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Nutrition is a development investment in kids that can never go wrong

Proper early nutrition can spectacularly change the entire life trajectory of a child. We know from long-term studies that it promotes brain development, making the child do better in school, and much better later in life, affecting everything from the happiness of marriages to the quality of jobs, and up to 60% more earnings. 
 
India has made significant progress in reducing child malnutrition, but with nearly half of all deaths of children aged under-five mainly caused by poor diet, much still needs to be done. Where could new policies make the biggest impact? 

William Joe and Abhishek Kumar of Institute of Economic Growth, and S.V. Subramanian of Harvard T. H. Chan School of Public Health, have undertaken analysis on how Andhra Pradesh could reach more young children and pregnant and lactating mothers. 
 
In Andhra Pradesh, where 60% of reproductive-age women are anaemic and a high percentage of children under five are stunted, the progress of nutrition programs has been slow, and the potential from investment in nutrition is great. 
 
Direct nutrition-based interventions include counselling for behaviour change, supplementary food and micronutrient supplements, which are primarily delivered through the government health programmes. A 10 percent increase in coverage would avoid 181 deaths, and reduce stunting by 20% in the population receiving the intervention. Each rupee spent will be worth 9 rupees in benefits. 
 
Maternal & Child Undernutrition 
 
The health status of a child is inextricably linked to the health status of the mother. Women who are anaemic are likely to de-liver low birth weight babies, who are likely to remain anaemic and suffer from cumulative growth and development deficit. 
 
Adequate nutritional health is critical for safe motherhood and to break the otherwise perpetual intergenerational cycle of under-nutrition. In India, there is a very high prevalence of both maternal and child undernutrition. 
 
All children below 6 years of age, pregnant women and lactating mothers are eligible for availing of supplementary food services under the Integrated Child Development Scheme (ICDS) which is funded by both Central and State government. Supplementary nutrition needs to be better targeted towards those sections that actually require the appropriate nutrition. 
 
Benefits aplenty
 
The primary beneficiaries are children aged 6-12 and 12-36 months and pregnant and lactating women. The benefits will accrue through reduction in deaths and morbidity from specific diseases due to provision of improved nutrition. It is estimated that 161 lives will be saved for a ten percent increase in coverage. 
 
Stunting will be reduced by 18% in the population receiving the intervention. Benefits realized per beneficiary are ₹107,135, 89 per cent of which represent improved lifetime productivity from avoided stunting. At a cost of 10,341 rupees per beneficiary, each rupee spent will achieve 10 rupees worth of social good. 
 
Another intervention the researchers look at is micronutrient supplementation for pregnant women during ANC visits. The focus is on providing Vitamin A supplementation, iron, iodine, calcium, zinc and ORS. At a total cost of ₹88 crore for one year, this intervention can avoid 106,882 cases of maternal anaemia, 25,293 low birth weight babies, 113 maternal deaths, 19,103 preterm births, 1,337 preterm deaths and 210 stillbirths in Andhra Pradesh. Each rupee spent targeting supplements to pregnant women in antenatal care would have benefits worth nearly ₹40. 
 The researchers also look at interpersonal counselling for behaviour change. Diarrhoea is a major cause of deaths among children under 5 years of age in Andhra Pradesh. Low socioeconomic status, poor maternal literacy, inadequate breastfeeding, malnutrition, poor sanitation and hygiene practices of the mother or the caretaker are the major determinants of diarrheal diseases. 
 
A six-year intervention which includes counselling for breast-feeding and counselling for complementary feeding and hand washing will help to avoid 240 deaths in Andhra Pradesh which are related to diarrhoea. Every rupee spent will yield more than 60 rupees in benefits to society. 
 
Seldom in life are the benefits of simple, cheap policies so obvious and clear-cut: the new evidence points unambiguously to massive benefits from prioritizing closing gaps in access to nutrition interventions. 
 

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