IndiaSpend Mount Abu | March 31 Ensuring supplementary nutrition for children in the zero-to-three years age bracket could raise the number of graduates in India by 3.17 million, according to new research. Children who received extra nutrition through government-run programmes from the time they were in their mothers’ wombs until age three were 11 percent more likely to acquire a graduate degree than those who received them between ages three and six, according to a new study published on 1 January, 2018, in the Journal of Nutrition. These early life beneficiaries of supplements, supplied through the Integrated Child Development Services (ICDS), were also nine percent more likely to complete secondary education, five percent more likely to be employed or enrolled in higher education as young adults, and six percent more likely to have remained unmarried until the age of 25, said the study. Adequate nutrition during what is called the 1,000-day-window-of-opportunity – the time between pregnancy and a child’s second birthday – is known to protect children against stunting and cognitive deficiencies. Scientists who followed the lives of children and mothers at anganwadis – government centres that offer health and nutrition services – found positive health impacts persist till adolescence. When anganwadi children aged 13-18 were studied, it was found that early life beneficiaries were 14 mm taller, with healthier cardiovascular systems, more likely to be enrolled in school and about a grade ahead of others, earlier studies had shown. The new study offers conclusive evidence that adequate nourishment to unborn babies and infants creates benefits that enhance their education and employment prospects in later life. With the education benefit of early-life nutrition extending to college, the researchers estimated that such daily exposure could potentially increase India's college graduates from 7.5 percent of the country’s 73.8 million 20-24-year-olds to 11.8 percent. An increase in the college graduation rate, in turn, would deliver significant economic gains from higher wages. This would be a significant economic achievement for a country with one in four of the world’s 156 million stunted under-five-year-olds. In 2016, it was estimated that growth faltering among India’s under-five-year-olds would cost $37.9 billion in future, through lost schooling and economic productivity. By delaying the age at marriage of beneficiaries, better nutrition in the crucial first 1,000 days of life would also foster a new generation of healthier and brainier children. A single year’s delay in marriage lowered the chance of a woman giving birth at home by 2.2 percent, increased the breastfeeding rate by 5.5 percent and the chance of children being fully vaccinated by 4.6 percent, according to this 2017 Journal of Development Economics study. Poor supervision keeps ICDS food quality, coverage low The ICDS is a 33-year-old programme, so the question is, why isn’t India already experiencing these gains? “Quality is the biggest factor for the potential educational gains not being experienced so far,” Arindam Nandi, the lead author of the study and a researcher at the Tata Centre for Development, University of Chicago, and the Centre for Disease Dynamics, Economics & Policy, told IndiaSpend. “The base study conducted between 1987 and 1990 was done in a highly controlled setting, with close oversight of service and meal quality,” Nandi said. Anganwadi workers involved in the study, conducted in villages near Hyderabad, prepared a blend of corn and soya in soybean oil under strict supervision so as to provide 500 kcal of energy and 20-25 grams of protein to pregnant women and half of those amounts to the infants. “In contrast to that tightly controlled scenario, the real-life conditions in anganwadis across the country are, and always have been, vastly different, keeping the quality and coverage low,” said Nandi. A network of 1.36 million anganwadis implements the ICDS’ supplementary nutrition programme. This decentralised delivery approach is necessary to reach out to far-flung communities across the country. However, this spread also makes supervision challenging. “Because the programme (ICDS) is administered very locally (at the village), improving quality and coverage is a very difficult task,” said Nandi. Where the local supervision is good, the food quality is better and the uptake of the service is higher. For instance, about six in 10 lactating mothers and pregnant women and five in 10 children aged six months to six years registered with an anganwadi in a Delhi slum used supplementary nutrition, according to a 2017 study. This was higher than the 40 percent minimum expected uptake from the service, an outcome that the study co-author attributed to “the quality of the cooked meal”. “The Delhi government’s centralisation of the cooking and strict monitoring of anganwadis has helped maintain the quality,” Jitendra Kumar Meena, co-author of the study and assistant professor, department of community medicine, Geetanjali Medical College & Hospital, Udaipur, told IndiaSpend. However, Meena, who visited anganwadis in Haryana, Rajasthan, Punjab and Uttar Pradesh, said food quality is poor in anganwadis that are not closely monitored. “Poor quality of food is a big reason for the low coverage of many anganwadis,” he said. Across India, less than half of India’s needy children and women use the supplementary nutrition service of the anganwadis, according to a 2013-14 report. Government authorities are apparently deliberating the poor quality of food, but no solution has been made public as yet.“A committee is looking into the issue of poor quality of food served by anganwadis,” KB Singh, director, ICDS, the ministry of women and child development, told IndiaSpend. Complaints about anganwadi nutritional supplement services also include irregularities in distribution, which individual studies suggest are also a local phenomenon caused by poor supervision. Interruptions in distribution were reported by more than half of the 130 anganwadis in 12 districts of Gujarat and the union territory of Diu surveyed in a 2016 study. In contrast, Meena found the anganwadi in Delhi’s urban slum had received regular supplies.
