The COVID-19 pandemic and related disruptions to food, health, and economic systems continues to threaten the nutrition conditions worldwide. Measuring the impact of COVID-19 on nutrition has been a challenge as information systems did not deliver regular, timely and complete data during the crisis. In India, it is critical to monitor the effects of the COVID-19 pandemic in order to prevent the potential increase of all forms of malnutrition (undernutrition, overweight/obesity and micronutrient deficiencies). The situational overview report for the 4th quarter of 2021 (October-December 2021) provides a systematic tracking and documentation of data to understand the impact of COVID-19 on food and nutrition scenario along with identification of gaps in information.
The report starts with the National Family Health Survey (NFHS-5). No conclusions can be made from this survey on the national level impact of COVID-19 on nutrition as data collection was completed for 22 states/Union Territories (UT) before COVID-19 and in the remaining 14 states/UTs both before and during the pandemic. At the national level there was stagnation in the reduction of undernutrition and an increase in the prevalence of anaemia and overweight /obesity amongst different age groups. The subsequent chapters in the report document the direct and indirect impact of COVID-19 on immediate, underlying, and enabling determinants of nutrition in the population with a specific focus on maternal and child nutrition.
The threat of stopping breastfeeding in suspected or COVID infected children or mothers were found in anecdotal data. There is a need for more granular data to understand the trends on individual dietary diversity in the populations especially among those most vulnerable to malnutrition (preschool children, adolescents and pregnant women). Both prior and during the pandemic, low dietary diversity was noted as an important issue. A longitudinal study conducted in August 2020 found less than one in five children in Uttar Pradesh were fed with a minimum dietary diversity (≥4 food groups). A cross-sectional study from Maharashtra conducted in May-June 2020 highlighted that only half of the lactating women consumed a diet with a minimum dietary diversity. A large study that focused on women’s conditions in 10 states found that more than one in ten women limited their food intake or ran out of food in the week they were surveyed. There is a paucity of representative data on individual level nutritional intakes among all age groups.
A number of studies collected data on the impact of pandemic on dietary intake among household members and found an overall reduction in meal frequency and quantity. One rapid assessment conducted among rural households across 12 states in April 2020 found over two thirds of surveyed households reported reduced number of food items consumed in each meal, and half reported consuming a lesser number of meals.
Nutrition is a determining factor in outcomes of common childhood infections such as diarrhoea, pneumonia. There has been concerns that the COVID-19 pandemic has limited access to preventive and curative treatment from health services affecting the nutrition of the vulnerable populations. The annual tuberculosis (TB) Report 2021 documented that notification for TB decreased by one-third in 2020 compared to 2019. To ensure uninterrupted distribution of essential medicines for other chronicinfectious disease like AIDS, measures like multi-medicine dispensing were implemented by the National AIDS control program during the pandemic.
Social safety schemes were strengthened at the beginning of the pandemic. The targeted public distribution system for the general population provided additional grain distribution under Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY). Currently, this scheme continues until March 2022. UNICEF monitored the provision of some social safety nets and nutrition services across 14 states (Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujrat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Telangana, Uttar Pradesh and West Bengal) from the start of the lockdown in April 2020. Provision of growth monitoring and promotion services increased from 2 states in May 2020 to 14 states in December 2021. The critical lifesaving facility-based management of severe acute malnutrition (FSAM) services were converted into COVID wards in many hospitals. Services for SAM children were provided in 11 states in May 2020 increasing to 13 states by December 2021. The provision of Take Home Rations from ICDS for children under 6 years and pregnant women continued throughout the pandemic without a reduction in services in most states (except Jharkhand). THR for children is functional in all monitored states in December 2021 and THR for pregnant and lactating women is functional in 13 states except Jharkhand.
Many small-scale studies documented the fall in income and loss of livelihoods in women and the working class. A ten-state study on the effects of COVID-19 on women found that half of respondents reported an increase in unpaid chores during the pandemic and lockdown. One survey from July 2021 reported that daily wage workers, domestic workers, small farmers and shopkeepers from 3 states had no work at the time of survey (e.g., 54.7 percent respondents from Uttarakhand) and had decreased nutritious food intake e.g. egg consumption fell from 77.8 (pre-pandemic) to 26.2 percent. A rapid assessment of rural households across 12 states found that half of the households who sold milk and 40 percent of those in poultry business reported income losses. About 5 percent of respondents reported the sale of different productive assets as coping mechanism.
In terms of nutrition policy, several updates were made during the pandemic period. The POSHAN 2.0 was announced in January 2021. To ensure that social safety programs would meet the needs of the vulnerable communities in the Union Budget 2020-21, Rs. 35,600 crore was announced for ‘nutrition-related programmes’. The PM proclaimed rice fortification for all public distribution programs in August 2021. The Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) scheme was approved in September 2021. The PM POSHAN is a modified version of the earlier Mid-Day Meal in Schools.
At the start of the pandemic and lockdown in April 2020, frontline workers were shifted from their routine responsibilities to support COVID prevention and address needs of migrants returning to their home states. The delivery modality of many services changed as Anganwadi centres and schools were closed and in-person contacts were restricted. Distribution centres were closed and doorstep delivery was initiated producing new challenges as infrastructures were not in place to ensure last mile delivery. As in-person and group counselling were no longer allowed due to COVID risks, a shift to tele-counselling facilitated behaviour change messaging with anecdotal evidence on enhanced male participation in early childhood development in for instance Maharashtra and Rajasthan.
Global reviews covered at the end of this report elaborate upon the potential increasing burden of global poverty along with the social safety schemes needed to mitigate the negative effects of the pandemic. A modelling study by Standing4Nutrition estimates that the pandemic will have a long-term impact on economics, development and nutritional status among the vulnerable populations for years to come.
The loss of livelihoods, increased food insecurity and reduced dietary diversity could have an impact on the status of maternal and child nutrition. Data gaps exist in monitoring both the comprehensive delivery of essential public health nutrition services, social safety nets along with measures of the impacts on the population in terms of undernutrition, overweight/obesity and micronutrient deficiencies. More robust data systems are needed to identify early signs of distress among communities. Strong mitigation measures are in place but need to achieve full coverage with an equity focus to ensure that all populations are protected from the destructive effects of malnutrition.