(Mandangad, Pune and Bhiwandi)
“My daughter eats about two to three Vada Pav (bun with fried patty) outside her school in a week. Chinese Bhel is a favourite and is probably consumed more often,” says Meera Pandhirkar, an Anganwadi Sevika and a mother of a teenager. While Vada Pav and Chinese Bhel are a common go-to street food for all of us, their frequent consumption hints at a deeper problem in the nutritional status of adolescent girls in India.
During the Poshan Pakhwada 2020 celebrations in Maharashtra, I had the chance to visit Anganwadis and discuss adolescent girls’ nutritional status with several Integrated Child Development Services (ICDS) workers in Maharashtra. The picture remains grim, but innovation and persistence of the trio of ICDS workers – Auxiliary Nurse Midwife (ANM), Anganwadi Sevikas, and Accredited Social Health Activists (ASHA) has made headways into a nutritional gap deeply entrenched in gendered attitudes, regional inequity and socio-economic divides.
Adolescents – defined by the United Nations as those between the ages of 10 and 19 – number 1.2 billion in the world today, making up 16 per cent of the world’s population. Adolescent girls world over are at a higher risk of intergenerational nutrition deficits which cause anaemia and malnourishment, the risk for which is higher amongst them than their male counterparts.
In India, the Adolescent Girls (AG) Scheme, implemented by the Ministry of Women and Child Development under the ICDS, primarily aims at breaking the intergenerational lifecycle of nutritional and gender disadvantage and providing a supportive environment for self-development. The scheme aims at enabling adolescent girls to be self-reliant, improve their nutrition status and ensure that they remain in school.
According to a 2011 UNICEF report, over half of girls aged 15–19 (56 per cent) in India are anaemic. This has serious implications, since many young women marry before age 20 and being anaemic or underweight increases their risks during pregnancy. Anaemia is the main indirect cause of maternal mortality, which stood at 230 maternal deaths per 100,000 live births in 2008.
Manisha Jadhav, an Anganwadi Sevika in Mandangad explains, “Under the Nutrition Component of the scheme, we deliver ‘Take Home Ration’ for girls between the age groups of 11 to 14 who are out of school. In Mandangad, Ratnagiri you will find a significant tribal population whose girls have to drop out of school due to economic hardships.” Pandhirkar, who also operates in the same area as an Anganwadi Sevika explains, “When ANMs, ASHA and I hold health checkups in our area, we’ve found that almost 7 out of 10 girls test positive for anaemia.”
Take Home Ration or Hot Cooked Meal for 11‐14 years out of schoolgirls aims at providing a meal with at least 600 calories of good nutrients per day for 300 days in a year. The ICDS workers also provide zinc and folic acid tablets as micronutrient fortification.
During the Poshan Pakhwada, Anganwadis in Maharashtra normally hold activities such as Awareness Campaigns, Health Check Up Camps, Youth Group meetings and Home Visits to engage with girls and their parents. However, given the COVID-19 pandemic this year, Anganwadi Sevikas could only do home visits in Pune and Mumbai. Says Kiran Shivsharan, an Anganwadi Sevika in Pimpri-Chinchwad, Pune, “This year we visited about 100 homes to talk about adolescent girls’ nutrition, menstrual hygiene and awareness about their changing needs. In urban areas, one common problem while speaking about nutrition is to fight the ‘diet’ fad. Everyone wants to look like a movie star!”
Shivsharan’s colleague, Rohini Joshi added, “But we try to drill the idea of a balanced diet into their minds. We emphasize on protein intakes, taking special care and rest during their menstruation days, and trying to eat home-cooked meals as often as possible.”
Nutritional statuses also depend on socio-cultural belief systems of a family. Take for example, the case in Bhiwandi, an area which has a fair number of Muslim households. While families do cook nutritious meals including mutton, chicken and dals, by the time the elders and men in the house have eaten, girls often just get leftover curry and little else. Girls often don’t get mutton pieces or flesh, the actual parts which contain proteins. Diets in these households are rich in proteins but lack dietary diversity. Anganwadi Sevikas in these areas then try to convince parents to integrate leafy vegetables, millets and vitamins in their food.
Poor nutrition amongst adolescent girls in India is a complex problem; gender disparity, traditional customs, financial limitations, access to cheap street food which consists of nothing but calories, and socio-cultural beliefs, and lack of access to information about quality food are some threads that shape this complex problem. To combat this problem, some ICDS workers are also coming up with innovative strategies. Shivsharan shared, “I call all the mothers to my Anganwadi and do live demonstrations of how one can integrate variety in everyday meals with very little time.”
In Mandangad too, Jadhav and Pandhirkar face the challenge of girls feeling fed up of everyday meals – “We try to talk about healthier and interesting alternatives that are cheap and easy to make at home – like Thalipeeth Pizza, Bhaji Rolls, and Cauliflower rice to combat the repetitiveness of everyday food.”
There’s still a long way to go for an anaemia-free India. Nevertheless, Anganwadi Tai’s resolve paints a hopeful picture!