I attended the launch of the Global Nutrition Report at the House of Commons on Tuesday 2nd December. I picked up on something said by lead author Lawrence Haddad about Maharashtra (see below) and the appropriate role for industry. I made a plea that nutrition policy setting should be set by those who have a duty to protect health and human rights and that it should be safeguarded from influence by corporations – who after all have a fiduciary to the shareholders.
Other participants questioned the efficacy and predominance of micronutrient initiatives and the way development funds are being diverted into products (such as Plumpy Nut) rather than support for health systems and more sustainable bio-diverse culturally appropriate foods.
I’m intrigued at how often at the many meetings I’ve attended over the last month, (including WHO’s Ending Child Obesity Commission, ICN2 and Codex) businesses have admitted that there is a lack of evidence for their interventions. Hasn’t anyone else noticed – or is it just that the train has already left the station???
Below is a quote from Page 12 the report about the progress in improving breastfeeding rates and malnutrition in Maharashtra mainly due to measures such as increasing well trained staff and sustained political commitment. “Nothing fancy – just people doing their job.”
Dramatic improvements in Maharashtra (Page 12)
Maharashtra, one of the wealthiest states in India, managed to reduce the share of children under age five affected by stunting from 36.5 percent to 24.0 percent between 2005–2006 and 2012, or a rate of more than 2.0 percentage points a year (equivalent to an average annual rate of reduction of 5.8 percent). What drove this rapid improvement in children’s nutrition? A recent mixed-methods study1 addressed this question and found the following (Haddad et al. 2014):
The enabling environment for stunting reduction was favorable. Maharashtra, already a wealthy state, posted higher rates of economic growth and poverty reduction than the all-India average. Its governance, in terms of transparency, anticorruption efforts, and service delivery, was not the best but not the worst in India.
Underlying determinants were reasonably supportive: women’s decisionmaking status inside and outside the home was high; the Public Distribution System (PDS), which distributes subsidized food to poor people, suffered from slightly less leakage than the all-India average; and female education rates were high and rising. There were vulnerabilities, however, with weak agricultural growth, still-high levels of PDS leakage, and high levels of open defecation.
Spending on nutrition doubled from a low level, and vacancies among frontline workers in the Integrated Child Development Services (ICDS) scheme dropped dramatically.
The decline in stunting was broad based and was greater—absolutely and proportionately—for the least wealthy, the least literate, and those with the worst access to improved water sources.
The determinants that improved the most between the two surveys were the age of mother at first birth, maternal underweight, maternal literacy, coverage of antenatal visits, delivery in the presence of birth attendants, child feeding practices, and access to ICDS.
The state’s Nutrition Mission was seen as a signal of high-level political commitment to nutrition improvements and helped coordinate different sectors at village and policy levels.
Overall the three research approaches used in the study dovetailed to lead to three main conclusions:
- The large decline in stunting rates was due to improvements across a wide range of determinants, and some improvements were quite modest.
- The declines in determinants were not so strong or comprehensive that Maharashtra should be perceived as exceptional— similar declines could be achieved by other Indian states and other countries.
- The declines in stunting in Maharashtra are impressive, but they were 10 years in the making and required sustained commitment from government and civil society.
Information about the report
This report was produced by an Independent Expert Group (IEG) empowered by the Global Nutrition Report Stakeholder Group. The writing was a collective effort by the IEG members, supplemented by additional analysts and writers. They are all listed here:
Lawrence Haddad, International Food Policy Research Institute, Washington, DC; Endang Achadi, University of Indonesia, Jakarta; Mohamed Ag Bendech, Food and Agriculture Organization of the United Nations, Rome; Arti Ahuja, Women and Child Development, Odisha, India; Komal Bhatia, Institute of Development Studies, Brighton, UK; Zulfiqar Bhutta, Center for Global Child Health, Hospital for Sick Children, Toronto, Canada, and Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Monika Blössner, World Health Organization, Geneva; Elaine Borghi, World Health Organization, Geneva; Esi Colecraft, University of Ghana, Accra; Mercedes de Onis, World Health Organization, Geneva; Kamilla Eriksen, University of Cambridge, UK; Jessica Fanzo, Columbia University, New York; Rafael Flores-Ayala, Centers for Disease Control and Prevention, Atlanta; Patrizia Fracassi, Scaling Up Nutrition Secretariat, Geneva; Elizabeth Kimani, African Population and Health Research Centre, Nairobi; Eunice Nago, University of Abomey-Calavi, Benin; Julia Krasevec, United Nations Children’s Fund, New York; Holly Newby, United Nations Children’s Fund, New York; Rachel Nugent, University of Washington, Seattle; Stineke Oenema, Interchurch organization for development cooperation (ICCO) Alliance, Utrecht, Netherlands; Yves Martin-Prével, Institut de recherche pour le développement, Marseille, France; Judith Randel, Development Initiatives, Bristol, UK; Jennifer Requejo, Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva; Tara Shyam, Institute of Development Studies, Brighton, UK; Emorn Udomkesmalee, Mahidol University, Bangkok, Thailand; and K Srinath Reddy, Public Health Foundation of India, New Delhi