 2020, predicted global under-five wasting to rise by 14.3% of which 80% would be in South Asian and African countries with an estimate of 10,000 additional malnutrition-related child deaths. Reports linked poor nutrition to increased COVID-19 susceptibility and fears that the gains India had made during the last few decades would be retraced owing to food stresses during the pandemic. Further, data of the National Family Health Survey (NFHS-5) 2019-21 showed 19.3% children under five are wasted (low weight-for-height), 35.5% are stunted (low height-for-age) and 32.1% are underweight (low weight-for-age), with no significant change as compared to NFHS-4 in 2015-16. Anemia prevalence on the other hand has increased from 58.6% (NFHS-4) to 67.1%.

While these figures portray a grim picture of child nutrition, annual monitoring surveys conducted by the Society for Nutrition, Education and Health Action (SNEHA) in vulnerable urban settlements commonly referred to as slums, in Mumbai pointed towards a silver lining. As part of its child nutrition programme evaluation, SNEHA regularly monitors the nutrition rates of children in the communities it operates in. A comparison of malnutrition data of children under two years of age from January 2020 (pre-pandemic) to January 2021 (during the pandemic) reported a decline in malnutrition rates. This urged us to understand the causes of such an improvement, when national figures and predictions pointed otherwise.

Key Insights from our study

SNEHA conducted an in-depth qualitative study from June to September 2021, by interviewing 25 mothers of children under two years of age. The location for the research was one of SNEHA’s implementation sites in a slum settlement in Mumbai. This study particularly aimed to focus on the positive deviance and interviewed mothers whose children had improved from being undernourished pre-pandemic to normal nutrition status during the pandemic; mothers whose children’s nutrition level remained the same in both time periods were also studied. This enabled us to better understand the possibilities and probable factors that pointed to an improvement in nutrition levels among young children in vulnerable communities during the pandemic.

The three key factors during the pandemic that contributed to improvement in nutritional status of children under the age of two years, as reported by the mothers are as follows:

1) Migration

While the exodus of migrant workers and their families during the lockdown, brought to light grave concerns regarding the city’s informal service economies and lack of adequate housing; SNEHA’s study highlights its linkages with nutrition and health. Mothers reported that their children had a much better environment in the village – open spaces to play, fresh air, interaction with other children; along with low access to junk food, better availability of nutritionally diverse food like fresh vegetables and fruits, fresh cow’s milk, pure ghee- which could be one factor leading to improvement of nutritional status among such children.

Here in the village there are other children also, so she eats with them. In Mumbai, she does not eat much. Yahan baccho ke saath baithkar khana kha leti hai. - Mother of a two-year-old girl

Also, the slower pace of rural life gave adequate time for mothers to spend with children. Having other members around to support them in child care activities including oil massages to babies, feeding etc. were some reasons expressed by mothers that promoted growth.

2) Change in Food Habits

Respondent mothers in SNEHA’s interviews reported that the pandemic led to increase in consumption of home-cooked meals as compared to junk food, improving child nutrition. Junk food consumption is otherwise high for children under the age of two years because it is cheap, easily available/prepared and there is low awareness of its ill-effects among the population. Lesser junk food availability during the lockdown, especially as a replacement to meals, could have contributed to improvement in nutrition indicators among children. Some mothers took conscious efforts to not spend money on junk food and rather use that for making home-cooked meals for the entire family.

Food insecurity among households was addressed through distribution of a more nutritionally diverse ration as compared to pre-pandemic times, both by the Government services (Public Distribution System, Integrated Child Development Services) and the Non-Government Organisations like SNEHA, which promoted consumption of nutrient-rich meals.

3) Support from Husband and Family

SNEHA’s study found that division of care-giving and household chores between men and women proved beneficial for the child’s nutrition and overall health. Those respondents who were overburdened with housework, care-giving and other family responsibilities were not able to pay as much attention to their child’s needs as those who reported that their husbands and in-laws helped them during the lockdown. Mothers reported that their husbands spent more time with the children, fed and bathed them, played with them, etc. which acted as one probable factor for improvement in nutrition and overall health of the child.

Yes, he (father) also took care of them, when he was home during the lockdown. He did all the work like spoon-feed the child, bathing them, etc. – Mother of a girl aged 22 months

Other family members like grandparents and older siblings were also reported to spend more time with young children, a likely cause for improved child behavior, activity time and feeding pattern.

Apart from these, mothers followed COVID-19 appropriate behavior and took extra efforts in maintaining the personal hygiene of children, such as timely changing of clothes, bathing them daily or twice a day with hot water. While the fear of infection, high cost of treatment and hospital visits during the pandemic were primary reasons for this, mothers reported that it resulted in fewer illnesses among children.

In addition, the support and guidance received from SNEHA frontline workers and staff who were in constant touch with these mothers during the pandemic through telephonic and video calls motivated them to continue adopting healthier practices.

They (SNEHA’s frontline workers and staff) used to tell us how to take care of my child…  I feel good, like there is someone who gives information about children… yes I used to call them also.
- Mother of a boy aged 22 months

SNEHA provided regular guidance and information to them and even connected them to other services like the Public Distribution System, immunisation camps and follow-ups to track their children’s growth. The mothers valued health messaging from SNEHA and being connected to the NGO during the pandemic.

To summarise, it emerges from the study that there is need for adequate housing including water and sanitation services and access to open spaces, for improving child nutrition in vulnerable urban settlements. Change in cultural norms and attitudes like shared household responsibilities can greatly contribute to better nutrition and overall health outcomes for the child. Finally, awareness about the ill-effects of junk food complemented by continued support from the Government-led food security/nutrition schemes with a specific focus on providing nutrient-rich, diverse food/ration, could drastically improve child nutrition.

This Poshan Maah let’s aim to focus on the need for a multi-dimensional approach to tackle nutrition.