The ICDS programme launched in
the 1970s was based on the results
of extensive surveys which identified
rampant child under-nutrition in
India. Using the weight-for-age and
height-for-age criteria, only 10 per cent
children under five could be classified
normal. And 15-20 per cent were underweight
even when they were short.
The situation has not improved in the past 35 years despite juggling with classification. With a 500-600 calories (cal) deficit in energy intake, it is not surprising there is unimaginable hunger among Indian children. Over 70-80 per cent of the calories consumed by children are derived from cereals and some pulses. The intake of other protective foods such as eggs, milk, fruits and oil is minimal. The reasons for this nutrition emergency are many but the most important are undoubtedly poverty and inadequate diet.
A modified adult diet of cereals/ gruel in inadequate amounts serves as the only complementary food for children in poor households. Though the actual deficit in intake was around 500 cal, and about 10 gm of protein, nutritionists decided on a supplement of 300 cal and 10 gm of proteins when ICDS was launched.
The early menus under the scheme were based on a cereals, pulses, groundnut, oil, milk powder and sugar combination to fill the calorie gap; it was called the Hyderabad Mix. Deficits were not laid out in terms of food, but in terms of calories and proteins, assuming recipes would be adapted to regional tastes and translated into foods appropriate for children, like milk.
In the 1930s, W R Aykroyd, director of the Nutrition Research Laboratories in Coonoor, realized the importance of proteins, fats, vitamins and minerals for a child's growth. He wrote, "It is important to work out diet schedules in such a manner that the non-cereal portion of the diet (milk, vegetables, fruits, and eggs) provide most of the essential nutrients. Subsequently carbohydrate rich foods such as rice, wheat and sugar can be included."
He advocated milk for children because milk proteins are ideal for growth compared to cereal and pulse proteins. He even advocated replacing milled rice with parboiled rice and adding oil or ghee in children's diet.
With this background, ICDS should have included foods necessary for children's growth. But this was not to be. Planners, bureaucrats and even nutritionists reworked basic principles of child nutrition, and the mantra was 'least cost diets'. Not surprisingly 300 cal was constructed with cereals like rice and wheat with minimum pulse and jaggery. Even this was altered depending on costs and the cynicism of the implementing authorities. After all, about 300 cal can be derived from any of the following combinations: a) 50 gm of cereal, 10 gm of pulse and 10 gm sugar and 5 gm oil, b) 60 gm cereal, 10 gm groundnut, 10 gm sugar,
c) 85 gm of rice or wheat, or even starch,
d) even 75 gm of sugar.
In the 1960s, nutritionists--upper class, no doubt--abetted this crime against poor hungry children by providing "laboratory evidence" in favour of "vegetarian sources of proteins", stating "a combination of vegetarian proteins (from cereal, pulse, milk) was nearly as good as egg protein". Bureaucrats were now free to create artificial diets providing 300 cal, because proteins were safely included in the cereals (cereals contain 6-8 per cent protein). It was not their fault, they remembered the operative term vegetarian and forgot about the necessary combination of foods. In any case, the money allocated to ICDS could only provide dalia (broken wheat) equivalent to 300 cal.
Children who desperately required a proper meal of eggs, milk, pulse and vegetables, were provided calories from broken cereals. They are unable to consume dry unappetizing cereals to make up for the calorie deficiency, because of its sheer bulk, monotony and lack of energy density. (WHO recommends 40 per cent calories must come from fats and oils).
Providing double the ration of inedible cereals for the severely malnourished only made matters worse. It is known undernourished children have loss of appetite, infections and other illnesses which requires special diets, not double the ration of cereals. Unless proper food is provided malnutrition in India can only get worse with the present ICDS.
Veena Shatrugna retired as head of the clinical division, National Institute of Nutrition, Hyderabad, and is currently a consultant at the Indian Institute of Public Health, Hyderabad
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