By Dr. Dewesh Kumar, Rupa Prasad and Sraban Bandanayak
A mother’s overall health and wellbeing is important in ensuring that her newborn is healthy. Investment in quality maternal nutrition can go a long way in promoting inter-generational growth and boost the child’s potential. However, it is an area that has not received enough attention which is clearly reflected in the present status of maternal deaths and deficiencies. India contributes to one-fifth of the global burden of maternal death, and one of the major reasons is nutritional deficiencies and lack of nutrition awareness among pregnant women and lactating mothers. The available data in Jharkhand also tells a similar story.
According to SRS 2018, in Jharkhand, for every 100,000 live births, 165 mothers die during pregnancy, childbirth and in the post-partum period.
This is strongly related to the status of nutritional deficiencies reflected in data reported by NFHS-4. Almost one-third of women of reproductive age are undernourished or malnourished in Jharkhand, with a body mass index less than 18.5 kg/m2.
Another significant indicator of nutritional deficiency is anaemia among women of reproductive age which has witnessed minimal change in last 10 years- from 69.5 percent in 2006 to 65.2 percent in 2016. Even IFA consumption is very low and has made very little improvement from 9.5 percent in 2006 to 15.3 percent in 2016. Most mothers are not aware or they have pre-conceived notions regarding what is beneficial for them and what is not.
One of the critical interventions that can positively impact the nutritional status of women in the reproductive age in Jharkhand is the change in the level of awareness as well as the existing dietary practices. According to JES-2016, more than 90 percent expectant mothers are unaware of health and nutrition issues and only 8.6 percent new mothers are aware of nourishment during pregnancy, breastfeeding and child feeding practices.
Only 19 percent of women consumed milk or curd, pulse or beans are consumed by only 41percent, green leafy vegetables by 42 percent, fruits -17 percent, eggs- 30 percent, chicken, fish or meat -30 percent and fried foods consumed by 24 percent. Due to a lack of awareness and poverty, women in Jharkhand, eat just rice-salt or rice-potatoes. Dal and vegetable consumption are very low.
Pregnancy is a unique phase in a women’s life which has a huge impact on her health as well as on the health of the new born. To ensure that the health outcomes are positive, it is important to focus on the women’s diet and ensure inclusion of energy filled food, protein, iron and folic acid, Vit A& D, calcium and importantly diet that includes all five food groups. Having wholesome meals, replete with all macros and micros are absolutely important.
Each food group and micronutrients have their specific roles and minimizes adverse health conditions during pregnancy. Calcium supplements help prevent pre-term birth and serious problems caused due to high blood pressure in pregnancy so, daily intake of at least one gm/day of calcium in pregnancy after the first trimester reduces the risk of pre-eclampsia by at least half with an additional one fourth reduction in the risk of pre-term birth.
However, evidence clearly shows that in India the daily calcium intake during pregnancy and lactation is less than 30%, against the recommended protocol. Pregnant women also need energy filled foods to mitigate the damage caused due to low protein diet. Protein deficiency results in decreased brain size, shorter gestation, decreased birth weight and increased stress sensitivity.
Iron deficiency lead to anaemia, and anaemia during pregnancy is well associated with conditions leading to postpartum hemorrhage, low birth weight, premature births, stillbirths and maternal deaths. To avert anemic conditions, it is essential to eat iron rich food along with adequate Vitamin A, B12 and folate supplements.
Iron intake can be met through intake of green leafy vegetables, cooked beans and peas, meat, etc. and can be best absorbed if Vitamin C, or acidic foods like lemon, guava, orange or lime are included in the diet. Pregnant women and lactating mothers should consume one IFA tablet daily starting from the month of pregnancy, at 14th week of gestation, continued throughout pregnancy (180 tablets) and continued for 180 days, post child birth.
Jharkhand demonstrated its commitment to address the issue of maternal ill-health and undernutrition. In one of the speeches, the Hon’ble Chief Minister of the state, Mr. Raghubar Das said, “Jharkhand will be made ‘Kuposhan Mukt’ state, within 10 years”.
The state commits to institutionalize mechanism to improve nutrition governance by facilitating effective implementation and convergence between flagships to contribute towards improved nutrition indicators. POSHAN Abhiyaan strategizes to improve nutritional status through multi sectoral approach and creating accountability at all levels.
(Dr. Dewesh Kumar, Assistant Professor- RIMS, Ranchi; Ms. Rupa Prasad & Mr. Sraban Kumar Bandanayak – WeCan – IPE Global)