Eleventh Five Year Plan

Nutrition and Social Safety Net 143fortified hygienically prepared food. The decisionbetween these two options need to be based on acareful evaluation of pros and cons and will be animportant part of the proposed restructuring. Thechoice between the two could also be left to decentralizeddecision making.• Poor sanitation leads to high incidence of diarrhoealdisease in the early years, undermining whateverlittle poor nutrition the infant taking in; hence,the Total Sanitation Campaign (TSC) must forceits pace, particularly in urban areas where thedensity of population is high and the risk of fecalcontamination even higher than in rural areas.• Convergence between nutrition and health interventionsneeds to be ensured. An institutionalmechanism should be put in place to ensure betterdelivery of the services through regular periodicmeetings of the functionaries of the two programmesat village, block, district, State, and Centrallevel. Even more importantly, joint training ofICDS and Health Department staff, includingthe Accredidated Social Health Activists (ASHAs),is necessary.• Micronutrients do not work unless the child andmother are consuming sufficient calories throughproper quantity of fat, protein, etc. For childrenbetween 3–6 years food diversification is necessary,that is, addition of egg, milk, fruits, leafy vegetablesto their meal. There is also need for fortificationin the diet of adolescent children especially girls.This is especially needed to address iron deficiency.It would be desirable to have an area-specificapproach to the issue of micronutrients, ratherthan a thin spread across the country. There hasbeen very little research on the efficacy of differentforms of fortified foods/micronutrient supplementationfor resolving micronutrient deficiencies.There needs to be much greater research into thestrategy of providing fortified foods to addressmicronutrient deficiencies. The Eleventh Planwill support food fortification based on scientificevidence.• LBW. It is necessary to improve the nutritional statusof adolescent girls to make a significant dent onLBW babies and infant/child maternal mortality.The fact that the Mid Day Meal programme is beingextended to UPS from 2007–08 will provide SNPto all girls between the ages of 12–14, which will gosomeway towards meeting the additional calorie requirementsof adolescent girls. However, on its own,this intervention will not suffice, and more seriousthought needs to be given on how to address theLBW problem.• Maternity benefit. Poor women continue to workto earn a living for the family right upto the lastdays of their pregnancy, thus not being able to puton as much weight as they otherwise might. Theyalso resume working soon after childbirth, eventhough their bodies might not permit it—preventingtheir bodies from fully recovering, and theirability to exclusively breastfeed their new born inthe first six months. Therefore, there is urgent needfor introducing a modest maternity benefit to partlycompensate for their wage loss. This could be anextension of the scheme of JSY of the MoHFW orpart of a restructured ICDS.• PSE is the weakest link of the ICDS. There is incontrovertibleresearch that preschool education is criticalto improve primary school readiness of the childof functionally illiterate parents, and thus improvingdropout rates. Keeping in view the potential ofPSE in enhancing enrolment and reducing schooldropout rates, the component of PSE has to be necessarilystrengthened (either under ICDS or in theprimary school).If this is to be done under ICDS, AWWs will needto be provided adequate training to upgrade theirskills for imparting Pre-school Education (PSE) atanganwadis and the issues of their work-load andincentives would need to be considered. It may also beadvisable to train and involve adolescent girls to impartPSE to supplement efforts of existing AWWs, forwhich too incentives will be required.4.1.69 The aim should be to halve the incidence ofmalnutrition by the end of the Eleventh Plan to thelevel noted in Annexure 4.1.3 and to reduce anaemiaamong pregnant women and children to under 10%.There has to be provision made for annual or biennialsurveys throughout the country to measure the incidenceof underweight (mild, moderate, and severe),stunting, and wasting. There should also be a regularmeasurement of the status of anaemia among women