I began studying nutrition to transition to the hotel industry, not to become a public health professional, and certainly not a storyteller. But the study of biology, biochemistry and physiology hooked me onto nutrition and banished thoughts of a hotel career.

It was a slow journey from understanding the biology of nutrition to appreciating that the biology of what nutrients do in the human body is a culmination of a series of social, political, and economic conditions that put people — especially the poorest and most vulnerable — in situations where they cannot nourish their bodies and those of loved ones.

Over the past few years, as my work and career evolve, it has become a mission of sorts to tell stories about these conditions that lead to poor nutrition, mostly using data. Back in 2008, as new data emerged from the National Family Health Survey, I realised how little discussion there was about the sorry state of nutrition in children and women. Today, with new data from the Rapid Survey on Children, and the emergence of more positive stories, there is still a need to tell stories using data.

The motivation is clear — bringing to public discourse things we’d rather sweep under the carpet. That in states like Rajasthan, one out of every two women say they were married before the age of 18, that 90 per cent of households in Odisha haves no toilet, that in most states only a third of the mothers of children under five have at least 10 years of education, that poverty is still widespread, and that basic health services aren’t reaching even half the pregnant women in Bihar. These numbers connect to the lived reality of mothers and families that are trying to bring up and nourish their children across India. They matter because people must understand that poor nutrition among children starts with the things that society does, or doesn’t do, for their parents, especially the mother.

My work over two decades has been to try and understand how women make choices about what to feed their babies and how the public health and nutrition community can support them.

Colleagues from around the world have spent considerable time with poor mothers in Bangladesh, Haiti, Ethiopia, Vietnam, and India. In almost every instance, every country, this work takes us back to the basics.

Every time we study programmes that try to improve the diets of poor families, we are also compelled to confront the conditions that led to poor nutrition in the first place. These conditions are starkly different from anything we in the privileged sections of society are familiar with. For instance, I gave birth to my daughter in a small college town in the US, surrounded by the best medical care. I breastfed my daughter in a wonderfully supportive environment of family care, where I had time off from work, enough food to eat and enough time to rest and rejoice in the wonders of a new baby. At around the same time, I was working on a study in Haiti, where poverty was deep, and women were compelled to walk hours to markets to sell their goods, their little babies, sometimes barely a month old, often left in the care of other children. I have met women in Uttar Pradesh who were utterly weighed down by all they had to do to keep their babies fed because they were too poor, had little food, little ability to make decisions for themselves, and certainly no clean water. I met women in Bangladesh — with so much spark and not as much poverty as in places I’ve visited in Bihar, but with so much to manage in their busy lives that it was challenging to find ways to care for their babies.

But all these women and their families did it anyway, to make children’s lives as decent as possible.

So how can the government and society support these families and women? We need to make it easier for parents to do their job of parenting and caring for their children — this, in turn, can put babies on a path to better nutrition.

And, it is possible. In Haiti, this was done by providing a food security and healthcare package for all pregnant and breastfeeding mothers and for babies up to the age of two. In Bangladesh, this was done by providing families with a decent cash transfer, together with information on the right food choices. In Brazil, this was done through a combination of cash transfers, and supply of basic healthcare, water and sanitation.

In India, our recent India Health Report on Nutrition shows that these essentials are nowhere in place for many families. There are 27 million births annually. Now imagine the struggles that half, or more, of the new mothers and families will encounter in states like Bihar, UP and Jharkhand. Life is slightly better in a state like Odisha, where basic health services for mothers and babies are in place, but poverty, poor sanitation, food insecurity and poor education are problem areas. In states like Kerala and Goa, women are more educated, more able to delay marriage, have more access to sanitation, antenatal care, are in less poor households and, thus, their children are in better shape.

There are no easy solutions here. We must all do what we can to make things work, especially for the poor; make sure girls are in school, that sanitation programmes actually work, that health services are available for everyone. There should be enough jobs to put money in the pockets of the poor. The numbers tell the stories of the challenges that parents must manage in order to nourish their children’s little bodies. Those who make the policies, come up with the strategies, and decide how much to spend on tackling this grand problem of malnutrition must not lose sight of this simple fact.

(Purnima Menon is a senior research fellow at the International Food Policy Research Institute, and co-author on the Global Nutrition Report as well as the India Health Report on Nutrition)

Related Topics