Opinion Food for politics

was yesterday,and what needs to be done is clear enough.

The health journal The Lancet recently released its 2013 Maternal and Child Nutrition Series,and the articles highlight,first,that poor nutrition is the single biggest contributor to child mortality. The estimates also indicate that poor malnutrition in the womb is a particularly difficult challenge,contributing to a substantial proportion of both mortality and stunting. Even as the series offers evidence that scaling up coverage of nutrition-specific actions will reduce one-fifth of the burden of under-nutrition,it emphasises the need for cross-sectoral approaches to create the underlying conditions children need to grow well. This includes healthy and educated mothers,food-secure and income-secure households and clean household environments. The series also reminds us that addressing nutrition requires attention to politics and governance — both significant challenges in India.

At the same time,the series also shows us that India is not without success stories. In 2006,the state of Maharashtra created a state nutrition mission and used political and bureaucratic leadership for the mission to bring together actors from two sectors to tackle under-nutrition. By 2012,the combination of economic growth in Maharashtra and the focused scaling up of interventions by the state departments of health and women and child development,for the first 1,000 days,led to a decline in childhood stunting,from 39 per cent to 23 per cent.

While the ministries of health and women and child development must indeed take the lead in many nutrition initiatives,other sectors must also take up this challenge. Indeed,as the series notes,the potential for nutrition-sensitive programmes in agriculture and social protection goes largely untapped. Despite greater availability of food grains,progress in supporting diet diversity,a key element of adequate nutrition,has slowed. And despite campaigns,sanitation conditions in much of India remain poor.

Paper 3 in the series shows us that better nutrition can be achieved by raising incomes of rural families and empowering women. Transfers of both the food and non-food variety could help improve nutrition and reduce child mortality,but for maximum impact,they need to be more narrowly targeted to the first 1,000 days,and supported by quality health and sanitation services. Similarly,improved girls’ schooling will go a long way in empowering future caregivers to make informed choices,keeping them in school and delaying marriage and childbearing.

The fourth article,however,reminds us that in the end,nutrition is a political issue,and that ignoring the politics behind nutrition is self-defeating. Nutrition will not advance unless governments create an enabling environment and take action to tackle malnutrition. The ingredients for such

an enabling environment include marshalling knowledge and evidence,coordinating diverse stakeholders,strengthening good governance,nurturing nutrition leaders,and ensuring better capacity and sustained financial resources to translate words into actions.

India must forge ahead to change the precarious conditions in which too many young children grow up. The devastating combination of poverty,poor status of girls and women,food insecurity,especially in vital nutrient-rich foods,poor health services,and abysmal sanitary conditions simply cannot sustain healthy child growth and nutrition.

Along with continuing to foster economic growth,India now needs to to do the following. One,confront and quantify

the problem itself. It needs to collect routine national and subnational surveillance data,at least every two to three years,and use programme-monitoring data effectively.

Two,strengthen implementation systems and reduce leakages in all programmes — the Public Distribution System,Integrated Child Development Services,the National Rural Health Mission and more.

Three,layer and focus nutrition-specific and nutrition-sensitive interventions that already exist in India in the places that need them the most.

Four,address the politics of nutrition head-on by continuing to bring diverse stakeholders together,being transparent about evidence,and completing the feedback loop from evidence to action.

The writers are senior research fellows at the International Food Policy Research Institute and co-authors of two of the Lancet Nutrition Series papers