Those of us who have been working diligently on issues related to nutrition in India for decades have become used to, in recent times, a certain unhelpful reaction from the government to denounce malnutrition data and pronounce it as malicious, or as an attempt to tarnish the image of the country.
To be fair, the rhetoric related to the data found in the press and media from the government or its political opposition is often neither balanced nor technically correct, though many of us attempt to present a more rational, reasoned, professional, and careful response.
The recent storm in a teacup over a peer-reviewed study, by established researchers published in a well-respected journal, is yet another case in question, eliciting a strongly worded response by the Ministry of Women and Child Development dismissing it as ‘malicious’ and 'an attempt to sensationalise fake news'.
What is 'Zero Food'?
The study, if one were to actually read it, is a straightforward one and makes its entire content abundantly clear in the abstract itself.
It does not exaggerate its findings and is, more so than most studies, quite analytical about its limitations, which is commendable and indicates a good research practice.
It finds, simply, that 19.3 percent of children aged 6 to 23 months in India had not been fed any animal milk, formula, or solid, or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker.
This accounted for the majority of children in 92 low and middle-income countries.
They conclude the study to make the modest, simple, and non-controversial recommendation of the need for ‘targeted interventions to improve feeding practices’.
However, they create the term ‘zero food’ which appears dramatic, imprecise, and somewhat provocative – like the mistaken conflation of malnutrition with the word ‘hunger’ in other reports such as the Global Hunger Index.
The squabbles over terminology are only leading us into unnecessary debates and distracting from the real value of these studies and reports.
Is the Study Really Misleading?
In essence, by definition, ‘zero food’ is misleading since the study criterion does not include breastmilk as food.
What it actually defines is ‘no complementary feeding’ of children beyond the period of exclusive breastfeeding, which is a standard Infant and Young Child Feeding (IYCF) recommendation, and a known problem issue in India.
The NFHS-5 data, released in 2022, tells us, for instance, that only 11 percent children in India aged 6 months to 23 years meet the criteria of minimum acceptable diet.
This is a huge tragedy which should be a matter of enormous concern.
The need and importance for complementary feeding are too well established to need any discussion, and one does not expect any denial of this problem for India from any government agency.
What the data from the study is not interpretable as is that 19.3 percent of children are starving or going without any food whatsoever, since breastfeeding was not included in this definition.
The study itself does not make any such misinterpretation and it is highly counter-intuitive that 19.3 percent of parents in India – however poor and unsupported they might be – would leave their child completely starving for a full 24 hours.
However, one percent of children in the entire sample across all 92 countries went without any food, meaning without breastfeeding as well (1.5 percent in India).
If correct, this is really an emergency needing immediate and urgent attention for their identification and support. This might include sick children, children in some emergency, orphaned children, children being left in the care of other children, etc.
Getting to the Root of the Problem
In the experience of this author, even 19.3 percent is difficult to imagine since most children would be handed some sad biscuit to nibble and chew on as their parents toil in the fields, brick kilns, or at construction sites.
However, considering 89 percent of children 6 months to 23 years are deficient in prescribed standards of food (quantity and quality) for their age as per NFHS-5, 19 percent ‘zero food’ children does not sound untenable.
For the country, the NFHS data of 89 percent not receiving a minimum adequate diet, should be the more important data to focus on, even if ‘zero food’ children were to go down to zero percent - with ‘zero food’ children being yet another indicator that adds to complete the picture of a fairly poor state of affairs with respect to IYCF.
As practitioners and experts, when asked to comment on this study, many of us have pointed to the fact that it is highly likely that the data is concentrated amongst the younger age group of children aged six months to one year – a point that the authors themselves discuss in the study report.
This age group is notoriously difficult to feed and many culturally generated myths challenge the establishment of complementary feeding at six months, such as the fact that the child has not yet generated teeth etc.
The one point that we have tried to reinforce is that complementary feeding in the age group six to 23 months is highly related the presence of an informed adult caregiver who is able to spend the time, energy, and effort to feed their baby/toddler as many as five times a day to start with.
Most of us practising on the ground know from experience that the information gap on when to start complementary feeding is very low now thanks to the work of the Anganwadi and ASHA workers.
Lack of food material is also unlikely to contribute to this data of ‘zero food’ since the data does not qualify ‘type of food’ as mentioned above.
Thus, other than factors of lack of information and cultural practices, we relate the problem to the absence of support systems such as maternity entitlements and childcare services especially for the vast majority of women working in the informal sector.
It is a truism that all poor women are working women and make an economic contribution to the family in many ways without acknowledgement, wages, or social support. This most certainly contributes to the problems being faced with complementary feeding.
'Let's Not Shoot the Messenger'
All data and all studies have limitations. Not a single study exists on this earth that is foolproof, or that perfectly represents the ‘truth’.
Surely studies need to be engaged with professionally, constructively, read, analysed, and used to take positive actions rather than superficially dismissed as fake, false, malicious, or mal-intended.
It would help if we – researchers, practitioners, government agencies, and the press and media – steered clear of exaggerations of language that seem to evoke a fairly polarised, visceral response, and provide a handle to distract from the real and serious issues.
What is desperately needed instead of this frustrating and strident discourse, is a common cause to improve the lives of our fellow human beings, especially children.
Let us not shoot messengers, especially when we do know that the message is meaningful even if not wholly accurate.
(Dr Vandana Prasad is a community pediatrician and public health professional with over two decades of experience working in the social sector. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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