Prioritizing MIYCN component in facility-based health settings

The Sample Registration System (SRS) data showed that the maternal mortality ratio (MMR) declined somewhat faster than the Neonatal Mortality Rate (NMR) in India, from 327 during 1999-2001 to 97 maternal deaths per 100,000 live births during 2017-19 and as regard to Neonatal Mortality Rate (NMR), there is a decline from 79 per 1,000 live births in the late 1970s, to accelerated decline to 22 per 1,000 in 2019. Recently, the Ministry of Family Health and Welfare (MoHFW) with the National Health Mission (NHM) and National Health System Resource Centre (NHSRC) and contributions from UP-TSU, the Indian Institute of Population Sciences (IIPS), and the University of Manitoba released an Exemplar Study Report on Maternal and Newborn Health India to understand the factors improved the maternal and newborn survival over the past two decades. As per the study, there is a remarkable increase in coverage of maternal and newborn health services including Ante Natal Care (ANC) and Post Natal Care (PNC) services. The coverage of ANC with contents and institutional delivery doubled since the 1990s, accelerating between 2005-12. Postnatal care (PNC) check-ups within 0-2 days for the mother or newborn increased more than six-fold from 13% during 1998-99 to 83% during 2019-21. There has been an improvement in several essential newborn care practices. There is an 89% increase in institutional deliveries by the public sector including a 62% increase in deliveries in lower-level non-hospital facilities (government health sub-centers, primary health centers, and community health centers), followed by a 27% increase in public hospitals and 11% in private hospitals. India has expanded the ANC services, institutional delivery cases, and PNC services by increasing the number of health facilities. The rise in CHC density at the district level facilitated the increase in institutional deliveries, especially in the higher mortality state cluster. However, one of the most crucial administrative reforms was clustered around decentralization and associated administrative capacity building.

The Indian Association of Preventive and Social Medicine, All India Institute of Medical Sciences in association with UNICEF India has organized a roundtable meeting on Maternal, Infant, and Young Child Nutrition (MIYCN) to address knowledge gaps and strengthen MIYCN practice in health facilities and community settings organized. The discussion on best practices in MIYCN in India led by the National Health Systems Resource Centre (NHSRC), the strategies for improving the delivery of MIYCN in Medical Colleges led by Alive & Thrive, FHI360, and broader discussions on building consensus framework of action for MIYCN in India led by AIIMS New Delhi, AIIMs Bibinagar, University College of Medical Sciences (UCMS) and Lady Irwin College.

The deliberation brought multiverse ideas, knowledge, and best practices to the table, which further helped shape robust strategies and frameworks for improving health and nutrition outcomes. The meeting was held in the presence of Dr Zoya Ali Rizvi, Deputy Commissioner, Ministry of Health and Family Welfare, Government of India, followed by the signing of a declaration by the dignitaries.

Panchayati Raj Institution members supported by Piramal Foundation strengthening health and nutrition in Wazirganj, Bihar

Despite several efforts to address malnutrition, many children were suffering from severe acute malnutrition (SAM) and have been continuously admitted to the Nutrition Rehabilitation Centre (NRC) in Wazirganj, Bihar. The Block Coordinator and Mukhiya (village leader) identified the gap in coordination and communication between the Panchayati Raj Institution (PRI) Member and ASHA Sevika in the block. Additionally, proper guidance and counseling were not given to the caregivers at the NRC. 

The PRI member Rajeev Ranjan Kumar (RRK) added, “Continuous efforts are being made to get the SAM children admitted to the NRC, but due to the lack of cooperation from the parents and the local stakeholders, it has become a challenging task to admit children to the NRC. During the field visit, I observed the lack of knowledge and awareness of NRCs among people and health workers led to their reservations about sending their children to the NRC facilities. As a result, the SAM children were not availing the NRC's care

Empowering Musahar Community Women through Kitchen Gardens: A Solution to Malnutrition in Uttar Pradesh

Amid India's battle against malnutrition and hunger, the Musahar community in Varanasi, Uttar Pradesh (UP) stands as a testament to resilience and transformation. Their journey from vulnerability to empowerment is a result of an innovative approach – kitchen gardens. Spearheaded by the People's Vigilance Committee on Human Rights (PVCHR), these gardens have become a symbol of hope, addressing malnutrition at its core and empowering women to rewrite their destinies.

For years, the Musahar community endured both societal discrimination and malnutrition. The plight of girls and women was particularly alarming, as they bore the brunt of insufficient diets and inadequate care. The consequences were far-reaching, perpetuating a cycle of ill health and deprivation that transcended generations.

Enter the PVCHR's kitchen garden initiative – a groundbreaking endeavor that harnessed vacant plots within the Musahar communities of Varanasi. These gardens were not just about cultivating crops; they were about cultivating empowerment. Guided by PVCHR's teachings, families learned the art of vegetable cultivation, from soil preparation to nurturing seedlings, ensuring proper drainage, and harnessing sunlight effectively.

Newborns rely on breastfeeding for nourishment, safety, and affection, fostering a strong mother-child bond. Responsive feeding during breastfeeding enhances psychosocial child development. Optimal Infant and Young Child Feeding (IYCF) practices include early initiation, exclusive breastfeeding for up to six months, and continued breastfeeding with complementary feeding for up to 2 years. Breastfed infants achieve developmental milestones and perform better academically and professionally. However, recent trends show a concerning shift from breastfeeding to bottle feeding with formula feed or Infant Milk Substitutes (IMS), raising health and nutrition concerns.

The NFHS 5 data highlights breastfeeding practices in Bihar with increased infant stunting. Wasting has slightly decreased (28.9%) among 9-11-month-olds from NFHS 4 (34.6%) but rises with age.

Exclusive breastfeeding (EBF) rates improved slightly to 58.9% in NFHS-5 from NFHS-4, but there is still ample room for improvement. It was observed that 73.8% of children are exclusively breastfed for the first two months which drops to 40% by 4-5 months. Equally concerning is the fact that 12.6% of infants aged 0-5 months are given only water alongside breastmilk. Thus, increasing awareness of discontinuing water will potentially improve exclusive breastfeeding approximately by 12%. 

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Recent Publications

Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia

This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka).

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Right message, right medium, right time: powering counselling to improve MIYCN in South Asia

Quality counseling can positively impact maternal, infant and young child nutrition (MIYCN) behaviors linked to poor nutrition outcomes. Global guidance includes 93 recommendations on MIYCN counseling. A desk review and key informant interviews sought to assess compliance to the recommendations, reach and quality, systemic gaps and opportunities for MIYCN counseling in seven South Asian countries. Results showed that national guidelines were inconsistent with global recommendations for seven thematic areas.

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